12. Methods To Replace Missing Teeth — Bridges

In the last topic, the advan­tages and dis­ad­van­tages of replac­ing miss­ing teeth by remove­able par­tial or full den­tures was dis­cussed. In this topic, the advan­tages and dis­ad­van­tages of replac­ing miss­ing teeth by fixed bridges and their vari­a­tions will be dis­cussed. First a very brief dis­cus­sion will fol­low for those peo­ple who are not famil­iar with bridges.

A bridge involves prepar­ing teeth to a cer­tain form so that the involved teeth can be cov­ered with a retainer and one or more false teeth are joined to the retain­ers. The entire bridge con­sist­ing of the retain­ers and false teeth are then cemented over the pre­pared teeth and the bridge is not nor­mally removed. In other words, the bridge is “fixed or non-removeable”. Vari­a­tions in bridges involve vari­a­tions in the design of the retainer(s) used to main­tain the bridge on the sup­port­ing teeth. Also implants can be used instead of nat­ural teeth to sup­port a bridge.

One advan­tage of a bridge is that it is not remove­able, which to many peo­ple is a sig­nif­i­cant advan­tage over a remove­able par­tial or full den­ture. Also the bridge has the poten­tial to pro­vide a bet­ter cos­metic result than a remove­able par­tial or full den­ture. In addi­tion, another advan­tage is that peo­ple adapt to fixed bridges very eas­ily in most cases. Bridges can also feel or almost feel like nat­ural teeth in many cases, unlike a remove­able par­tial or full den­ture. Also adjust­ment appoint­ments are min­i­mal for a fixed bridge com­pared to a remove­able par­tial or full den­ture. Even though bridges gen­er­ally cost more in the short term than remove­able par­tial or full den­tures, it is for these rea­sons that before implants became widely used, fixed bridges were a very pop­u­lar option to replace miss­ing teeth.

How­ever there are sig­nif­i­cant dis­ad­van­tages asso­ci­ated with the fixed bridge option to replace miss­ing teeth. One dis­ad­van­tage is that teeth must be pre­pared or reduced to a cer­tain form to accept the retainer of the bridge and sup­port the bridge. The rea­son teeth must be reduced is to cre­ate enough space between the oppos­ing teeth and the pre­pared teeth so that there is enough thick­ness for the mate­ri­als of the bridge (retainer and false tooth ) so that when the bridge is cemented over the pre­pared teeth, it fits within the bite of a per­son when that per­son nor­mally closes and moves the jaw side to side and back and for­ward. If the bridge did not fit within the bite, the per­son after a short period of time may expe­ri­ence tooth pain, jaw joint pain, loose­ness of teeth, frac­ture of the porce­lain of the bridge or any com­bi­na­tion of these unde­sire­able effects.

When teeth are pre­pared for the retain­ers of a bridge, there is a low pos­si­bil­ity of tooth sen­si­tiv­ity or even pulp (nerve ) necro­sis over a period of years, where a future root canal may be needed on one or more of the pre­pared sup­port­ing teeth. This low pos­si­bil­ity is a poten­tial dis­ad­van­tage. Also another poten­tial dis­ad­van­tage is that if the edges ( mar­gins ) of the bridge are below the gums, early detec­tion of caries that can develop under the bridge is very dif­fi­cult or may not be pos­si­ble. If the caries under the gums is on the cheek or tongue side of the sup­port­ing tooth, it will not appear on X rays unless it is very large. When such caries is even­tu­ally detected, it is large and often requires replace­ment of the bridge.

There­fore a sig­nif­i­cant dis­ad­van­tage is that if one of the sup­port­ing teeth of the bridge is lost for any rea­son such as bone loss ( peri­odon­tal dis­ease ), caries or frac­ture, the whole bridge must often be removed and replaced with an even larger bridge involv­ing prepa­ra­tion of more teeth. This dis­ad­van­tage is a sig­nif­i­cant advan­tage of using implants to replace miss­ing teeth, which will be dis­cussed in the next article.

In addi­tion, another dis­ad­van­tage of a fixed bridge is that it is harder to clean around a fixed bridge, espe­cially under the false tooth com­pared to the other options of replac­ing miss­ing teeth. Clean­ing around bridges requires a cer­tain amount of man­ual dex­ter­ity and com­mit­ment, which is lack­ing for some people.

In sum­mary, replac­ing miss­ing teeth with a fixed bridge is a good option that is usu­ally a bet­ter option for most peo­ple than a remov­able par­tial or full den­ture. How­ever the best option for replac­ing miss­ing teeth for most peo­ple are implants and the restora­tions placed over implants. In the next topic, details about the option of replac­ing miss­ing teeth by implants and their restora­tions will be discussed.