When a couple of vital, strong teeth are situated adjacently to the gap, the application of a bridge can be reasonable. In a situation like this, the healthy teeth to the left and the right of the gap serve as pillars and are responsible for the stable support of the dental bridge in the jaw. In order to ensure this function, the abutment teeth need to be ground, obviously interfering with the healthy tooth substance. Subsequently, they are covered with a custom-made anchor crown. These two crowns represent our bridge anchors which are firmly connected to the intermediate bridge. This bridge can consist of one or perhaps two pontic(s) covering the gap between the teeth and is thus constructed in a state of free-floating, devoid of a firm connection to the jaw; though hardly visible, it is supported solely by the two abutment teeth. Therefore, the dental bridge provides an esthetically consistent and functionally convincing tooth replacement enabling the patient to return to a full-fledged participation in everyday life.
Advantages and Disadvantages
Dental bridges have been a reliable form of care for many years now. They are subsidized by statutory health insurance providers and are thus attractive for price-conscious patients as well. The treatment is less complex compared to the application of an implant and can be conducted routinely in most practices. Dental bridges are safely fixed within the jaw and represent an esthetically consistent solution. One of their disadvantages, however, is the fact that the grinding of the neighboring teeth entails an attack on the healthy tooth substance. For this reason, there is a slight risk of a “grinding trauma“ and, subsequently, of a dying tooth nerve. The bridge creates a burden on the pillars which are not always able to withstand permanently. As sessile dentures, dental bridges are more difficult to clean than prostheses but nonetheless must be kept clean by their carriers so as to prevent any tooth decay from arising. Also, since the bridge tends to float freely, the bone underneath is not “trained“, frequently resulting in bone resorption. In contrast to an implant-supported solution, the dental bridge cannot be extended. Generally speaking, dental bridges tend to last for up to ten years before having to replace them.
During the first session, the neighboring teeth are sanded, provided that both pillars are exactly parallel. The tooth color for the final bridge is identified. A molding is performed and the teeth are protected from environmental influences by means of a temporary measure. During the second appointment, the patient tries the dental bridge on: It needs to be ensured that the bridge does not pinch or pull. Following this step, the dental bridge is completed in the lab and perhaps veneered. During the third session, the completed bridge is applied and inspected in terms of tight, yet relaxed fit. Its accuracy is then tested once again during a successive follow-up appointment.
All-Ceramic / Materials
Typically applied materials can be used in this context as well. Frequently solid metal alloys are used for constructing the bridge and are then veneered by means of ceramic. However, it is also possible to produce the entire bridge with metal (i.e. gold) or non-precious metals (NEM). For veneering, synthetic material can be applied; once again, there is no “one size fits all“ solution. Since health insurance providers only grant patients fixed subsidies, the choice of material is obviously also dependent on the price, but if possible, a full-ceramic bridge should be applied. Visually, ceramic is hardly distinguishable from a natural tooth, utterly stable and long-lasting, very well tolerated by patients suffering from allergies, and hardly temperature-sensitive. They are either manufactured completely out of ceramic or, alternatively, a combination of zirconium oxide and ceramic.
Adhesive Bridges / Maryland Bridges / Composite Bridges
The so-called adhesive bridges represent an unusual form of dental bridges as the neighboring teeth do not (hardly) need to be ground. Instead, the bridge is glued to the neighboring teeth by means of a special type of synthetic material. A well-known version of the adhesive bridge is the so-called Maryland bridge, which usually consists of a metal framework and is anchored to the rear side of the neighboring teeth by means of metal or ceramic wings. It can be produced with a ceramic veneer or, in the front tooth region, all-ceramic material. Conversely, the composite bridge consists of a stable glass fiber framework, which acts as a platform for multiple layers, i.e. *composites* typically resembling the existing teeth in terms of color due to their transparency. In earlier days, adhesive bridges were mostly applied with children and adolescents due to the fact that the jaw was still growing and the main priority was to prevent any damaging of the healthy tooth substance. Apart from that, its durability did not tend to be very long, resulting in frequent temporary use. However, modern adhesive bridges manufactured in accordance with the newest technical methods tend to provide a cost-effective and long-lasting alternative to the standard bridge.
The telescopic bridge represents an unusual type of bridge as it is not attributable to sessile dentures in the proper meaning of the word. Telescopic bridges are not firmly “cemented onto“ the pillars, but instead connected by means of telescopic crowns. This way, the bridge can be removed, thus enabling a more effective cleaning process. For this reason, telescopic bridges should actually be considered removable or combined dentures as they contain removable as well as sessile parts. Regarding its function and wearability, however, the telescopic bridge can definitely be compared to the sessile denture. It usually comes into play whenever it is foreseeable that (at least) one of the two pillars will not exhibit sufficient durability and is an esthetically high-profile, long-lasting, and bio-compatible solution representing an attractive alternative to the ceramic bridge, particularly for “teeth grinders“. However, due to its expensive manufacturing, it tends to be more costly than many other types of bridges. In general, the rise of implants has been instrumental in the telescopic bridge’s decreasing range of application.
Whenever particularly sessile and durable treatment is desired, an implant bridge should certainly be taken into consideration. This is also an attractive option when multiple teeth need to be bridged. Again, the neighboring teeth do not need to be ground: The implant-supported pillars carry the entire load. For this purpose, one implant can be placed to either of the two sides of the bridge. In case of larger gaps, a multi-element bridge resting on multiple implants can be applied.
The implant-supported denture holds tight and is hardly distinguishable from natural teeth for the patient as well as his surroundings. Depending on the choice of material, implants tend to be very bio-compatible.
Whenever an individual tooth at the end of a row of teeth needs to be replaced, the bridge can also only be replaced on one side. However, in order to accomplish this, the two adjacent teeth on that on one side of the gap need to serve as the pillars for the bridge as one individual tooth would not be capable of withstanding the emerging load for any real length of time. It is also important to note that merely single-tooth gaps can be tended to this way: Cantilever bridges do not come into question whenever the gap comprises two or more teeth. Due to the risk of tooth fractures, cantilever bridges tend to be applied rather seldomly.
Temporary Dental Bridge
The temporary dental bridge protects the exposed teeth while the final bridge is produced in the lab. It usually consists of synthetic material and is mounted by means of cement in order to be able to remove it as easily as possible. The temporary dental bridge also ensures that the neighboring teeth do not end up shifting into the cavity, the chewing function remains upright, and the patient is not compelled to accept any major visual disadvantages. Usually, the temporary dental bridge’s service life is very limited, although a long-term temporary solution may come into play in some cases. This can occur when the surrounding teeth need to be repaired, full oral health needs to be restored, or bone augmentation needs to be performed.