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A dental bridge replaces one or two missing teeth with false teeth joined to crowns on the teeth either side of the gap. It is fixed in place, made in about two weeks, and involves no surgery. Implants are now the usual replacement for a single tooth, but a bridge is often the better choice when the bone is poor, when an implant would need grafting or a sinus lift, or when a patient does not want surgery. At Vizcaya Dental Arts all bridges are zirconia, and every one is designed with room to clean underneath.
When a bridge makes more sense than an implant
When the bone and gum are good and placing an implant is straightforward, the implant is often the ideal choice for a single missing tooth, because it leaves the neighbors alone. But many gaps are not straightforward. If the bone has shrunk, an implant may need extensive grafting or a sinus lift first: more surgery, more time, more cost. Patients who are older, or who would rather not have surgery, may reasonably prefer a bridge, and we have made bridges for patients who were told elsewhere that an implant was essentially impossible or would cost a fortune to prepare for.
Two practical points:
- A three-unit bridge and a single implant with its crown are often similar in cost, before any grafting is added to the implant side.
- A bridge is finished in about two weeks, where implant treatment takes four months to a year.
A removable partial is the third option; it costs less and suits some situations, but most people prefer something that stays in.
Design
We prefer bridges supported by a tooth at each end, and we usually keep them to four units in total: two supporting crowns and two false teeth at most. Longer spans are possible but less predictable, and we recommend them only when there is no better option. Cantilever bridges, which hang a false tooth off one side, are rarely a good idea because the unsupported tooth cannot really be used for chewing, though in a suitable bite they can be done.
What a bridge needs:
- Supporting teeth that are healthy, with sound gums and enough root to carry the load, which we judge by the ratio of the tooth above the bone to the root within it.
- A bite that allows it.
- Your willingness to clean under it, because a bridge cannot be flossed the ordinary way.
- A night guard if you clench or grind, as for any dental work.
For a missing front tooth, a bonded bridge, often called a Maryland bridge, is a good option in selected cases: a false tooth bonded to the back of the neighboring teeth with minimal preparation. We use them for front teeth, particularly as an interim replacement while waiting for an implant. We do not use bonded bridges for back teeth, where they are not strong enough to chew on.
Materials
All of our conventional bridges are zirconia. For back teeth, where appearance matters less and strength matters more, we use monolithic zirconia, a single block of dense ceramic. For front teeth we use a zirconia framework for strength with feldspathic porcelain layered over the visible surfaces, which gives a bridge the translucency and lifelike quality of natural teeth.
Two visits, sometimes three
- Step 1 of 3 Preparation and impression
With the area numbed, the supporting teeth are shaped for their crowns and an impression is taken for the laboratory. For smaller bridges a temporary bridge is made in the office the same day.
- Step 2 of 3 Laboratory work
About two weeks. For a larger or more complex bridge the temporary is made in advance by the laboratory, which adds a preliminary impression visit at the start.
- Step 3 of 3 Fitting
The bridge is tried in and checked: closed margins, firm contacts, comfortable bite, natural appearance, and room underneath for cleaning. Then it is cemented.
This is the sequence for a simple bridge. A comprehensive rebuild of a whole arch is a different undertaking with many more visits, described on our full-mouth rehabilitation page.
Living with the temporary
The temporary bridge is made of a durable acrylic and feels much like the final one. It is cemented with a weaker cement on purpose, so it can be removed easily at the fitting visit, which is why we ask you to avoid sticky and hard foods while it is in. Some mild gum tenderness and sensitivity to cold around the prepared teeth is normal for a few days and settles. If the temporary loosens or comes off, call us; it usually takes a few minutes to recement, and the prepared teeth should not be left uncovered.
Appearance
For a bridge at the back of the mouth, strength is what counts, and monolithic zirconia is hard to tell from a natural tooth at conversational distance. For a front tooth the standard is higher, and a well-made bridge can look at least as good as an implant and sometimes better: the false tooth is shaped by the ceramist to emerge from the gum like a natural one, the layered porcelain carries the translucency of the neighbors, and there is no implant position or thin gum to work around. The gum under the false tooth is shaped during the temporary phase so that the final bridge sits against it naturally.
Bridges on implants
Where several teeth in a row are missing and the span is too long for a tooth-supported bridge, two or three implants can carry a bridge instead, with no natural teeth involved at all. That is an implant treatment rather than a conventional bridge, and it is described on our implants page. The comparison between the two routes is part of the same planning conversation.
Cleaning under a bridge
A bridge is a little harder to clean than separate teeth because floss cannot pass between the connected units. Every bridge we make is designed with space beneath the false tooth for floss to pass and for a brush to reach every edge; good bridges do not trap food, and the margins are sealed so nothing packs underneath. We recommend two tools:
- Super Floss, which has a stiff end to thread under the bridge and a fuzzy section that cleans the underside.
- A Waterpik, which flushes the area.
A minute a day with either is what keeps the supporting teeth healthy.
Because the bridge is only as good as the teeth holding it, that cleaning decides how long it lasts. A bridge that has been poorly designed, with no room for hygiene or margins that do not fit, traps food and inflames the gum, and we have remade a number of those for patients who came to us with them.
Two misconceptions
- Some patients use the word bridge for a removable partial denture. They are different things: a bridge is fixed and cemented; a partial comes out. Our dentures page covers partials.
- The other misconception is that implants have made bridges unnecessary. Implants are often the first choice, but when placing one would be difficult or disproportionately expensive, a bridge gives excellent service and, for front teeth, often an appearance that is at least as good.
Frequently asked questions
Bridge or implant?
When the bone is good and placement is straightforward, an implant is often ideal because it leaves the neighboring teeth alone. When an implant would need extensive grafting or sinus surgery, or you would rather not have surgery, a bridge is an excellent alternative: similar in cost to a single implant before any grafting, and ready in about two weeks instead of four months to a year.
Does a bridge damage the supporting teeth?
The supporting teeth are shaped for crowns, which removes some enamel; that is the trade-off. In return they get full-coverage crowns and the bridge is fixed in place. We only use teeth that are healthy and well rooted enough to carry the load, and a well-made bridge protects them rather than straining them.
How long does a bridge last?
A carefully made bridge can give many years of service, and we have made them for members of our own family. Its life is really the life of the supporting teeth: keep them free of decay and gum disease by cleaning under the bridge daily, and the bridge keeps going.
How do I floss under it?
With Super Floss, a floss with a stiff threader and a fuzzy section, or a Waterpik. Every bridge we make is designed with room underneath for floss to pass and for a brush to reach the edges. If food packs under a bridge, something is wrong with its design, not with you.
Is a bridge removable?
No. A fixed bridge is cemented to the supporting teeth and stays in. Some people use the word bridge for a removable partial denture, which is a different thing; our dentures page covers those.
What if one of the supporting teeth fails later?
Then the bridge usually has to be remade, sometimes with an implant replacing the failed tooth. That is why we are strict about which teeth can support a bridge, and why cleaning under it matters: the bridge is only as good as the teeth holding it.
Sources
Professional guidelines and peer-reviewed reviews this page draws on.
- Pjetursson BE, Bragger U, Lang NP, Zwahlen M. Comparison of survival and complication rates of tooth-supported fixed dental prostheses and implant-supported fixed dental prostheses and single crowns. Clinical Oral Implants Research. 2007;18(Suppl 3):97-113. DOI
