Fixed bridgework

Before the dramatic improvement of implants, fixed bridgework was the only option available to patients who wanted something that looked natural and was not removable. Different from a removable partial denture, a fixed bridge has no hooks, feels like your natural teeth, and is cemented in place. Fixed bridgework can be used to replace one to three or four teeth depending on certain circumstances. The technique involves using the teeth adjacent to the ones missing to support the replacement. The most common way to use the adjacent teeth as " anchors" is to place crowns on them (see section on crowns for more detail). These crowns have the replacement teeth connected to them, which completes the formation of the bridge (see illustration). Sometimes if the tooth to be replaced is small, all that is necessary is the use of one tooth as support instead of two. The procedure usually involves two appointments. During the first one the dentist will "prepare" your teeth to be capped, take a mold and send it to the laboratory. A temporary bridge is usually placed in the interim. On the second appointment, he/she will fit the bridge, do any necessary adjustments, and cement it with permanent cement. After a short period of adjustment, your bridge should feel like part of your mouth, and you will be able to use it almost as if it was your lost natural tooth. Similar to crowns, bridges are usually made out of gold or a metal substrate covered with porcelain. Only very recently have there been attempts at making bridges with no metal at all. This of course is in an attempt to provide the replacement of your teeth with a maximum esthetic look. This has been accomplished by substituting the metal substrate with a material similar to fiberglass in strength. Porcelain is then applied over this substrate to give an almost 100% natural look. Due to the strong forces placed on bridges during chewing, these bridges should only be used in special areas like upper front tooth replacement to avoid possible fracture. Consult with you dentist to see if this is a good option for you.

FAQ.

Is there a lot of food that is going to get stuck under my bridge, and how can I clean it out?

Due to the precise and custom fit of the bridge to your mouth, there shouldn't be a lot of food that gets underneath it. Having said that, it is extremely important for you to clean the usual plaque that will accumulate under the bridge and around the teeth that support the bridge. Unfortunately this can only be accomplished by the use of a special floss or floss threader. This will undoubtedly require a little more effort on your part but will get easier with time. If this is not done on a regular basis, you will assure the loss of your bridge to decay or gum disease down the road.

The thought of grinding down two natural teeth to replace to replace other teeth does not appeal to me. Isn't there any other way?

Great question. Over the years there have been many attempts to do fixed bridgework without having to grind down teeth, with varying success. In the mid 1980s, a technique called the " Maryland bridge" was developed, which essentially involved minimal to no tooth removal. It was based on making thin metal connections that would wrap around the inside of the adjacent teeth and then bonded in a very special way. Depending on the location and your biting force, these bridges had varying degrees of success. Some held out for many years before coming off. For many the biting force was just too much, and the bond ended up breaking in a matter of months. Today a similar type of connection is fabricated out of porcelain for maximum esthetics and bonded in place similar to a Maryland bridge. You should consult with your dentist to see if you are a candidate for this kind of a bridge. The best option available to you today would be the use of an implant(s) to replace your teeth. This would depend on whether you are a good candidate or not (see section on implants). With this option there is literally no touching of your adjacent teeth. Again, you would need to consult with your dentist /surgeon concerning this option. A major factor concerning this issue is the condition of the adjacent teeth. If these teeth already have very large fillings, they are probably good candidates for crowns anyway. If that's the case you might want to opt for a traditional bridge, which would take care of many birds with one stone.

I recently lost a back tooth, and even though my dentist says I need a bridge, I seem to be able to eat everything. Is it really necessary?

The answer to that question is unfortunately a yes. You see, your teeth are like a series of "dominoes". If one is lost the effect is felt by all the surrounding ones. When a space is created due to the loss of, say, a lower tooth, then the tooth on top of it will lose its support and will begin to drift down into the space created. Similarly the lower tooth behind the space will tip forward into the space, and the front tooth backwards. This may take several years. Not only will these unwanted movements be esthetically unpleasant, but the bite will become severely compromised, with possible joint problems and gum disease. It is best to have any lost tooth replaced as soon as possible.