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Procedure a Dental Bridge

A dental bridge is a way to replace a missing tooth or teeth. It is a fixed option for replacing the space (like an implant) meaning it stays permanently in your mouth. Dental bridges literally bridge the gap created by one or more missing teeth.

A lot of the information about crowns is very relevant here since the classic bridge is two crowns for the teeth either side, attached together via a fake tooth in the middle. Bridges do however, possess some additional considerations in the treatment planning phase: tooth preparation, the choice of material and how we care for them afterwards.

There are different designs and styles of bridges, but essentially they all use the teeth either side (or an implant) to hold a pontic (dentist speak for ‘dummy tooth’) in the gap to restore your smile and bite.

Why would I need a Dental Bridge?

Dental bridges are a way in which missing teeth can be replaced, so first off you are going to need at least one missing tooth or have a tooth planned for extraction. To answer the question, “Why would I need a dental bridge?” We must look at the consequences of having missing teeth.

What can happen if you don’t restore the space?

  • It doesn’t look good (not aesthetic/ can lead to self esteem problems)
  • Difficulty chewing properly
  • Over-eruption of opposing teeth
  • Tilting of teeth either side of the space
  • Increased stresses/wear on other teeth
  • Loss of bone and support for muscles/facial structure (premature aging)
  • Sensitivity
  • Problems with TMJD
  • Further tooth loss
  • Increased risk of decay
  • Increased risk of gum disease
  • Speech problems.

A dental bridge can help:

  • Restore your bite, and ability to chew
  • Stop other teeth moving or over-erupting
  • Reduce the risk of TMJD
  • Reduce the risk of periodontal disease
  • Reduce the risk of tooth decay
  • Make you more likely to care for your mouth and make sure you don’t loose any more teeth
  • Prevent facial changes down the track by helping support your muscles and lips
  • Reduce the likelihood of problems with other teeth by taking pressure off them.

What are the Signs and Symptoms that I might need a Dental Bridge?

Besides having one or more missing teeth, if you or the dentist notice any of the consequences of the missing teeth discussed above, starting to happen, it is advisable to act sooner rather than later or at least weigh up the available options again at this time.

If you have a single missing tooth in one or two areas and a generally healthy mouth, you are certainly a candidate for a dental bridge. The more missing teeth you have and the larger the spaces (multiple missing teeth next to each other), the more complicated things start to become. That’s not to say that a dental bridge is not possible, only that it requires additional consideration and assessment of the available support.

Are there occasions when you don’t necessarily need a Bridge

If the missing tooth is the very last one at the back of your mouth, a bridge will not be suitable or even possible because it relies on a tooth either side for support. A single implant is the only ‘fixed’ choice available in this area. That said, in this position a missing tooth is less likely to give you any problems and consequences in terms of looks and chewing ability may not be noticeable depends if you have lost other teeth or not.

See how you go following the removal of the tooth and have the dentist monitor any changes. If you lost the tooth opposite this space at the very back, then you would simply be chewing on your first molar (assuming you don’t have wisdom teeth. In this case there would be no over eruption and the alternative is two implants)

If the tooth is not the very back one, it is best if you can to have it restored.

If you decide that filling your gap or gaps is necessary, then the decision is between:

A fixed approach– something that stays permanently in your mouth

A removable approach– something which will need to be taken in and out.

If the decision is ‘fixed’ your options are:

  • A Bridge (of which there are a few different types)
  • Implant
  • Some combination of the two– a bridge supported by an implant maybe needed, if there is not enough support available from your natural teeth, or if the space you are trying to replace is quite large. Multiple single implants with crowns can also be used.
dental bridge fixed

If your decision is ‘removable’ (we are talking about a partial denture); you have three types available: 

Acrylic Dentures

Cobalt Chrome Dentures

Flexi-Dentures (Valplast)

Combined with an Implant or Implants  if necessary for extra support

Our missing teeth series will provide you with lots more information, giving you a much better understanding of these choices and answering questions such as:

  • What are the advantages and disadvantage of ‘fixed’ versus ‘removable options’?
  • When is a removable option advisable?
  • When is a fixed option advisable?
flexi dentures in mexico
types of dental bridge

Types of Bridges

Fixed Bridge. This is the staple approach and involves two single crowns either side of the space holding a pontic in the middle. The abutment teeth (those that hold the fake tooth) can be natural teeth or implants.They tend to be one or the other, not a combination of teeth and implants. The reason for this is that teeth can move around a bit in their ligament, but implants are rigidly fixed to the bone and this difference can be problematic.

Cantelever Bridges. Here the pontic is attached only on the one side of the space. Depending on the tooth that is being replaced, on rare occasions two abutments can be used on the one side to provide extra support. Imagine the fixed-fixed bridge but forgetting the crown on one side.

Resin Retained Bridge. This may also be called a’ Maryland Bridge’ or a ‘Sticky Bridge’. It has metal or porcelain wings that are bonded to the teeth either side of the gap, suspending the fake tooth in the middle. Sometimes this type of bridge may have a cantelever design- meaning it is only attached by a wing on the one side.

Materials for Dental Bridges

Your bridge can be made from any of the methods and materials used for a single crown. The dentist will make the decision on the most suitable type of material, taking into account- the bridge design, your teeth, your bite, their past experiences, the technician/ceramist, your finances etc.

PFM in ocean dental cancun

Porcelain Fused to Metal

As with crowns, this is the most common type because of its predictability, strength and great aesthetics. If a precision attachment or rest is required then to incorporate this feature, the bridge must be of this type.

full porcelain in cancun

All porcelain

Dental porcelains are improving all the time, though long- term data regarding the success of these newer porcelains is not yet readily available. Cad-Cam technology (CEREC) has also advanced to being able to offer multiple porcelain units i.e. bridges, not just single crowns. There are many different types of porcelain available, some are stronger, some are more aesthetic- the main types are discussed in dental crowns options.

metal gold crowns

All metal or Gold

These have the advantage of requiring less tooth to be removed, but the issue of aesthetics means they are rarely used. With the price of gold sky rocketing, the cost of a gold bridge could be prohibitively high, given that the cost of a single gold crown is expensive enough.

Other metals, though less superior to gold in their physical properties can be used. Porcelain-fused to metal gives the dentist the added bonus of being able to choose the amount of metal/porcelain, so where maximum tooth needs to be kept for strength, a metal surface can be used whilst still having the tooth coloured porcelain on the side for aesthetics- a bit of a compromise.

What Type of Bridge is Best for Me?

Assuming that a bridge is the right alternative for restoring your missing tooth, how do you decide which type of bridge is best?

Well luckily, when it comes to treatment planning, the dentist is a professional used to making these decisions, so don’t feel overwhelmed; they will present you with the different options.

Fixed bridgework is essentially crowns holding a fake tooth or teeth. As such the dentist must take into account all of the information we discussed when ‘choosing a crown’. There are some additional considerations to appreciate that are specific to bridges. These factors are weighted differently and your dentist will put them in the context of your desired outcome, timing, expectations and finances in helping you to make the right decision.

Factor to consider include:

These are the teeth to be used to support the bridge. Are they healthy and untouched by dentist hands, or are they heavily restored and filled, or even crowned?

If they are untouched, the more conservative a bridge the better- an all-porcelain fixed-fixed bridge would involve a lot of drilling down of your tooth and would be better avoided in favour of an implant. The more heavily filled teeth are, the more having crowns on them, as part of the bridge will have a protective role rather than a destructive one. Small fillings can sometimes be replaced and incorporated into an inlay bridge or used to gain extra surface area for bonding-in a ‘sticky type’ bridge.

Glass fibre reinforced composite bridges are not very widely performed, but if your dentist does them, they can be a good option when you have largely healthy teeth that you want to protect.

  • For front teeth, these are suitable options:
    Fixed Bridges
    Cantelever Bridges
    Resin retained or bonded bridges
  • For back teeth, all bridge designs are possible  it just depends on the situation as to whether they are appropriate. The vast majority of the time  the extra forces that need to be absorbed at the back of the mouth from chewing make the resin-retained bridge unsuitable.

The best aesthetic bridges are unarguably the fixed-fixed type bridge or single fixed cantelever. The metal wings of a resin-retained bridge (RRB) which bond it to the teeth next door, can cause some greying of the holding teeth. Porcelain bonded bridges can now be made which act on the same principle (still minimal drilling), but they do away with any metal and its associated problems.

A single cantelever is commonly used to replace a lateral incisor using the canine as the abutment. Canine teeth have very long strong roots, so it is not always necessary to prepare the central incisor as well- unless there is a problem with it avoiding the need and extra expense of a fixed-fixed design. The lateral incisor, (one of the most common teeth to be lost) is also replaced fairly well with a RRB if the conditions in your mouth (bite etc.) are favourable.

The further back in your mouth that you go, the less a small amount of metal work matters- that said you may insist, for aesthetic reasons, you would like an all porcelain bridge to be made.

If one of the supporting teeth has had a root canal filling, protecting it with a crown is a good idea anyway. So a fixed-fixed or fixed movable design would be ideal. However, if it also has a post into the root canal, this tends not to be regarded as the most ideal situation for supporting a bridge. Pressures on the bridge can risk the post fracturing the root- this would cause the tooth to be lost and a major rethink would be needed.

When I say it is not ideal, I mean, we (dentists) still have to do it in many situations when our options are limited, but it is a risk you need to be aware of. A post crown as part of a bridge, in say a bruxist with a heavy grinding habit, would not be the best idea.

There are many factors that will determine the success of each individual bridge. Generally speaking, resin-retained bridges are regarded as the least reliable because they involve the least tooth preparation and rely entirely on the strength of the cement.

If this was to fail, it can probably be stuck back in, though the length of time it would be expected to last generally wouldn’t be as long as before. The other types of bridge and alternatives do however still remain open if it fails and can be progressed to if need be.

Fixed-fixed and fixed-movable are both very reliable bridges and have excellent long- term outcomes. They are both most consistent and predictable.

We would hope a bridge would last you 10-20 years. Well-planned and executed bridges may last even longer, but there are many factors that will influence the success of your dental bridge and hence the length of time it lasts.

Dentists will have treated cases similar to yours before, (although not exactly the same). They will therefore have a good idea as to what is most likely to work in your given situation and they can share their experiences to help you make a decision.

If a patient asked for a particular type of bridge and I felt it wouldn’t work, or was not in their best interests, then I would politely say- “No!” If I felt that it might work, I would just need to make sure they understood the limitations of that option, even if it was not the choice I would have made!

Whatever work you have done at the dentist, your bite is a key factor in its success. You can bite on a fixed- fixed bridge as you would normally, but a resin-retained bridge-bridge would need to be kept out of the bite, if it was to stand any real chance of lasting. You would also need to be careful when biting and chewing hard foods.

The cost of the bridge may also narrow down or dictate your options, including reconsidering a partial denture, until you have saved enough money for a bridge or implant if that’s what you decide to do.

how long do dental bridges last?

Factors such as:

  • The quality of the supporting teeth
  • The experience of the dentist and quality of their work
  • The design of the bridge chosen
  • The length of bridge- the more units and teeth involved, the more risk of something going wrong
  • The types of material used
  • The experience of the dental technician (lab). and quality of their work
  • How well you look after it
  • The forces you place upon it.

So a successful bridge relies on the correct diagnosis and choice of bridge, quality treatment and you!

Success Factors

The success of your dental bridge depends on many things which we have touched on throughout this series. If you are considering fixed-fixed bridgework, everything affecting the success of a single crownwill apply to each of the crowns that make up the bridge. These are some of the main factors that influence the success of your bridge

The Abutment Teeth

  • The quality and strength of the cores
  • The amount of good natural solid tooth remaining
  • The state of the nerves
  • The quality of the root canal treatments if you have them, or need them
  • The quality of the post or posts if you have them, or need them
  • The periodontal condition of the teeth (amount of good bony support)
  •  Your bite do you have missing teeth elsewhere meaning the bridge is going to have to take extra pressure? Do you clench or grind your teeth?

The bridge

  • The type of bridge
  • The design of the bridge
  • The material for the bridge
  • The cement used.

Patient

  • Your oral hygiene
  • Your attention to the special cleaning of your bridge
  • Your diet
  • Regularly seeing a dentist to check everything is OK
The success of a dental bridge relies on meeting your expectations through an appropriate diagnosis, good treatment planning and selecting the right bridge/material for your specific situation All of the information above will be considered during the consultation and examination in order to advise you of the possible solutions, outcomes and costs

Before and After Dental Bridges

dental bridge before and after in ocean dental cancun

Previous Evaluation

To fully assess the above factors, you can expect the dentist to perform the following special investigations

vitality test dental in cancun

Vitality testing

We want to assess the nerves in the teeth that will be supporting the bridge and we do this with an electric pulp tester or some cold spray to see if they are alive. Ideally we will have either a normal living nerve or a well performed root canal treatment for the most predictable outcome. Questionable nerves pose a bit of dilemma; should they have a root canal or should they be left? If left, it is possible, should the tooth play up later, for the dentist to perform a root canal through the bridge- though we try to avoid this situation if we can. If in doubt the dentist may choose to observe the tooth for a while or make you aware of the options and ask what you would prefer to do.

If an abutment tooth has a less than ideal root treatment, it would, in most cases be more advisable to have it re-done prior to bridge placement, rather than risk it playing up after the bridge has been has been placed. What About the State of the Nerve in Crownswill discuss this all in more detail.

X- Ray

These must be taken to help assess:

  • The quality of the core; are there any deficiencies or dental caries?
  • The quality of the support for the abutment teeth (i.e. periodontal disease) and the amount of good quality bone available to hold the roots in position.
  • If there are any signs of needing a root canal, or to assess the success/failure of previous root canal treatment
    • Gum assessment (periodontal condition)

X-rays are a vital part of this assessment, but pocketing and bleeding must also be examined to give a complete picture of the state of the gums.

Any active gum disease must be controlled before considering the bridge. A fixed-fixed design can help to splint loose teeth together, but may result in all the teeth in the bridge being lost at once further down the track- something you would definitely want to know!

x ray bridge in cancun by ocean dental cancun

Study models (+ Diagnostic wax up)

Study models are often taken but aren’t always necessary. The more changes that are planned and the more crucial the aesthetics, the more likely this stage is to be needed. They also help the dentist look at your bite; how the teeth should be prepared; what design of bridge may be best and they can be used to help make a temporary bridge for you.

Procedure for a Dental Bridges

First up, like any treatment, is diagnosis and treatment planning which is done at the initial consultation or examination. Here we are assuming all that has been done, the different options discussed and the decision made to have a bridge to replace your missing tooth. In general, unless part of a more complicated treatment plan involving other teeth or the whole mouth two appointments are required. The first to prepare the tooth and take the impression. The second to stick the bridge in. Additional visits may be needed if the cores on the abutment teeth need to be replaced for any reason or a tooth requires a root canal and post beforehand.

procedures of dental bridge
  • Anaesthetic This is generally required but may not be in the case of a resin-retained or sticky bridge which requires only a very light preparation in enamel
  • Preparation of the teeth This takes the majority of the time (and is discussed below)
  • Impressions To accurately provide the lab with a mould of your teeth that they can use to make the bridge on
  • Shade The dentist will take the shade of your teeth to match the bridge as best as possible to the natural teeth either side
  • Temporaries crowns or bridge.
  • Anaesthetic
  • Removal of the temporary bridge- and any temporary cement on the teeth to be bridge
  • Try in– to check the fit, the margins, the bite and make sure you are happy with the colour
  • Final cementation- The dentist will use his choice of cement to stick or bond in the bridge
  • Aftercare instructions. (see below)

The procedure is just like the procedure for a crown (as essentially that’s what it is) if it’s a fixed-fixed bridge design; except for the following differences

For a bridge, the two teeth either side of the gap will need preparing. These single crown preparations must actually be parallel to each other to allow a good impression to be made and a bridge that will fit simultaneously down onto both teeth. If more than two teeth are involved in the bridge- these must also be prepared parallel.

The only exception to this is if the abutment teeth are at very different angles and attempting to make them parallel may expose the nerve inside one of the teeth, or reduce the retention of the bridge. In this case, a special joint known as a precision attachment or a telescopic crown can be used which allows two separate parts to be stuck in at different angles instead of the one solid bridge.

If the bridge is a simple case of replacing one or two teeth without changing the way you bite together- we dentists call it a ‘conformative approach‘- meaning the bridge will ‘conform’ to your existing bite or occlusion, then the bite described in the crown section will be fine.

However, if the bridge is part of a full mouth reconstruction involving many other teeth; we call this a ‘re-organised approach‘, then a ‘facebow’ record may be necessary. This is a more accurate way of recording how you bite together, which allows the models of your teeth (from the impressions) to be put on an adjustable articulator. This allows the dentist to consider how best to change your bite as part of the proposed treatment.

The temporary bridge is made of the same material as a temporary crown or veneer for that matter. If it is made on an impression of the diagnostic wax up, it will mimic the shape of the final bridge. This is important for a reorganised approach to see how it functions in the mouth. In these circumstances, you may be required to wear the temporary bridge for some time first to ensure everything is ok.

Otherwise, if it is just a routine bridge- the temporary will simply be put on for a week or two whilst the lab make the real thing in order to maintain the space and protect against sensitivity. If the bridge is in the back of the mouth and no diagnostic wax up has been done, two separate temporary crowns may be made instead of a temporary bridge.

Now because the fake tooth is attached solidly to the abutments, it is not possible to floss in the way you normally would i.e. pass the floss down the sides of the teeth. Superfloss was designed with this in mind and has a firmer plastic end, which can be threaded beneath the bridge. This is then pulled through from the other side until the thicker part of the floss rests on the gum under the bridge.

The floss is now taken all the way underneath the bridge from one side to the other to remove the plaque and food that has built up there. By doing this regularly at least every few days you will help prevent decay or gum disease starting on the abutment teeth.

Not really, sometimes you can get a bit of soreness from the gum or perhaps a bit of sensitivity if the tooth hasn’t had a root canal filling. Everything should be back to normal within a few days.

Anaesthetic will take a few hours to wear off so just be careful during this period straight after it has been fitted.

Sometimes when you’re numb, it’s not that easy to get you to bite in your natural position, so the bridge’s bite may not be adjusted fully. If after the anaesthetic has worn off, the bridge feels high, give it a few days to settle down. If the feeling persists, return to your dentist who will make the necessary adjustments and polish it down to the correct level.

It is also possible the bridge feels a little rough after being placed. This will often smooth down on its own, after a couple of days of normal eating and chewing. If the feeling persists pop back to your dentist as there may be a little bit of excess cement remaining that needs to be cleaned up.

Dental Bridges Complications

As with any treatment, the dental bridge is not without its risks. The potential problems of a traditional fixed bridge are pretty much the same as the risks of having a crown only proportionally greater because a bridge involves more crowns. If a problem occurs with one of the abutment teeth it can potentially compromise the whole bridge putting you back to square one, or even further behind if it means another tooth gets lost.

The bigger the bridge, the more teeth are involved, the larger the stresses placed on it and therefore the greater the likelihood of something going wrong. You can potentially get a problem with one or both of the adjacent teeth – both would be severely unlucky!

In summary, the risks are:

  • Dental caries
  • Periodontal disease
  • Wear of opposing teeth
  • Nerve problems
  • A dark line at the gum (see aesthetic problems below)
  • A chip or fracture
  • A bridge coming off because:

(i) The cement fails – this is good because it means generally it can just be stuck back in

(ii) The core fails- generally a pretty bad sign- the bridge is likely to need replacing with some extra modifications.

Additional Issues include:

  • Hygiene problems

A bridge does not allow normal floss to pass through and requires special cleaning instructions. This means that the potential for plaque to collect around it and lead to decay or gum disease is higher than an individual crown or an implant.

  • Aesthetic problems

Assuming you have no functional problems with the bridge you may find in 10-20 years because your gums have shrunk it just doesn’t look like it used to. If it is at the back of the mouth then this will actually make cleaning easier and is unlikely to be a major problem. If however, it is your front teeth, then if the looks are no–longer acceptable to you, the only option may be to replace it.

Resin retained bridges (aka sticky or bonded bridges) are more prone to coming off than a normal bridge. More commonly they are of the cantelever type, meaning they are only attached on one side because if the cement fails, it will cause the bridge to fall out. If it has wings on both sides, one side can de-bond and you can get caries underneath without noticing, which if this goes undetected for some time, could land you with a large problem.

If this type of bridge fails repeatedly, you can progress to a more traditional fixed bridge or perhaps an implant crown.

Dental Bridges FAQ

There are consequences to missing teeth that you may not have thought about, so it is important to make yourself aware of what might happen if you do nothing.

To fill or not to fill the gap, is ultimately your decision, not the dentist’s. Remember it is your mouth not theirs- you are going to have to pay for it and live with whatever you decide to have done- not the dentist- so you need to go with what is right for you.

Their job is to give you all the information (ups and downs) that you need to know to make the decision; provide their best professional opinion on what you should have done and then actually carry out the treatment to the best possible standard.

This is known as ‘informed consent’ and is the basis of ethical dental practice. It is not to coax you into having a treatment, or drum up enough pain, so that you decide to take action and have, say a crown, when a filling is a perfectly suitable option. Making an ‘informed decision’ is empowering and necessary.

The benefits of replacing your missing teeth (such as improved appearance, speech and chewing) must be weighed against the possible consequences, risks and adverse effect of doing so. This must be considered in the context of all the different options and the costs of the various treatments.

The line between dental healthcare and cosmetic dentistry has become a little more blurry of late. There was always some overlap, as certain treatment options do look significantly better than others unfortunately these tend to be slapped with suitably larger price tag and so are definitely not within reach of everybody.

Whether these are the best choices in the long term is slightly different and the answer is certainly not as clear cut as you may think. Every single situation and individual is different, no one case is ever quite the same.

You only have one set of adult teeth, so until we learn how to grow new teeth like sharks and crocodiles, it is worth doing everything you can to preserve them for your entire life and that may not be drilling them down to stubs and sticking beautiful porcelain crowns over the top at the age of 20.

There are the circumstances in which a dental bridge may not be sensible or even possible. These are the same for both crown and bridges.

In summary, the reasons you may not be able to have a bridge are:

  • Finances don’t permit it
  • Lack of space

Not enough space for the dentist to work or the bridge to fit.

  • Serious medical conditions

Any medical conditions which stop you lying down, or staying still for the long appointments.

  • Poor oral hygiene

If you can’t look after your mouth before having a bridge, chances are it will only make things worse.

  • Poor periodontal support

Good solid teeth are needed to support a fake tooth. Where the bone support is poor, a bridge may cause more problems than it solves. If additional bone is lost from the extra pressures of supporting a missing tooth, the teeth will progressively loosen. Eventually they will be so loose or cause pain and need extracting, leaving you with a considerably bigger gap.


It may not be sensible to have a bridge if other options are more appropriate
:

  • Multiple missing teeth


These may be better restored with a partial denture, unless you can afford multiple bridges and implants as part of a full mouth rehabilitation.

  • Healthy teeth

If you have two perfectly healthy teeth either side of the space, an implant crown would in most cases be the best option leaving these totally untouched.

  • You are likely to lose more teeth

A tooth can be added to a partial denture without too much problem. This is not possible with a bridge, so if more teeth are likely to be lost – this should be planned from the start and taken in to account.

  • Missing last molar tooth.

A bridge here is very difficult and often even unnecessary. An implant would be a better solution if you wanted the space restored with a fixed option.

A dental bridge will allow you smile, eat and chew as normal assuming it is the fixed-fixed type. You need to be extra careful with the resin retained bridges as these are notoriously weaker, so you should be careful about putting lots of pressure on them. It is sensible to cut up apples, chocolate bars etc and be conscious when eating any hard foods.

If you are a bruxist and grind or clench your teeth, you should be wearing a night splint anyway, but if you have had crown and bridge work it is even more important you get one made and wear it!

Anaesthetic will take a few hours to wear off so just be careful during this period straight after it has been fitted.

It is a good idea to reflect briefly on why the bridge was needed to begin with. Why did you need a tooth extracted- was it decay, a cracked tooth, gum disease etc? What could prevent you potentially needing this type of treatment again in the future? Maybe: more frequent dental visits, better cleaning, flossing, an improved diet, extra fluoride, a night guard

Sometimes when you’re numb, it’s not that easy to get you to bite in your natural position, so the bridge’s bite may not be adjusted fully. If after the anaesthetic has worn off, the bridge feels high, give it a few days to settle down. If the feeling persists, return to your dentist who will make the necessary adjustments and polish it down to the correct level.

It is also possible the bridge feels a little rough after being placed. This will often smooth down on its own, after a couple of days of normal eating and chewing. If the feeling persists pop back to your dentist as there may be a little bit of excess cement remaining that needs to be cleaned up.

Since a traditional fixed bridge essentially contains two crowns, there will be a certain % of teeth that actually die off from the trauma of preparing the tooth. The chances are minimised if the dentist is not overly destructive when preparing the teeth and places a good temporary in between appointments. However, at some point in the future, the theoretical risk exists that this could happen and one of the teeth supporting your bridge might die off and become painful. If this happens a root canal through the bridge would be the most likely course of treatment.

Your dentist will be able to tell you whether it is possible to repair your dental bridge or the whole thing is going to need to be replaced. A small amount of decay or slight deficiency at the margin of the bridge can often be repaired with a bit of white filling material. Small fractures can sometimes be repaired with composite or just smoothed if they are not an aesthetic problem and of concern to you.

If the nerve plays up and a root canal treatment is needed in one of the supporting teeth, it can sometimes be performed through the bridge without the bridge needing to be replaced. This is a bit more tricky than normal and will slightly affect the integrity (strength) so we try as best as possible to avoid this situation. It does happen though and following the root canal, the access (hole) in the top can just be filled with white or silver filling material to restore the crown.

A glass fibre reinforced composite bridge is much easier to repair should problems occur and rarely would it be necessary to replace the whole thing.

The following factors will influence the price the dentist charges for the dental bridge:

  • Size of the bridge (number of units)

This is one of the biggest determining factors. Bridges are measured in units, which essentially means the number of teeth that are involved in the procedure, ‘not’ the number of missing ones replaced . The most common is the three-unit bridge; two crowns holding a fake tooth to replace the ‘real’ one that is missing. If two teeth were missing, the bridge would need an extra fake tooth, making it a four-unit bridge… make sense? Pontics don’t cost as much as crowns because there is less worked involved in making them.

  • Does it involve an implant?

If there is not enough support from your natural teeth, then implants may be needed- as soon as implants get involved- expect the cost to go up considerably.

  • Dentist

Since there are no set fees to say what a dentist should charge, only guidelines, fees can vary quite a lot from practice to practice as the average price range above suggests. Ask yourself- is the dentist a general dentist, a cosmetic dentist or a prosthodontist ?

The level of training, expertise and experience may affect how much the dentist decides to charge. Though all dentists are trained to make bridges, this doesn’t make them all equal. For example, a prosthodontist is a registered specialist, trained in advanced dentistry and restorative procedures; the prices they charge are likely to reflect this.

  • Technician/ Ceramicist

The artistic and technical skill of the person making the dental bridge is crucial to getting a good fit and a natural looking result. The more experience and training they have, the higher you would expect the lab charges for the dentist to be, and thus the more you will end up paying. Different dental laboratories have different price lists for the work they produce- some do work in Australia, others outsource to overseas- some do both- it just depends.

  • Location

The cost of a dental bridge will vary not only between countries, but also between states and between major cities and smaller towns and rural areas where access is more limited and there is less competition.

  • Insurance

Which health fund you are with and the type and level of insurance will determine how much you get back and how much you yourself actually end up having to contribute to the dental bridge.

  • Type of bridge

In addition to the number of units, the type of bridge will also affect the cost. A bonded-bridge involves significantly less tooth preparation (and time) than a conventional bridge. The lab charges will also be lower and so this will be reflected in the overall price. Unfortunately it can only be used in certain situations and these are quite limited.

If special precision attachments are incorporated into the bridge to relieve stresses or solve a problem of tilted teeth, expect there to be additional costs. If the dentist is thinking of using this in the design for whatever reason, they should inform you and factor it into the price.

  • Materials

Whether the bridge is made in all-porcelain or strengthened by a metal sub structure [which is most commonly the case] and the type of porcelain used, will have some impact on the amount the dentist must pay to the lab technician. Since you will pay more for an all-porcelain crown compared to a porcelain fused to metal crown, it is likely you will pay more for an all-porcelain bridge as this is the most cosmetic option.

  • Other costs

As with the cost of a dental crown, there are other treatments that may be required before preparing the teeth for the bridge. This may include replacing the fillings (cores) of the abutment teeth, having root canal treatment, and possibly a post and core.

After examining your teeth, your dentist can advise you if these will be needed and the cost of having them done. They will be included on your treatment plan.

Initially you are likely to be charged for the following as part of the pre- bridge assessment.

ITEM 013 or 014- A limited examination or consultation

ITEM 022 or 037- X-rays to check underneath the teeth

Study models and photos may also be needed and incur charges.

Financing

A lot of dentists offer payment plans for cosmetic, restorative and orthodontic treatment. Ask them if they have anything available. Third party financing may be possible if your dentist doesn’t offer this option and you meet the eligibility criteria. That way you can develop a monthly payment plan to suit your budget and not have to wait to have the treatment done.

Watch out for cheap bridges!

If you are shopping around for the cheapest dental bridge, a word of caution… you often get what you pay for. I would as always advise against going for the very cheapest. Cheap bridges suggest a corner is being cut somewhere, be that the length of time the dentist spends working on your teeth, assessing the case, inferior materials or using a very cheap overseas dental lab. Have the treatment with a dentist you trust and who you believe will do a quality job that will last you many years. A dental bridge that lasts well will end up being the most economical investment.

Advantages of having a Dental Bridge

The reason for having a bridge is to restore a missing tooth or teeth, the advantages of having a dental bridge are:

In a traditional fixed bridge, not only can you fill the space of the missing tooth, you can improve the colour and the shape of the teeth that you are crowning either side. This gives the technician a little more space to play with and allows a bit of flexibility in creating a desirable result. Porcelain looks great, matches the natural teeth exceptionally well and is very resistant to staining.

A bridge is fixed in your mouth- you don’t have to worry about taking it out to clean it like a partial denture. It is very important that you look after it and follow the special cleaning advice for bridges.

If the teeth either side are heavily filled or broken down then by crowning these teeth as part of the bridge you are actually helping to strengthen them and replace your missing tooth at the same time.

Studies have shown that fixed bridgework, like individual crowns, is very predictable, durable and lasts a considerable length of time. That said, they aren’t as good as natural teeth and once your teeth are prepared for this type of bridge, there’s no going back. Your teeth will always need a crown/bridge. Should you opt for a resin-retained or bonded bridge, it would not be expected to last as long as another type of bridge.

A bridge in general takes only a little longer than a single crown (depending on the size and type of the bridge) and once the decision to make a bridge has been made, unless part of a more complex treatment plan, it takes just two appointments from start to finish. This is a much quicker procedure than having an implant or even a partial denture.

Implants require one or more surgical procedures to place the implant or implants. You may also require bone grafting if you have insufficient natural bone available. For anyone who is unable to undergo implant surgery for medical reasons, it is a great fixed alternative.

Disadvantages of having a Dental Bridge

The main disadvantages of having a dental bridge are:

If the tooth is completely natural, the preparation is quite damaging. In order to make space for the bridge the teeth must be filed down. Where a tooth has already been heavily damaged or has multiple or large fillings, this can actually have a protective role. Here we are assuming the retainer is a full crown- some dentists may use other less destructive retainers in certain cases . Not all types of bridge are quite as destructive, both the resin-retained bridge bridge and glass-reinforced fibre composite bridge are much more conservative- though not as strong or as predictable. A cantilever design may also help to preserve the maximum amount of natural tooth.

When a tooth is prepared for a full crown, alone or as part of a bridge, 1-15% lose vitality (i.e. the nerve dies) and will require root canal treatment in the future. That is of course assuming a root canal has not already been carried out.

Single crowns are quite expensive, so with fixed bridgework, costs escalate quite dramatically. See- Bridge costs for a more detailed breakdown.

The procedure for the bridge is quite a long. The first appointment could take anything from one to three hours depending on the dentist.The second appointment should be completed in about an hour.

Some extra care is necessary to keep the underside of the bridge nice and clean, as it is prone to collecting plaque. Since the fake tooth is rigidly joined to the teeth either side it is not possible to floss in the normal way and super floss is needed.

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