Tooth Replacement and Dental Implants
A bridge is a restoration that holds a false tooth (pontic) in the space of a missing tooth and is not removable. The pontic is attached to a metal retainer (handle) that are stuck on the back of the teeth next to the space and together they are called an adhesive bridge. An adhesive bridge is most frequently used to:
- replace a missing tooth to restore a natural smile, especially when a long term replacement may not be required
- prevent teeth on either side of a space from progressively tipping over or teeth in the opposite jaw from over erupting which can result in an unattractive smile, an uneven bite and damage or pain in the jaw joints or muscles
- maintain the natural shape of your face by providing support for your lips and cheeks
Several steps are involved in placing an adhesive bridge. The first step is to design and plan the bridge to optimize its size and shape, your bite and access for cleaning. Your teeth may need some slight shaping so that a precisely fitted and natural appearing bridge can be made for you. A temporary acrylic (plastic) bridge is usually not required. The laboratory phase of making your bridge occurs between appointments and is completed by specially trained laboratory technicians. The final steps involve completion of any adjustments to your bridge prior to its adhesive attachment, after which your bridge is not removable.
Natural looking bridges need to be more than just 'white', they must match the complex color scheme of your other teeth or they will stick out like a 'sore thumb'. Color is approximately matched using standardized color tabs which are selected with your approval and is included in basic crown fees. If your crown is prominently visible, some degree of additional customization will usually be required to more closely match your other teeth. This customization process can proceed until the best possible match is obtained subject to the limitations of man-made materials and fees based on the length of time required for customization. When skillful clinical treatment is combined with artful laboratory technical work it is often difficult to detect the difference between a well made bridge and your natural teeth. Natural teeth will tend to slowly darken with age. Teeth replaced with an adhesive bridge will remain the same original color. Natural teeth can be somewhat lightened by dental bleeching.
Shape is extremely critical and is one of the most frequently overlooked aspects of many bridges. This has resulted in an otherwise attractive smile being ruined by bridges not matching the remaining teeth and appearing as if they stick out. Proper shape is also required to prevent food jamming between teeth and to permit fast and easy cleaning.
A well made bridge should feel completely even with the other teeth on the very first day and does not require time to settle in. A bridge that is slightly 'high' can result in great pain and inability to chew properly, whereas a bridge that is slightly 'low' will result in tooth movement and bite instability which compromises the other teeth. A bridge should also be made to feel comfortable when you slide your teeth from side to side or back to front as in chewing. A well made bridge should actually help stabilize your bite.
A bridge should feel comfortable and look natural. A missing tooth replaced with a bridge will maintain or restore your ability to speak.
An adhesive bridge is often considered to be an interim or temporary restoration as they can become detached from the teeth that they were attached to. This will usually result if excessive forces are placed on the replacement tooth but can also occur if the teeth are a little loose or if a sudden jolt occurs such as biting something hard. Sometimes these bridges can come loose for no apparent reason. Adhesive bridges often give fairly reasonable service for periods of up to about five years although each patient must be prepared for potential loosening which would require an attempt to re-attach the bridge by completely removing the bridge, cleaning it and then new adhesive attachment.
Cleaning teeth with a bridge on them has some differences to cleaning non-restored natural teeth. You must thoroughly brush your teeth and clean between the teeth and under the pontic using either floss and floss threader, super floss or a prox-a-brush every day.
Miss Q.T. at age 20 had some missing teeth but the spaces were too small to allow the placement of a dental implants and orthodontic braces were declined by Ms. Q.T. which might have created the proper space for tooth replacement with implant supported crowns. In addition, the gum and bone had shrunken causing dark shadows where the teeth were missing which can be corrected, but requires additional treatment that was also declined. Miss. Q.T. decided that she wanted to have just two adhesive bridges. The adhesive bridges were completed in 2000 and provides the look and functionality that Miss Q.T. desired with a minimum of treatment.
Mr. D.M. was referred to us by his periodontist in 1993 because his periodontal disease had resulted in the loss of some of his teeth and others tipping and moving out of alignment. We stabilized the position of the remaining teeth by connecting the back teeth together using crowns and bridges. Mr. D.M. lost a lower front tooth due to gum disease and because of the extent of bone loss, an implant supported crown may not have been the best option. A bridge was avoided because the adjacent teeth were small and poor supports. An adhesive bridge was attempted knowing that this type of restoration can come loose but knowing that no option was ideal. The adhesive bridge was completed in 1995 and it, as well as the crowns and bridges and the bite have remained stable ever since.