A tooth supported bridge is a fixed prosthesis that replaces one or more missing teeth. It is made from two or more crowns (or caps) that cover the teeth on each side of the gap, serving as anchors, and the fake teeth are called pontics.
The teeth near the gap must be prepared to make space for crowns with additional tooth structure removal.
A bridge is used when one or more teeth are missing leaving a small/medium gap. Before implants were available, bridges were the only fixed solution to replace teeth. Today, implants are the treatment of choice in most cases unless 1) the teeth near the gap that serve as anchors (or abutments) would benefit from crowns because they are structurally compromised or cracked, 2) there is insufficient bone for implants, 3) the patient cannot have or does not want implant surgery.
Bridges are fixed prosthesis shaped like teeth. They can look and feel very natural. There is no surgery required and the treatment time is shorter than for an implant. They are also usually cheaper than implants.
Because the teeth near the gap (abutments) must be prepared for crowns the pulp (or nerve tissue) may die, especially if the teeth were damaged beforehand. If the pulp dies, a root canal specialist can place a root filling with additional visits and costs. Nerve death can occur immediately after tooth preparation or several months or even years after the bridge is placed.
Teeth underneath the bridge can also decay if they are not adequately cleaned every day.
Another potential problem is fracture or chipping of the ceramic that overlays the bridge. This is more common in posterior teeth or in patients that clench/grind their teeth.
Scientific evidence finds that bridges typically last 10-15 years with significant variation. This depends on several factors like oral hygiene habits, diet, previous condition of the teeth supporting the bridge, length, etc.
Most bridges fail due to problems with the abutment teeth they are bonded to.
Bridges can be made of several materials depending on the patient´s needs and desires.
Usually, bridges have a metal frame that provides strength. The frame is layered with ceramic, giving a more natural appearance. This layer can chip if put under heavy loads (clenching/grinding).
Full ceramic bridges are weaker and may fracture under heavy load.
A splint or mouth guard may be indicated to protect restorations if clenching or grinding is present.
The bridge and the abutment teeth that support it must be cleaned daily. The fake tooth or pontic must also be cleaned underneath with little brushes or special floss for bridges.
Regular check-ups are recommended every 6-12 months to spot any problem early on.
The sequence for a bridge is:
Tooth preparation, impression and temporary bridge or crowns. If large fillings are present, these may need to be replaced by foundation cores.
Try-in, and if not, changes are to be made in colour or shape, the bridge can be inserted.
Any surgical or invasive procedure carries risks. Before proceeding with any treatment you may consider seeking a second opinion from an appropriate qualified health practitioner