Bridges
Content
Dental bridges literally bridge the gap created by one or more missing teeth. A bridge is made up of two crowns for the teeth on either side of the gap – these two anchoring teeth are called abutment teeth – and a false tooth/teeth in between. These false teeth are called pontics and can be made from gold, alloys, porcelain or a combination of these materials. Dental bridges are supported by natural teeth or implants.
What Are the Benefits of Dental Bridges?
Restore your smile Restore your ability to properly chew and speak Maintain the shape of your face Distribute the forces in your bite properly by replacing missing teeth Prevent remaining teeth from drifting out of position
Bridges:
What Types of Dental Bridges Are Available? There are three main types of bridges:
Traditional bridges involve creating a crown for the tooth or implant on either side of the missing tooth, with a pontic in between. Traditional bridges are the most common type of bridge and are made of either porcelain fused to metal or ceramics. Cantilever bridges are used when there are adjacent teeth on only one side of the missing tooth or teeth. Maryland bonded bridges (also called a resin-bonded bridge or a Maryland bridge) are made of plastic teeth and gums supported by a metal framework. Metal wings on each side of the bridge are bonded to your existing teeth.
What Is the Process for Obtaining a Dental Bridge? During the first visit, the abutment teeth are prepared. Preparation involves recontouring these teeth by removing a portion of enamel to allow room for a crown to be placed over them. Next, impressions of your teeth are made, which serve as a model from which the bridge, pontic, and crowns will be made by a dental laboratory. Your dentist will make a temporary bridge for you to wear to protect the exposed teeth and gums while your bridge is being made. During the second visit, your temporary bridge will be removed and the new permanent bridge will be checked and adjusted, as necessary, to achieve a proper fit. Multiple visits may be required to check the fit of the metal framework and bite. This is dependent on each individual's case. If the dental bridge is a fixed (permanent) bridge, your dentist may temporarily cement it in place for a couple of weeks to make sure it is fitting properly. After a couple weeks, the bridge is permanently cemented into place.
How Much Do Dental Bridges Cost?
The cost of dental bridges varies depending on the type of bridge selected and the area of the country in which the procedure is performed. Dental insurance will typically pay a percentage of the fee depending on the individual dental plan.
How Long Do Dental Bridges Last? Dental bridges can last 5 to 15 years and even longer. With good oral hygiene and regular prophylaxis, it is not unusual for the life span of a fixed bridge to be over 10 years.
Will It Be Difficult to Eat With a Dental Bridge? Replacing missing teeth should actually make eating easier. Until you become accustomed to the bridge, eat soft foods that have been cut into small pieces.
Will the Dental Bridge Change How I Speak? It can be difficult to speak clearly when teeth are missing in the front or anterior areas. Wearing a dental bridge with the anterior teeth in their proper relationship will help you speak properly.
How Do I Care for My Bridges? It is important to keep your remaining teeth healthy and strong as the success of the bridge (depending on the type selected) depends on the solid foundation offered by the surrounding teeth. Brushing twice a day and flossing daily helps prevent tooth decay and gum disease that can lead to tooth loss. Your dentist or dental hygienist can demonstrate how to properly brush and floss your teeth. Keeping a regular cleaning schedule will help diagnose problems at an early stage when treatment has a better prognosis. Selecting a balanced diet for proper nutrition is also important.
In dentistry, crown and bridge (Restorative Dentistry) refers to the restoration of natural teeth that have been damaged, decayed or lost. Once your dentist has examined your teeth and has evaluated your dental and medical history, he/she will be ready to provide a diagnosis, and treatment options. A crown may be constructed to restore an individual damaged tooth back to it's original form and function, while a bridge may be utilized to replace one or more teeth. These restorations are cemented onto the teeth and are referred to as "fixed" dentistry as opposed to a restoration of missing teeth with a removable appliance or partial denture.. A crown is fabricated using an indirect procedure. The tooth is modified and prepared by using special insturments and a copy of the tooth preparation is made is made by taking an impression The crown is then "permanently" cemented onto your tooth preparation. A fixed bridge refers to a prosthesis that will span the area of a missing tooth, known as a pontic. The procedure involves a local anesthetic and the preparation of two or more abutment teeth. Once this has been accomplished, an impression is made and sent to the dental laboratory for fabrication of your new tooth. This procedure will take five to ten days and will encompass two to four appointments. (A crown procedure takes two to three office visits.) The following is a brief description of how a crown will be made:
1. Upon arriving to the laboratory, your impression is cleaned (sterilized). 2. Powdered stone is mixed with water and poured into your impression, which once set hardens into a stone cast of your
3.
4. 5.
6.
7.
8.
upper/lower teeth. The casts are connected on an apparatus called an articulator that mimics your jaw motion. Using a bunsen burner, the dental technician melts wax and applies it to the prepped tooth stump. This process is called fabricating a coping or framework (if a bridge) which supports the tooth colored material called porcelain. The wax coping is invested in high heat stone, burned out in an oven and cast into metal. This is a similar procedure that a jeweler might use when making a ring. After the metal has been cast, the technician will use a variety of high and slow speed drills to contour the metal. The metal is then ready to be prepared to receive porcelain. Since porcelain is very clear, the silver gray colored metal needs to be masked out. This procedure is referred to as opaquing, or masking out the metal. Porcelain powder is mixed with water and applied by brush to the opaqued metal understucture. By using the casts that have been joined, the dental technician will be able to reproduce a lifelike copy of the original tooth. The porcelain build-up is fired in a ceramic oven at 1800 degrees. Using various diamond and carbide drills, the final contours are established. The porcelain-fused-to-metal restoration is then colored to the patients specific shade and glazed to render an enamel-like finish.
After the final fabrication phases have been completed, the finished crown is returned to your dentist to be checked for correct fit. Once all final adjustments have been made, your restoration is permanently cemented.
What is a Dental Bridge?
What is a dental bridge? A dental bridge is a false tooth, known as a pontic, which is fused between two porcelain crowns to fill in the area left by a missing tooth. The two crowns holding
it in place that are attached onto your teeth on each side of the false tooth. This is known as a fixed bridge. This procedure is used to replace one or more missing teeth. Fixed bridges cannot be taken out of your mouth as you might do with removable partial dentures. In areas of your mouth that are under less stress, such as your front teeth, a cantilever bridge may be used. Cantilever bridges are used when there are teeth on only one side of the open space. Bridges can reduce your risk of gum disease, help correct some bite issues and even improve your speech. Bridges require your commitment to serious oral hygiene, but will last as many ten years or more.
Introduction: Dental Bridges This section of About Cosmetic Dentistry will help you to learn more about dental bridges. You'll learn how the procedure is performed, what dental bridges cost and you'll have the chance to see photos taken before and after the dental bridge installation. In addition, you will be able to read personal experiences from patients and discuss bridges with other patients and potential patients. You can use the outline below to jump to a specific point in the dental bridge section, or you can use the "Continue" arrow button below to begin reading.
Who is a candidate for dental bridges? If you have missing teeth and have good oral hygiene practices, you should discuss this procedure with your cosmetic dentist. If spaces are left unfilled, they may cause the surrounding teeth to drift out of position. Additionally, spaces from missing teeth can cause your other teeth and your gums to become far more susceptible to tooth decay and gum disease.
Overview of dental bridge procedure If you a space from a missing tooth, a bridge will be custom made to fill in the space with a false tooth. The false tooth is attached by the bridge to the two other teeth around the space - bridging them together.
How is dental bridge accomplished? Your cosmetic dentist will prepare your teeth on either side of the space for the false tooth. You will be given a mild anesthetic to numb the area, and the cosmetic dentist will remove the an area of each abutment (teeth on either side of the space) to accommodate for the thickness of the crown. When these teeth already have fillings, part of the filling may be left in place to help as a foundation for the crown. The dentist will then make an impression, which will serve as the model from which the bridge, false tooth and crowns will be made by a dental laboratory. A temporary bridge will be placed for you to wear while your bridge is being made until your next visit. This temporary bridge will serve to protect your teeth and gums. Your cosmetic dentist may have you use a Flipper appliance. A Flipper is a false tooth to temporarily take the place of a missing tooth before the permanent bridge is placed. A Flipper can
be attached via either a wire or a plastic piece that fits in the roof of your mouth. Flippers are meant to be a temporary solution while awaiting the permanent bridge. On your second appointment, the temporary bridge will be removed. Your new permanent bridge will be fitted and checked and adjusted for any bite discrepan
Types of Dental Bridge Procedures There are three types of dental bridges: Traditional Fixed Bridge A dental bridge is a false tooth, known as a potic, which is fused between two porcelain crowns to fill in the area left by a missing tooth. There two crowns holding it in place that are attached onto your teeth on each side of the false tooth. This is known as a fixed bridge. This procedure is used to replace one or more missing teeth. Fixed bridges cannot be taken out of your mouth as you might do with removable partial dentures. Resin Bonded Bridges The resin bonded is primarily used for your front teeth. Less expensive, this bridge is best used when the abutment teeth are healthy and don't have large fillings. The false tooth is fused to metal bands that are bonded to the abutment teeth with a resin which is hidden from view. This type of bridge reduces the amount of preparation on the adjacent teeth. Cantilever Bridges In areas of your mouth that are under less stress, such as your front teeth, a cantilever bridge may be used. Cantilever bridges are used when there are teeth on only one side of the open space. This procedure involves anchoring the false tooth to one side over one or more natural and adjacent teeth. cies. Your new bridge will then be cemented to your teeth.
Dental Bridges Costs How much do dental bridges cost? The average cost of a single fixed bridge depends on many factors, from which region you're in to how many and which type of bridges are needed. Typically dental bridge cost ranges from $500-900 per tooth. Dental insurance typically pays for about half of the cost of the bridge. This is a cost per tooth in the bridge, and doesn't include the costs for any anchoring crowns on either side of the bridge. In the case of a Maryland type bridge, costs range from $250. to $550. for each attaching wing and $600. to $1200. for each false tooth or pontic.
Advantages & Disadvantages of Dental Bridges Pros and Cons of a Dental Bridge Advantages of dental bridges: Bridges are natural in appearance, and usually require only two visits to your dentist. If you maintain good oral hygiene, your fixed bridge should last as many as ten years or more. Disadvantages of having a dental bridge: It is common for your teeth to be mildly sensitive to extreme temperatures for a few weeks after the treatment. The build up of bacteria formed from food acids on your teeth and gums can become infected if proper oral hygiene is not followed
Personal Stories: Dental Bridges I turned forty last year, and have enjoyed playing softball since I was a kid. One drawback to the sport is the occasional hit from a ball. Several years ago I lost two teeth from such a mishap, and had worn a partial. I found the partial to be a bit embarrassing at my age, but my dentist had discussed no other option with me. Frustrated that I was stuck with this thing for the rest of my life, I started doing some research, which was hard to come by. And when I did discover information on alternatives, I didn't understand it. As many of you who are now visiting this site already know, such matters are not easy to speak with family or friends about. After visiting this site, I soon understood that I had a few options to remedy the spaces in my mouth. I located a Certified Cosmetic Dentist and discussed these options, including the fact that I wanted to avoid the more costly procedures, such as implants. His immediate solution was placing two bridges. It only took two appointments over two weeks, and I had a terrific smile again. Chris, thanks for the site! Gerry, New Hampshire
Determining the color for your dental bridge? When considering dental bridges a common question is how white the dental bridge should be. Usually, the answer is to whiten your natural teeth to either the level of whiteness you want or to the brightest they can be. Your cosmetic dentist will then have the dental bridge made to that color. Teeth are of course not monochromatic, so typically more than one color is used to create a very natural look. This color variation is critical in avoiding fake or artificial looking teeth. It is the internal contrast of colors that help create vitality. The internal play of light on the porcelain in the restoration helps to create this vitality. Surface texture is also very important, and helps to break up light reflections and make the dental bridge look more natural. Depending on the type of dental bridge you're considering, it's important that the crowns anchoring the bridge match both the dental bridge and the color of your natural teeth. There is no one standard system in the dental field to measure and determine tooth color. The most often heard about, however, is the Vita shade guide. This guide divides tooth color into four basic shade ranges: A (reddish brown) B (reddish yellow) C (gray) D (reddish gray). In the A range there are five levels of darkness. Ranges B, C and D, each have four levels.
Not all of your teeth are the same natural color. Usually your eye teeth tend to be darker than the others, your front teeth are typically the whitest, and molars tend to be a shade between the two. The goal for everyone is to achieve their individual optimum whiteness while still looking natural. Most dentists will show you a shade chart (like the above mentioned Vita Shade Guide) for you to pick from. Keep in mind, with a good cosmetic dentist this is merely a starting point. Other considerations when determining the color of dental bridges for each patient are your complexion, hair color, the color of your natural teeth and even your eye color.
A dental bridge, otherwise known as a fixed partial denture, is a prosthesis used to replace missing teeth and is not removable by the patient. A prosthesis that is removable by the patient is called a removable partial denture. A dental bridge is fabricated by reducing the teeth on either side of the missing tooth or teeth by a preparation pattern determined by the location of the teeth and by the material from which the bridge is fabricated. In other words the abutment teeth are reduced in size to accommodate the material to be used to restore the size and shape of the original teeth in a correct alignment and contact with the opposing teeth. The dimensions of the bridge are defined by Ante's Law: "The root surface area of the abutment teeth has to equal or surpass that of the teeth being replaced with pontics" [1].
The materials used for the bridge include gold, porcelain fused to metal, or in the correct situation porcelain alone. The amount and type of reduction done to the abutment teeth varies slightly with the different materials used. The recipient of such a bridge must be careful to clean well under this prosthesis. When restoring an edentulous space with a fixed partial denture that will crown the teeth adjacent to the space and bridge the gap with a pontic, or "dummy tooth", the restoration is referred to as a bridge. Besides all of the preceding information that concerns single-unit crowns, bridges possess a few additional considerations when it comes to case selection and treatment planning, tooth preparation and restoration fabrication.
Contents [hide]
1 Case selection and treatment planning 2 Tooth preparation 3 Restoration fabrication 4 See also 5 References
[edit] Case selection and treatment planning When a single tooth requires a crown, the prosthetic crown will in most instances rest upon whatever tooth structure was originally supporting the crown of the natural tooth. However, when restoring an edentulous area with a bridge, the bridge is almost always restoring more teeth than there are root structures to support. For instance, in the photo at right, the 5-unit bridge will only be supported on three abutment teeth. In order to determine whether or not the abutment teeth will be able to support a bridge without a virtually guaranteed failure due to lack of proper support from the remaining root structures, the dentist should employ Ante's rule, which states that the roots of the remaining abutment teeth must possess a combined total surface area in three dimensions more than that of the missing root structures that are to be restored with the bridge. When the situation yields a poor prognosis for proper support, double abutments may be required to properly conform to Ante's rule. When a posterior tooth that is intended to become an abutment tooth already possesses an intracoronal restoration, it might be in order to make that bridge abutment into an inlay or an onlay, instead of a crown. However, this may concentrate the torque of the masticatory forces onto a less enveloping restoration, thus making the bridge more prone to failure. In some situations, a cantilever bridge may be constructed to restore an edentulous area that only has adequate teeth for abutments either mesially or distally. This must also conform to Ante's rule but, because there are only abutments on one side, a modification to the rule must be applied, and these bridges possess double abutments in the majority of cases, and the occlusal surface area of the pontic is generally decreased by making the pontic smaller than the original tooth.
A semi-precision attachment between teeth #3 and #4, with the female on #4. Note the lingual buttons extending, in the photo, upward on #2 (on the left) and downward on #4. These are used to grasp the crowns with a hemostat and make them easier to handle. They can also be used to aid in removal of the crown in case there is an excessive amount of retention during the try-in. They are cut off prior to final cementation.
[edit] Tooth preparation As with preparations for single-unit crowns, the preparations for multiple-unit bridges must also possess proper taper to facilitate the insertion of the prosthesis onto the teeth. However, there is an added dimension when it comes to bridges, because the bridge must be able to fit onto the abutment teeth simultaneously. Thus, the taper of the abutment teeth must match in order to properly seat the bridge; this is known as requiring parallelism among the abutments. When this is not possible, due to severe tipping of one of more of the abutments, for example, an attachment may be useful, as in the photo at right, so that one of the abutments may be cemented first, and the other abutment, attached to the pontic, can then be inserted, with an arm on the pontic slipping into a groove on the cemented crown to achieve a span across the edentulous area.
The proximal surfaces of the pre-solder index abutment and pontic, showing labprocessed grooves for added retention of the GC pattern resin.
The abument and pontic joined with GC pattern resin in a solder index and reinforced with an old bur (lying horizontally across the occlusal surface of the copings).
[edit] Restoration fabrication As with single-unit crowns, bridges may be fabricated using the lost-wax technique if the restoration is to be either a multiple-unit FGC or PFM. As mentioned in the paragraph above, there are special considerations when preparing for a multiple-unit restoration in that the relationship between the two or more abutments must be maintained in the restoration; that is, there must be proper parallelism in order for the bridge to be able to seat properly on the margins. Sometimes, the bridge does not seat, but the dentist is unsure whether or not it is only because the spacial relationship of the two or more abutments is incorrect, or whether the abutments do not actually fit the preparations. The only way to determine this would be to section the bridge and try in each abutment by itself. If they all fit individually, it must have simply been that the spacial relationship was incorrect, and the abutment that was sectioned from the pontic must now be reattached to the pontic according to the newly confirmed spacial relationship. This is accomplished with a solder index. The proximal surfaces of the sectioned units (that is, the adjacent surfaces of the metal at the cut) are roughened and the relationship is preserved with a material that will hold onto both sides, such as GC pattern resin. With the two bridge abutments individually seated on their prepared abutment teeth, the resin is applied to the location of the sectioning to reestablish a proper spacial relationship between the two pieces. This can then be sent to the lab where the two pieces will be soldered and returned for another try-in or final cementation.
[edit] See also
Dental restoration Fixed prosthodontics
[edit] References 1. ^ Shillingburg, Herbert T. Shillingburg. Fundamentals of Fixed Prosthodontics, 3rd Edition. Quintessence, 1997. 7.5
Before Dental Bridge
After Dental Bridge
Teeth around the space are prepared.
The bridge is mounted and adjusted for fit and comfort.
The bridge is cemented into position
Full porcelain fused to metal
Full cast gold crown.
Q. When and where were the first dental bridges made? From N.S. Gill, Your Guide to Ancient / Classical History. FREE Newsletter. Sign Up Now!
A. According to Marshall Joseph Becker in "The Valsiarosa Gold Dental Appliance," from ETRUSCAN STUDIES: JOURNAL OF THE ETRUSCAN FOUNDATION. VOLUME 6, 1999, the first use of dental appliances or bridges comes from the Etruscans, whose masterful goldworkers made gold dental bridges for women so they could show off their wealth. Becker says the Etruscans were the first to use dental bridges and retention bands over 2600 years ago. Some Etruscan women would have their incisors removed (a process called "tooth ablation" or evulsion) so they could be fitted with the gold prosthetics
What Are the Benefits of Dental Bridges?
Restore your smile Restore your ability to properly chew and speak Maintain the shape of your face Distribute the forces in your bite properly by replacing missing teeth Prevent remaining teeth from drifting out of position
Bridges:
What Types of Dental Bridges Are Available? There are three main types of bridges:
Traditional bridges involve creating a crown for the tooth or implant on either side of the missing tooth, with a pontic in between. Traditional bridges are the most common type of bridge and are made of either porcelain fused to metal or ceramics. Cantilever bridges are used when there are adjacent teeth on only one side of the missing tooth or teeth. Maryland bonded bridges (also called a resin-bonded bridge or a Maryland bridge) are made of plastic teeth and gums supported by a metal framework. Metal wings on each side of the bridge are bonded to your existing teeth.
What Is the Process for Obtaining a Dental Bridge? During the first visit, the abutment teeth are prepared. Preparation involves recontouring these teeth by removing a portion of enamel to allow room for a crown to be placed over them. Next, impressions of your teeth are made, which serve as a model from which the bridge, pontic, and crowns will be made by a dental laboratory. Your dentist will make a temporary bridge for you to wear to protect the exposed teeth and gums while your bridge is being made. During the second visit, your temporary bridge will be removed and the new permanent bridge will be checked and adjusted, as necessary, to achieve a proper fit. Multiple visits may be required to check the fit of the metal framework and bite. This is dependent on each individual's case. If the dental bridge is a fixed (permanent) bridge, your dentist may temporarily cement it in place for a couple of weeks to make sure it is fitting properly. After a couple weeks, the bridge is permanently cemented into place.
How Much Do Dental Bridges Cost?
The cost of dental bridges varies depending on the type of bridge selected and the area of the country in which the procedure is performed. Dental insurance will typically pay a percentage of the fee depending on the individual dental plan.
How Long Do Dental Bridges Last? Dental bridges can last 5 to 15 years and even longer. With good oral hygiene and regular prophylaxis, it is not unusual for the life span of a fixed bridge to be over 10 years.
Will It Be Difficult to Eat With a Dental Bridge? Replacing missing teeth should actually make eating easier. Until you become accustomed to the bridge, eat soft foods that have been cut into small pieces.
Will the Dental Bridge Change How I Speak? It can be difficult to speak clearly when teeth are missing in the front or anterior areas. Wearing a dental bridge with the anterior teeth in their proper relationship will help you speak properly.
How Do I Care for My Bridges? It is important to keep your remaining teeth healthy and strong as the success of the bridge (depending on the type selected) depends on the solid foundation offered by the surrounding teeth. Brushing twice a day and flossing daily helps prevent tooth decay and gum disease that can lead to tooth loss. Your dentist or dental hygienist can demonstrate how to properly brush and floss your teeth. Keeping a regular cleaning schedule will help diagnose problems at an early stage when treatment has a better prognosis. Selecting a balanced diet for proper nutrition is also important.
In dentistry, crown and bridge (Restorative Dentistry) refers to the restoration of natural teeth that have been damaged, decayed or lost. Once your dentist has examined your teeth and has evaluated your dental and medical history, he/she will be ready to provide a diagnosis, and treatment options. A crown may be constructed to restore an individual damaged tooth back to it's original form and function, while a bridge may be utilized to replace one or more teeth. These restorations are cemented onto the teeth and are referred to as "fixed" dentistry as opposed to a restoration of missing teeth with a removable appliance or partial denture.. A crown is fabricated using an indirect procedure. The tooth is modified and prepared by using special insturments and a copy of the tooth preparation is made is made by taking an impression The crown is then "permanently" cemented onto your tooth preparation. A fixed bridge refers to a prosthesis that will span the area of a missing tooth, known as a pontic. The procedure involves a local anesthetic and the preparation of two or more abutment teeth. Once this has been accomplished, an impression is made and sent to the dental laboratory for fabrication of your new tooth. This procedure will take five to ten days and will encompass two to four appointments. (A crown procedure takes two to three office visits.) The following is a brief description of how a crown will be made:
1. Upon arriving to the laboratory, your impression is cleaned (sterilized). 2. Powdered stone is mixed with water and poured into your impression, which once set hardens into a stone cast of your
3.
4. 5.
6.
7.
8.
upper/lower teeth. The casts are connected on an apparatus called an articulator that mimics your jaw motion. Using a bunsen burner, the dental technician melts wax and applies it to the prepped tooth stump. This process is called fabricating a coping or framework (if a bridge) which supports the tooth colored material called porcelain. The wax coping is invested in high heat stone, burned out in an oven and cast into metal. This is a similar procedure that a jeweler might use when making a ring. After the metal has been cast, the technician will use a variety of high and slow speed drills to contour the metal. The metal is then ready to be prepared to receive porcelain. Since porcelain is very clear, the silver gray colored metal needs to be masked out. This procedure is referred to as opaquing, or masking out the metal. Porcelain powder is mixed with water and applied by brush to the opaqued metal understucture. By using the casts that have been joined, the dental technician will be able to reproduce a lifelike copy of the original tooth. The porcelain build-up is fired in a ceramic oven at 1800 degrees. Using various diamond and carbide drills, the final contours are established. The porcelain-fused-to-metal restoration is then colored to the patients specific shade and glazed to render an enamel-like finish.
After the final fabrication phases have been completed, the finished crown is returned to your dentist to be checked for correct fit. Once all final adjustments have been made, your restoration is permanently cemented.
What is a Dental Bridge?
What is a dental bridge? A dental bridge is a false tooth, known as a pontic, which is fused between two porcelain crowns to fill in the area left by a missing tooth. The two crowns holding
it in place that are attached onto your teeth on each side of the false tooth. This is known as a fixed bridge. This procedure is used to replace one or more missing teeth. Fixed bridges cannot be taken out of your mouth as you might do with removable partial dentures. In areas of your mouth that are under less stress, such as your front teeth, a cantilever bridge may be used. Cantilever bridges are used when there are teeth on only one side of the open space. Bridges can reduce your risk of gum disease, help correct some bite issues and even improve your speech. Bridges require your commitment to serious oral hygiene, but will last as many ten years or more.
Introduction: Dental Bridges This section of About Cosmetic Dentistry will help you to learn more about dental bridges. You'll learn how the procedure is performed, what dental bridges cost and you'll have the chance to see photos taken before and after the dental bridge installation. In addition, you will be able to read personal experiences from patients and discuss bridges with other patients and potential patients. You can use the outline below to jump to a specific point in the dental bridge section, or you can use the "Continue" arrow button below to begin reading.
Who is a candidate for dental bridges? If you have missing teeth and have good oral hygiene practices, you should discuss this procedure with your cosmetic dentist. If spaces are left unfilled, they may cause the surrounding teeth to drift out of position. Additionally, spaces from missing teeth can cause your other teeth and your gums to become far more susceptible to tooth decay and gum disease.
Overview of dental bridge procedure If you a space from a missing tooth, a bridge will be custom made to fill in the space with a false tooth. The false tooth is attached by the bridge to the two other teeth around the space - bridging them together.
How is dental bridge accomplished? Your cosmetic dentist will prepare your teeth on either side of the space for the false tooth. You will be given a mild anesthetic to numb the area, and the cosmetic dentist will remove the an area of each abutment (teeth on either side of the space) to accommodate for the thickness of the crown. When these teeth already have fillings, part of the filling may be left in place to help as a foundation for the crown. The dentist will then make an impression, which will serve as the model from which the bridge, false tooth and crowns will be made by a dental laboratory. A temporary bridge will be placed for you to wear while your bridge is being made until your next visit. This temporary bridge will serve to protect your teeth and gums. Your cosmetic dentist may have you use a Flipper appliance. A Flipper is a false tooth to temporarily take the place of a missing tooth before the permanent bridge is placed. A Flipper can
be attached via either a wire or a plastic piece that fits in the roof of your mouth. Flippers are meant to be a temporary solution while awaiting the permanent bridge. On your second appointment, the temporary bridge will be removed. Your new permanent bridge will be fitted and checked and adjusted for any bite discrepan
Types of Dental Bridge Procedures There are three types of dental bridges: Traditional Fixed Bridge A dental bridge is a false tooth, known as a potic, which is fused between two porcelain crowns to fill in the area left by a missing tooth. There two crowns holding it in place that are attached onto your teeth on each side of the false tooth. This is known as a fixed bridge. This procedure is used to replace one or more missing teeth. Fixed bridges cannot be taken out of your mouth as you might do with removable partial dentures. Resin Bonded Bridges The resin bonded is primarily used for your front teeth. Less expensive, this bridge is best used when the abutment teeth are healthy and don't have large fillings. The false tooth is fused to metal bands that are bonded to the abutment teeth with a resin which is hidden from view. This type of bridge reduces the amount of preparation on the adjacent teeth. Cantilever Bridges In areas of your mouth that are under less stress, such as your front teeth, a cantilever bridge may be used. Cantilever bridges are used when there are teeth on only one side of the open space. This procedure involves anchoring the false tooth to one side over one or more natural and adjacent teeth. cies. Your new bridge will then be cemented to your teeth.
Dental Bridges Costs How much do dental bridges cost? The average cost of a single fixed bridge depends on many factors, from which region you're in to how many and which type of bridges are needed. Typically dental bridge cost ranges from $500-900 per tooth. Dental insurance typically pays for about half of the cost of the bridge. This is a cost per tooth in the bridge, and doesn't include the costs for any anchoring crowns on either side of the bridge. In the case of a Maryland type bridge, costs range from $250. to $550. for each attaching wing and $600. to $1200. for each false tooth or pontic.
Advantages & Disadvantages of Dental Bridges Pros and Cons of a Dental Bridge Advantages of dental bridges: Bridges are natural in appearance, and usually require only two visits to your dentist. If you maintain good oral hygiene, your fixed bridge should last as many as ten years or more. Disadvantages of having a dental bridge: It is common for your teeth to be mildly sensitive to extreme temperatures for a few weeks after the treatment. The build up of bacteria formed from food acids on your teeth and gums can become infected if proper oral hygiene is not followed
Personal Stories: Dental Bridges I turned forty last year, and have enjoyed playing softball since I was a kid. One drawback to the sport is the occasional hit from a ball. Several years ago I lost two teeth from such a mishap, and had worn a partial. I found the partial to be a bit embarrassing at my age, but my dentist had discussed no other option with me. Frustrated that I was stuck with this thing for the rest of my life, I started doing some research, which was hard to come by. And when I did discover information on alternatives, I didn't understand it. As many of you who are now visiting this site already know, such matters are not easy to speak with family or friends about. After visiting this site, I soon understood that I had a few options to remedy the spaces in my mouth. I located a Certified Cosmetic Dentist and discussed these options, including the fact that I wanted to avoid the more costly procedures, such as implants. His immediate solution was placing two bridges. It only took two appointments over two weeks, and I had a terrific smile again. Chris, thanks for the site! Gerry, New Hampshire
Determining the color for your dental bridge? When considering dental bridges a common question is how white the dental bridge should be. Usually, the answer is to whiten your natural teeth to either the level of whiteness you want or to the brightest they can be. Your cosmetic dentist will then have the dental bridge made to that color. Teeth are of course not monochromatic, so typically more than one color is used to create a very natural look. This color variation is critical in avoiding fake or artificial looking teeth. It is the internal contrast of colors that help create vitality. The internal play of light on the porcelain in the restoration helps to create this vitality. Surface texture is also very important, and helps to break up light reflections and make the dental bridge look more natural. Depending on the type of dental bridge you're considering, it's important that the crowns anchoring the bridge match both the dental bridge and the color of your natural teeth. There is no one standard system in the dental field to measure and determine tooth color. The most often heard about, however, is the Vita shade guide. This guide divides tooth color into four basic shade ranges: A (reddish brown) B (reddish yellow) C (gray) D (reddish gray). In the A range there are five levels of darkness. Ranges B, C and D, each have four levels.
Not all of your teeth are the same natural color. Usually your eye teeth tend to be darker than the others, your front teeth are typically the whitest, and molars tend to be a shade between the two. The goal for everyone is to achieve their individual optimum whiteness while still looking natural. Most dentists will show you a shade chart (like the above mentioned Vita Shade Guide) for you to pick from. Keep in mind, with a good cosmetic dentist this is merely a starting point. Other considerations when determining the color of dental bridges for each patient are your complexion, hair color, the color of your natural teeth and even your eye color.
A dental bridge, otherwise known as a fixed partial denture, is a prosthesis used to replace missing teeth and is not removable by the patient. A prosthesis that is removable by the patient is called a removable partial denture. A dental bridge is fabricated by reducing the teeth on either side of the missing tooth or teeth by a preparation pattern determined by the location of the teeth and by the material from which the bridge is fabricated. In other words the abutment teeth are reduced in size to accommodate the material to be used to restore the size and shape of the original teeth in a correct alignment and contact with the opposing teeth. The dimensions of the bridge are defined by Ante's Law: "The root surface area of the abutment teeth has to equal or surpass that of the teeth being replaced with pontics" [1].
The materials used for the bridge include gold, porcelain fused to metal, or in the correct situation porcelain alone. The amount and type of reduction done to the abutment teeth varies slightly with the different materials used. The recipient of such a bridge must be careful to clean well under this prosthesis. When restoring an edentulous space with a fixed partial denture that will crown the teeth adjacent to the space and bridge the gap with a pontic, or "dummy tooth", the restoration is referred to as a bridge. Besides all of the preceding information that concerns single-unit crowns, bridges possess a few additional considerations when it comes to case selection and treatment planning, tooth preparation and restoration fabrication.
Contents [hide]
1 Case selection and treatment planning 2 Tooth preparation 3 Restoration fabrication 4 See also 5 References
[edit] Case selection and treatment planning When a single tooth requires a crown, the prosthetic crown will in most instances rest upon whatever tooth structure was originally supporting the crown of the natural tooth. However, when restoring an edentulous area with a bridge, the bridge is almost always restoring more teeth than there are root structures to support. For instance, in the photo at right, the 5-unit bridge will only be supported on three abutment teeth. In order to determine whether or not the abutment teeth will be able to support a bridge without a virtually guaranteed failure due to lack of proper support from the remaining root structures, the dentist should employ Ante's rule, which states that the roots of the remaining abutment teeth must possess a combined total surface area in three dimensions more than that of the missing root structures that are to be restored with the bridge. When the situation yields a poor prognosis for proper support, double abutments may be required to properly conform to Ante's rule. When a posterior tooth that is intended to become an abutment tooth already possesses an intracoronal restoration, it might be in order to make that bridge abutment into an inlay or an onlay, instead of a crown. However, this may concentrate the torque of the masticatory forces onto a less enveloping restoration, thus making the bridge more prone to failure. In some situations, a cantilever bridge may be constructed to restore an edentulous area that only has adequate teeth for abutments either mesially or distally. This must also conform to Ante's rule but, because there are only abutments on one side, a modification to the rule must be applied, and these bridges possess double abutments in the majority of cases, and the occlusal surface area of the pontic is generally decreased by making the pontic smaller than the original tooth.
A semi-precision attachment between teeth #3 and #4, with the female on #4. Note the lingual buttons extending, in the photo, upward on #2 (on the left) and downward on #4. These are used to grasp the crowns with a hemostat and make them easier to handle. They can also be used to aid in removal of the crown in case there is an excessive amount of retention during the try-in. They are cut off prior to final cementation.
[edit] Tooth preparation As with preparations for single-unit crowns, the preparations for multiple-unit bridges must also possess proper taper to facilitate the insertion of the prosthesis onto the teeth. However, there is an added dimension when it comes to bridges, because the bridge must be able to fit onto the abutment teeth simultaneously. Thus, the taper of the abutment teeth must match in order to properly seat the bridge; this is known as requiring parallelism among the abutments. When this is not possible, due to severe tipping of one of more of the abutments, for example, an attachment may be useful, as in the photo at right, so that one of the abutments may be cemented first, and the other abutment, attached to the pontic, can then be inserted, with an arm on the pontic slipping into a groove on the cemented crown to achieve a span across the edentulous area.
The proximal surfaces of the pre-solder index abutment and pontic, showing labprocessed grooves for added retention of the GC pattern resin.
The abument and pontic joined with GC pattern resin in a solder index and reinforced with an old bur (lying horizontally across the occlusal surface of the copings).
[edit] Restoration fabrication As with single-unit crowns, bridges may be fabricated using the lost-wax technique if the restoration is to be either a multiple-unit FGC or PFM. As mentioned in the paragraph above, there are special considerations when preparing for a multiple-unit restoration in that the relationship between the two or more abutments must be maintained in the restoration; that is, there must be proper parallelism in order for the bridge to be able to seat properly on the margins. Sometimes, the bridge does not seat, but the dentist is unsure whether or not it is only because the spacial relationship of the two or more abutments is incorrect, or whether the abutments do not actually fit the preparations. The only way to determine this would be to section the bridge and try in each abutment by itself. If they all fit individually, it must have simply been that the spacial relationship was incorrect, and the abutment that was sectioned from the pontic must now be reattached to the pontic according to the newly confirmed spacial relationship. This is accomplished with a solder index. The proximal surfaces of the sectioned units (that is, the adjacent surfaces of the metal at the cut) are roughened and the relationship is preserved with a material that will hold onto both sides, such as GC pattern resin. With the two bridge abutments individually seated on their prepared abutment teeth, the resin is applied to the location of the sectioning to reestablish a proper spacial relationship between the two pieces. This can then be sent to the lab where the two pieces will be soldered and returned for another try-in or final cementation.
[edit] See also
Dental restoration Fixed prosthodontics
[edit] References 1. ^ Shillingburg, Herbert T. Shillingburg. Fundamentals of Fixed Prosthodontics, 3rd Edition. Quintessence, 1997. 7.5
Before Dental Bridge
After Dental Bridge
Teeth around the space are prepared.
The bridge is mounted and adjusted for fit and comfort.
The bridge is cemented into position
Full porcelain fused to metal
Full cast gold crown.
Q. When and where were the first dental bridges made? From N.S. Gill, Your Guide to Ancient / Classical History. FREE Newsletter. Sign Up Now!
A. According to Marshall Joseph Becker in "The Valsiarosa Gold Dental Appliance," from ETRUSCAN STUDIES: JOURNAL OF THE ETRUSCAN FOUNDATION. VOLUME 6, 1999, the first use of dental appliances or bridges comes from the Etruscans, whose masterful goldworkers made gold dental bridges for women so they could show off their wealth. Becker says the Etruscans were the first to use dental bridges and retention bands over 2600 years ago. Some Etruscan women would have their incisors removed (a process called "tooth ablation" or evulsion) so they could be fitted with the gold prosthetics
