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 crowns (caps) that are placed on the teeth next to the space and together they are called a bridge. A bridge is most frequently used to:
- replace missing teeth to restore a natural smile, restore an even bite for better chewing or to facilitate normal speech sounds
- 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
- prevent or restore tipped teeth which are more susceptible to decay and periodontal (gum and bone) disease
- prevent excessive wear on the remaining teeth when some teeth are missing
Several steps are involved in placing a 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 are then carefully and meticulously shaped so that a precisely fitted and natural appearing bridge can be made for you. During this same appointment, a temporary acrylic (plastic) bridge is made for these teeth which will keep them comfortable, protect them and allow you to eat, speak and have a normal appearance. A well made temporary bridge will function similarly to the final bridge. Once the teeth and gums are healthy, a mold will be made of your teeth from which the bridge will subsequently be made. 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 attachment, after which your bridge is not removable.
Natural looking bridges need to be more than just 'white', they must approximate 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 bridge fees. If your bridge 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 and restored with a bridge will remain the same color.
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.
Red, blue or swollen gums and gum recession are ugly and can be caused by improperly made bridges. The gum around the bridge should be pink, firm and not bleed during cleaning. Well made bridges completed using gentle techniques should have minimal effect on natural looking pink gums.
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 and maximize those teeth's chewing ability.
If carefully planned and designed, bridges can be used to re-create an even bite and give the impression that crooked teeth are actually well aligned. This can ensure optimal chewing ability and help maintain bite stability over many years which is important if you are planning to keep your teeth for a lifetime.
A bridge should feel comfortable and look natural. A missing tooth replaced with a bridge will maintain or restore your ability to eat and speak.
Most bridges fail because of tooth decay under the edge of the bridge or gum disease, both of which are frequently caused by a poor fitting bridge and inadequate cleaning. An extremely well fitting bridge is less likely to allow decay to get under the bridge destroying the supporting tooth underneath it. A bridge that fits well is also easier and faster to clean saving you time every time you clean your teeth and saving you money every time the dentist cleans your teeth. A bridge that can be properly cleaned will last much longer, further reducing the financial cost of dental care throughout your lifetime but even more importantly, a bridge that lasts longer will increase the likelihood that you will keep your teeth a lifetime.
The shape of the teeth under a bridge is extremely critical. The greater the expertise in completing this treatment, the more likely the teeth and gum will not require additional expensive corrective treatment. If properly designed and shaped, bridges should not fall off. Expert treatment during the shaping of the teeth when the bridge is first made can essentially eliminate additional future costs of re-attaching or remaking a bridge that won't stay on.
It is important to have all of your teeth examined and cleaned regularly by your dentist especially when they have bridges on them. By using specialized knowledge, skill and experience in combination with careful planning and attention to detail a bridge can usually be made to last for many years if appropriately cleaned. A well made bridge will minimize the need for future treatment and increase the likelihood you will keep your teeth for a lifetime. All these details will give you the best value for your time and financial investment.
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.
Mrs. F.B. was referred to our office by her general dentist in 1993 at age 59 because she had lost two teeth in the upper right area and she was having a tough time chewing. She had worn a removable partial denture but it no longer fit very well. It was apparent to us that the problems were much more extensive than just a couple of missing teeth. Additional teeth were missing, the teeth did not line up or bite very well which accounted for a great deal of the difficulty chewing as well as a very significant compromise in her appearance. There was also periodontal (gum) disease and loose teeth. Mrs. F.B. also had diabetes. Following a period of analysis and consultations, Mrs. F.B. decided to proceed with the removal of the very poor upper teeth, an immediate upper denture, orthodontic braces to align the lower teeth and a bridge to replace a missing tooth in the lower left. The improvement in appearance was very dramatic but her ability to chew was also improved.
Mr. J.L. came to our office in 1996 at the age of 53 wanting some improvements to his smile and the replacement of some missing teeth. His teeth were sliding slowly out of their normal position and tipping over because some teeth had been lost and not been previously replaced. Initially, Mr. J.L. was very nervous and anxious about having any dental work done. The first step he wanted to start on was some bleaching (color lightening) of his upper teeth, followed by careful reshaping of some front teeth to make them appear a little straighter. With this turning out to his satisfaction and his gaining confidence, we then proceeded to remove some teeth that had periodontal (gum and bone) disease and were in an uncorrectable position. Some teeth on the lower left had tipped over and they were realigned by slowly moving them back to the proper position. Following this, new crowns were placed on the lower front teeth to better match the color of the upper teeth and a new bridge was placed on the lower left to replace the missing tooth and create an aligned bite. Mr. J.L. was becoming very enthusiastic about the improvements he was seeing and appointments were no longer a cause of stress and anxiety for him. He then decided to proceed with crowns on the two upper front teeth which would be longer lasting and have improved appearance over the temporary bonding. Three back teeth also had crowns placed on them to create an even bite. The last step was to replace a missing molar in the lower right area which required two implants for adequate support. Mr. J.L. now has the smile he wants and his teeth are much more likely to last his lifetime because the important missing teeth have been replaced and his bite is even and stable.
Ms. K.W. was referred to us by her general dentist in 1999 when she was 48 years old. She wanted to improve the appearance of her teeth. She also wore a removable partial upper denture but wanted something that was fixed and not removable. The clasp display of the denture bothered her esthetically, there were shadows near the missing front teeth and she wanted lighter colored teeth. She reported that many teeth had been removed many years ago. Following examination, we discussed the various ways of improving the upper front teeth with crowns and bridges to accomplish some of her goals. The missing upper back teeth could be replaced best with implant supported crowns as this would be strongest but, if not all of the teeth had to be replaced from Ms. K.W.’s perspective, then a cantilever bridge would be possible to replace some of the teeth. Because the cantilever bridge involved a smaller financial cost and this was of some concern, Ms. K.W. decided to proceed with this treatment. She decided to simply maintain the lower teeth basically ‘as is’ for the time being. Some gum work was initially required on the upper teeth followed by an extensive bridge with cantilevers, which has been very successful achieving the esthetic goals and which Ms. K.W. feels is far better than her previous partial denture.