A dental bridge is a restorative procedure which replaces missing teeth with multiple crowns that are connected into one piece. These crowns are not individual units because they're joined together which does present a unique flossing challenge.
However, they've been the preferred alternative to partial dentures since they are a fixed prosthetic option and not a removable one. Although with the advancement in implant technology they've fallen slightly out of favor.
Nonetheless, they can be a less costly option for replacing multiple teeth so it would behoove you to learn what this procedure is all about.
Table of Contents:
What is a dental bridge?
Commonly called a "bridge" is a dental procedure which is a fixed restorative option to replace missing teeth. You can think of it as multiple crowns that are joined together but in essence, it consists of two different components in varying combinations.
The components of a bridge consists of two distinct entities:
Abutment. This is the tooth in your mouth which the bridge gets glued onto. There needs to be at least two abutments per prosthesis.
Pontic. This is the middle fake or dummy tooth. Dentists call it a dental pontic and it is essentially the missing tooth that this procedure is meant to replace.
The dental bridge can be as long as you need it to be but the minimum length would be at least 3 units. The only exception would be a maryland bridge which is a cantilevered two unit prosthetic.
How a bridge for dental purposes works is very similar to how a bridge used for transportation works.
The two ends of the dental version must be anchored by abutment teeth.
The two ends of the transportation version must also be anchored by abutments.
Without anchorage or abutments at the ends, the entire structure would be unstable. It would wobble whenever you chew on it.
What does it look like?
The bridge looks very similar to what dental crowns look like except they are joined together. Essentially they're multiple crowns that are connected together and they cannot be separated without cutting them apart with drilling.
The two images above show what a dental bridge looks like:
First photo shows how it looks when they're on teeth on a stone model.
The second photo shows what it looks like off the model. We also flipped it over so you can see what the underside of it looks like.
Types of dental bridges
There are four different types of bridges with the difference being how they anchor the pontic.
Traditional fixed bridge. This bridge has two abutment teeth, one on each end to anchor it. It is the most stable one out of the four different types of it. These are typically made of metal, porcelain fused to metal, or ceramic.
Cantilever bridge. This type of bridge only uses a single abutment(s) with one or both ends having a cantilever pontic.
Maryland dental bridge. A maryland bridge is only used for a missing front tooth, most frequently for a maxillary lateral incisor. What makes this procedure unique is that it does not require a full crown prep for the abutment teeth. Only the lingual or tongue side need to be conservatively prepped.
One-wing variation - bonded or cemented onto one abutment tooth.
Two-wing variation - bonded or cemented onto both adjacent abutment teeth.
Implant supported bridge. Essentially a traditional bridge except it uses dental implants as the abutment teeth.
Materials
It can be made from different types of materials, such as different types of ceramic.
Porcelain fused to metal. Traditionally, most of them were made from PFM crowns. That means there is a metal substructure but porcelain is layered over it for aesthetics.
All ceramic. These are known as "metal-less" restorations. Most often they'll be made of zirconia but emax (lithium disilicate) can be used in the right situation.
Gold. Due to its metallic appearance, this is typically not used unless there isn't enough interocclusal distance in the posterior of the mouth. Basically if you don't have enough space, you may need a gold crown.
When is a dental bridge necessary?
You can't just get one because you simply want it. Your dentist will only offer it to you if you meet certain eligibility requirements. The benefits must outweigh the risks.
Who would benefit from one?
The most common situation which would require a dental bridge is if the patient is missing a single tooth or multiple teeth in the same arch. However, when they are missing multiple teeth, it must be nearby, otherwise it would have to be a separate bridge.
We've provided a diagram below showing you different variations of missing teeth and how the bridge could be made. These are examples of when you would benefit from getting one.
Example: Bridge #1
Two missing teeth
Two abutments
Two pontics
Example: Bridge #2
One missing tooth
Two abutments
One pontic
Example: Bridge #3
Two missing teeth
Three abutments
Two pontics
A commonality among all three examples is that there is an abutment at each end. This configuration provides the greatest stability. Having a cantilever will always be less stable since it produces additional torque on the prosthesis.
Who wouldn't benefit from one?
There are two situations where a bridge would be contraindicated:
Missing the last tooth in the arch such as the second molar.
If you're not missing any teeth.
Missing last tooth
Typically if you lose the last tooth in your mouth such as the second molar, the recommendation is to replace it with an implant. Not that you can't do a bridge but having a cantilever bridge there wouldn't be stable. Due to strong chewing forces of your back molars, there is a good chance it will FAIL after a couple months. If you want something that lasts, go with the implant.
Below are x-rays of a patient who lost two second molars. Both of them were replaced with implants and not with cantilever bridges.
Not missing any teeth
If you're not missing any teeth but you need crowns, there is absolutely no reason to connect them together. Splinting the crowns together will only add to the oral hygiene challenge.
A better option would be to keep them as separate individual crowns so that you can floss more easily. If you're able to keep them clean more easily, they will be less prone to cavities.
The Procedure
The dental bridge procedure involves two separate appointments.
First visit - Prepare the teeth (shave down); Take impression; Make temporary bridge
Second visit - Remove temporary; Permanently glue the bridge
The combination of both visits should take approximately 90 minutes total.
Visit one will take 60 minutes to complete.
Visit two should take about 30 minutes to finish.
You will most likely numb for both appointments unless the teeth have already had root canals and they're dead.
First appointment
The first part of the dental bridge procedure will take the longest, about 60 minutes total. The purpose is to prepare the teeth and take an impression of them so that the dental lab can make the bridge. You will leave with a temporary one while waiting for the permanent one to be made, which may take 2-3 weeks.
What to expect:
Administer local anesthesia. Numbing gel first and then a lidocaine injection.
Prepare the abutments. Drill and shave down the abutment teeth to the appropriate size. There should be enough buccal, lingual, mesial, distal, and occlusal clearance. If it isn't shaved down enough, you will end up with a very bulky tooth bridge.
Pack cord. A small string will be placed into the sulcus of the gums to push them away which will allow a more accurate impression.
Take impression. An impression of the teeth will be taken with PVS or polyether material. A counter impression and a bite registration will also be taken.
Fabricate temporary. Your dentist will make a temporary to cover over the shaved teeth. It protects them and prevents sensitivity while eating/drinking.
Cement temporary. It will be glued in with temporary glue because this needs to be removed next visit to put in the permanent.
Second appointment
The second part of the procedure will take less time than the first, about 30 minutes total. The purpose is to try in the permanent bridge and then glue it in permanently if it fits.
What to expect:
Administer local anesthesia. Numbing gel first and then a lidocaine injection.
Remove temporary. It doesn't need to be drilled off, can be wiggled off with a hemostat.
Try in permanent. The permanent bridge will be placed on the teeth so that you can check if it fits and whether or not you like it.
Adjustments. More often than not, the bite and the contacts will need to be adjusted. The bite is if it feels too high and the contact is if flossing feels too tight.
Permanent cement. It will be glued in permanently with permanent glue.
Clean off residual cement. All excess glue will be cleaned off with an explorer and floss out.
Aftercare instructions. Most importantly your dentist will show you how to take care of it because it is different from your typical crown.
What to watch out for:
Check the color. Look at your new bridge and make sure you're happy with the color of it. If you don't like it or you don't think it matches the adjacent teeth, it will need to be remade.
Check the shape. Make sure the shape of it is to your liking. Sometimes it can be too bulky or too skinny.
Check the bite. When you bite your teeth together, it should feel normal. If it feels too high, it will need to be adjusted.
Risks and complications
There are downsides to getting a dental bridge which you should take into consideration. If you don't think you can handle it, perhaps you should opt for an alternative.
Bridge fracture. Crowns can fracture if you bite into hard foods the wrong way and bridges are no exception. You can chip the porcelain or even worse, break the entire thing in half.
Expensive to replace. If you chip an abutment or pontic, you can't simply replace the affected one. You must replace the entire prosthesis which makes it very expensive.
Difficult to clean. The abutments and dental pontics are connected so you can't floss through it. Cleaning requires floss threaders or superfloss to clean underneath of it.
May loosen. It is glued in but somethings the permanent glue can dissolve and it can come out.
Tooth decay. The porcelain itself cannot get a cavity but your natural tooth underneath can still become decayed. In other words, you still need to brush and keep it clean.
Costs
The average cost of a dental bridge is at least $3918.82 and that is without dental insurance. The reason why it costs much more than a single crown is because it's basically at least three crowns in one prosthesis.
It consists of at least two abutments and one pontic. However, longer span bridges can have a wide variety in the number of abutments and pontics. The longer it is, the more costly it'll be.
The table below is a breakdown of the cost of each abutment and each pontic:
Crown Type | Cost per unit | Cost Range |
|---|---|---|
Abutment | $1315.59 | $1050-1725 |
Pontic | $1287.64 | $1000-1675 |
How to calculate the cost of your personalized tooth bridge:
Multiple the number of abutments you need with $1315.59
Multiple the number of pontics you need with $1287.64
Add up the total and that is your final cost.
Note: For implant supported bridges, the costs would be completely different. They use their own set of dental billing codes.
Cost with insurance
The average cost of a dental bridge with insurance is $1959.41 if you have 50% coverage. Most frequently, this procedure is covered at 50% with most insurances.
Billing dental codes for bridge:
D6750 - Abutment crown
D6240 - Pontic
Note: You should be aware that some insurances do have a missing tooth clause. What that means is you'll get denied coverage if you lost that tooth before getting the insurance. If that is the case, the entire procedure will have to be paid for out of pocket.
Alternatives
Fortunately, there are alternative options to replace missing teeth. Some are more expensive while others are less so but they all come with their own pros and cons.
Dental implants. A fixed option that is more expensive but also much more conservative because it spares the adjacent teeth. The total treatment time may take 8-12 months while you wait for the body to integrate the implant into the bone.
Removable partial denture (RPD). The least costly option but is not the preferred option since it is removable instead of fixed. That means you can take it out and put it back in your mouth at will. The downside is that they can come out while you're eating.
Tooth flipper. A temporary solution to replace a missing tooth. It is similar to a RPD but it is not as sturdy and is only meant for looks. You're supposed to take the flipper tooth out before you eat so you don't break it.
If you're unsure of which option you want to replace your tooth you can give the flipper a try. Wearing it will give you an idea of whether or not you can tolerate a removable appliance. If you absolutely can't stand it, you're going to have to go with a fixed option like implants or the bridge.
Outlook
Dental bridges can last a very long time if you take care of them. The literature shows that the 10 year survival rate is approximately 84% but the length of the prosthesis affects its longevity.
Shorter bridges tended to have a higher survival rate.
Longer bridges with 5 or more units had a lower survival rate.
The most common causes for failure were either breakage or tooth decay.
Bridge aftercare
It is not immune to cavities because your natural tooth underneath is still susceptible. That means you will need to brush it for at least two minutes twice a day.
However you won't be able to floss it like your other teeth since the abutments and pontics are joined together. You will need a different type of floss in order to clean under it.
Floss threader. You thread your usual floss through the threader. Then you can insert the stiff threader underneath of the pontic.
Super floss. Similar to regular floss but one end is extra stiff which lets you thread it through the pontic.
Water flosser. A device which shoots pressurized water to flush out plaque and food.
The recommendation by our dentists in Long Island City is to use a floss threader or super floss. The water floss can be used as an adjunct because it may have trouble getting underneath if you have tight gums. However, if there is space underneath of the tooth bridge, you can use this as your primary means of cleaning.
