Restorative Dentistry: Getting Your Smile Back Using a Dental Bridge

What is a Dental bridge?

If you have suffered from an oral disease or trauma that has caused you to lose your teeth, you should not be worried. Your natural smile can be restored using a type of false teeth known as “dental bridge”. These are dental prostheses that can easily fill the space of your missing teeth. Bridges were used to be often made of gold; however, many people did not like the aesthetic aspect of using gold-plated teeth. Hence, ceramic-based bridges with zirconium metal cores have become increasingly common. This is simply because of the resemblance of ceramic to our natural teeth. Also, metals such as zirconium offer higher stability and mechanical performance such as fracture resistance (1,2).

Relative Surgical Protocol and Different Types of Dental Bridge

To assess your eligibility to receive a dental bridge, your dentist initially checks the position of the missing teeth. After evaluating the region, he/she will discuss the choice of available options with you.

The initial steps of dental bridge assembly often involve a reduction of neighbouring (abutment) teeth surfaces (enamel). This pre-treatment allows the bridge to fit securely on top of the prepared teeth to fill the empty space between them. Your dentist injects a local anaesthetic to your gum before starting to remove any enamel from your teeth surface. Once complete, he/she then takes an impression from your mouth to order a suitable bridge for you. Fabrication process usually takes around one to two weeks. During this time your dentist may ask you to wear a temporary bridge to fill the empty space. After receiving your bridge, your dentist cements the fabricated bridge to the prepared abutment teeth. Four main categories of dental bridges (based on their attachment to the abutment teeth) are as follows:

· Conventional Bridges

Most conventional bridges require major shaving and preparation of adjacent teeth. The position of missing tooth and condition of teeth that sit alongside the gap are among factors that help your dentist determine the type of conventional dental bridge.  There are four types of conventional bridges including:

1.   Fixed-Fixed:

In this design, abutment teeth on both sides of the empty space act as a support for the bridge. Subsequently, the bridge is permanently cemented on top of the abutment teeth on both sides.

2.   Fixed-Movable

Ageing-associated tooth movement and pathological changes in the bone structure may put extra stress on the abutment teeth. As an alternative, bridges can permanently attach to only one of the abutment teeth. The remaining side is connected to a retainer, located on top of the other adjacent tooth. The retainer allows a minor movement of the bridge and significantly reduces the pressure on the supporting teeth. (3).

3.   Cantilever

Cantilever bridgework involves a one-sided connection of pontic (false tooth) to an abutment tooth. Therefore, the other unsupported side does not have any form of attachment. Maxillary teeth on the upper jaw are among teeth that can be replaced by this procedure (4).

4.   Spring-Cantilever

Sometimes the attachment of the cantilever bridge may affect the appearance of your smile. Also, the bordering teeth may have extensive caries or periodontitis which makes them incompetent to support a bridge. In such cases, your dentist uses a distant abutment tooth (teeth) to hold the pontic in place (5).

· Adhesive Based Bridges

Using an adhesive bridge is a less invasive approach to fill the missing gap between the teeth. The process involves the application and subsequent bonding of resin to the enamel. The bridge can then be secured on this resin component. The main advantages of adhesive bridges in comparison to conventional bridges are their ease of use and minimal teeth preparation (6).

· Hybrid Design

Hybrid bridges include both conventional and resin-bonded methods. The conventional section often has a movable design (7).

Dental Implant for Supporting a Bridge

In the presence of several missing teeth, the bridge can be supported by a dental implant. Dental implants prevent bone loss and can be a substitute for the role of natural teeth as an abutment. However, their assembly often requires a surgical procedure, and some patients may not be medically fit to receive them.

Common Dental Bridge Complications

Gum disease

As mentioned earlier, physical alteration of the abutment teeth is the requirement for many types of dental bridgework. This alteration puts extra pressure on the abutment teeth and their surrounding soft tissue. Hence,  the gum around these teeth can be more prone to inflammation, plaque build-up and bleeding (8). Older patients and individuals who have had their dental bridge for a long duration are at increased risk of developing the gum disease (9).

Bridge detachment and Chipping

Bridges form strong bond with their anchoring teeth. Hence, they do not detach unless they are affected by a physical accident or dental diseases. The chances of such traumatic events are rare. Instead, their surface may chip, or they may loosen due to cement failure.  A five-year study of 153 cases involving dental restorations showed that only 4.5% of cases had minor complications that involved chipping and decementation of the bridge. Most of the complications were not of biological nature and were mostly caused by physical/mechanical trauma to the bridge and supporting abutment teeth (10).

How to Maintain Your Dental Bridge

It is crucial that you clean the bridge and its surrounding soft tissue. This will help eliminate germs and prevent the development of gum disease. You should brush twice daily. You can use interproximal brushes to clean between the teeth and harder to reach regions around the bridge.

Similarly, flossing is also necessary to maintain gum health. Nylon tape-based flosses may not be adequate for cleaning the dental bridge. Alternatively, you may opt for water flosses which are more effective against plaque build-up and gum disease (11).

Cost of Setting up a Dental Bridge

If you would like to use the NHS service to receive a dental bridge, you will need to make a contribution towards your treatment. Dental bridges sit in the Band 3 of NHS dental category. Hence, you will need to pay £256.50 once you have completed your course of treatment (12). If you choose to select a private dentist for your treatment, then he/she will guide you through the cost. The materials and the type of procedure are the key factors that affect the price of your treatment.  For instance, conventional three-unit bridges can cost somewhere between £300 to £1000. Comparatively, if you choose to select a 3-unit implant retained bridge, then the cost can soar up to £3000. Therefore, always check the price of your dental procedure before receiving any private dental treatment.

 

References:

 

  1. Griggs JA. Recent advances in materials for all-ceramic restorations. Dent Clin North Am [Internet]. 2007 Jul;51(3):713–27, viii. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17586152
  2. Ban S. Reliability and properties of core materials for all-ceramic dental restorations. Jpn Dent Sci Rev [Internet]. 2008;44(1):3–21. Available from: http://dx.doi.org/10.1016/j.jdsr.2008.04.001
  3. Tipton P. Bridge Design, Part Two: fixed-movable bridgework. Restor Aesthetic Pract. 2000;2(6):96–103.
  4. Sharma A, Rahul GR, Poduval ST, Shetty K. Assessment of various factors for feasibility of fixed cantilever bridge: a review study. ISRN Dent [Internet]. 2012;2012(January 2010):259891. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22461987
  5. Kiran Kumar HS, Bhat S, Patil SG, Madhavan S, Kulkarni R. Spring Cantilever: When and Why – A Clinical Report. IJSS Case Reports Rev. 2014;1(4):2–5.
  6. Ahmad M, Naim H, Meshni A, Mohsin Adawi A, Siddiq A, Mosa Zaud Mayidi H, et al. A conservative approach to replace missing teeth in the aesthetic zone with Maryland bridge – A case report. Dent Oral Craniofacial Res [Internet]. 2017;3(4):1–3. Available from: http://oatext.com/A-conservative-approach-to-replace-missing-teeth-in-the-aesthetic-zone-with-Maryland-bridge-A-case-report.php
  7. Zuhr O, Hurzeler M. Replacement of missing teeth. Plast Periodontal Implant Surg a Microsurg Approach. 2012;(April):609–798.
  8. Silness J. Periodontal conditions in patients treated with dental bridges. 2. The influence of full and partial crowns on plaque accumulation, development of gingivitis and pocket formation. J Periodontal Res [Internet]. 1970;5(3):219–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/4254185
  9. Al-Sinaidi A, Preethanath RS. The effect of fixed partial dentures on periodontal status of abutment teeth. Saudi J Dent Res [Internet]. 2014;5(2):104–8. Available from: http://dx.doi.org/10.1016/j.ksujds.2013.11.001
  10. Pott P-C, Eisenburger M, Stiesch M. Survival rate of modern all-ceramic FPDs during an observation period from 2011 to 2016. J Adv Prosthodont [Internet]. 2018 Feb;10(1):18–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29503710
  11. Sharma NC, Lyle DM, Qaqish JG, Galustians J, Schuller R. Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop [Internet]. 2008 Apr 1;133(4):565-71; quiz 628.e1-2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18405821
  12. NHS. Understanding NHS dental charges [Internet]. Available from: https://www.nhs.uk/using-the-nhs/nhs-services/dentists/understanding-nhs-dental-charges/