Replacing teeth with bridges

One or more teeth can be replaced with a bridge. What dentists refer to as a normal bridge is where a natural tooth is followed by the bridge pontic (the artificial tooth), anchored on the other side to the adjacent natural tooth. This bridge design is like a bridge across a river — the dental bridge consists of two interconnected and crowned teeth which carry the missing tooth between them. With a cantilever bridge two natural teeth are used in front of the gap, which may be wider, as a bridge pillar.

 

Bridges consist of a stable framework and ceramic veneering. As framework materials, high performance ceramics are used or, more rarely, metal alloys. Not only is the eating function restored but also the aesthetic appearance of the teeth. Bridges can be adapted to suit the remaining teeth, especially in patients who cannot be supplied with implants due to medical problems.

In adhesive bridges (also known as Maryland bridges) the anchors of the bridge are not designed as a full crown, but as a partial crown, veneer or inlay and attached to the adjacent teeth of the gap using a special technique with adhesive cement. The teeth are ground down much less and their natural elasticity can be better preserved. An adhesive bridge thus generally represents a lower risk in the long term than a classical bridge for the bridge bearing teeth. Adhesive bridges, however, are mostly used for back tooth replacement and can, except in the lower jaw front, only replace a single tooth.


Tooth replacement with bridges

Dental bridges are used to replace missing teeth. They can be tooth supported or implant supported and close the gap perfectly. Ceramic bridges adapt best to the natural tooth colour and offer an excellent aesthetic result. Bridges consist of a rigid frame and ceramic veneering. High performance ceramics or metal alloys are used in addition as framework material. Nowadays monolithic bridges are possible as well, thus reducing the chipping risk. 

Advantages of a full ceramic bridge:

  • Excellent aesthetics
  • High durability and stability
  • Precise fit
  • High biocompatibility

Different types of bridges

Dental briges are differentiated according to the material used, the preparation, size and how they are cemented. The individual restorations vary in the time it takes to produce them, which also affects the cost. Common to all bridges is the production in a dental laboratory.

  • all-ceramic bridge (completely made of ceramic, giving excellent aesthetic results)
  • Metal-ceramic bridge (framework of metal, veneered with ceramic)
  • solid bridge made entirely of metal
  • Adhesive bridge (Maryland bridge)
  • Inlay bridge (the anchoring teeth are prepared with inlays to hold the missing tooth)
  • Implant supported bridge
  • Full arch bridge
  • Removable bridge (eg telescopic bridge)

How are bridges produced?

Before a bridge is made we first have to prepare the neighbouring teeth meticulously to guarantee the final and accurate fit of the bridge and ensure certain material thickness parameters. Then we take an impression of the teeth to allow the dental technician to manufacture the bridge in the dental laboratory. The impression is mostly taken digitally using an intraoral scanner — only in rare cases do we need to go back to conventional impression materials.

The exact colour determination of the existing teeth by the dentist and dental technician is the prerequisite for a perfect aesthetic result. On the basis of the scan or the impression, our master dental laboratory produces the bridge in the desired material.

In the meantime we protect the prepared teeth with a temporary plastic bridge. When the permanent bridge is finished we remove the temporary restoration, clean the teeth and cement the bridge onto the teeth with a high performing adhesive cement.


Metal vs all-ceramic: which bridge should it be?


Bridge restorations are a common way to close tooth gaps. Anyone who has opted for this type of restoration is faced with the next question: which material should it be? Metal ceramics or all-ceramic?

High quality bridges should...
Be made of a stable material and be designed to last as long as possible. At the same time they should have an abrasion-resistant surface, be compatible and look appealing. Most bridge materials meet these criteria with appropriate processing by the dentist. Nevertheless, the materials differ in the details.

Pure metal bridges — barely in use
Pure solid metal bridges are stable and cheap, but not tooth colored. Because they can be extremely visible, conduct heat and cause a metallic taste, they are barely used today. Even bridges made of gold are rarely used.

The 'gold' standard: pros and cons of the metal-ceramic bridge
Metal ceramic bridges consist of a metal framework, which is veneered with ceramic. This technique has been used in dentistry for over 50 years, so dentists have gained a lot of experience with these materials. Because the metal framework is very stable, this denture can also close larger gaps. Due to the tooth-colored appearance, metal-ceramic bridges are also aesthetically pleasing. In addition, they are less thermally conductive than bridges made entirely out of metal.

After five to ten years, however, the gums may discolour because metal ions dissolve. In addition, the aesthetic appearance may suffer because deeper layers may shimmer through or the metal margin may become visible as the gums recede over the years.

All-ceramic bridges made of lithium disilicate
For a long time there were only metal and metal ceramics bridges. The search for better aesthetics eventually led to the development of all-ceramic bridges. They are almsot indistinguishable from natural teeth. All-ceramic is also considered to be very biocompatible.

Lithium disilicate bridges hold as long as metal-based bridges, but can only be used for individual tooth gaps in the area of ​​the small molars and anterior teeth. Like normal teeth, they can break when hard food is consumed.

High performance ceramic zirconia
More and more zirconium all-ceramic bridges are being used in modern dentistry, which work well without any metal. Zirconium oxide is very resilient, therefore zirconium oxide ceramics can also be used for several missing teeth in the posterior (back) region. However, this extreme stability also has disadvantages, because the opposite tooth can be worn down if the opposing bridge has not been sufficiently polished after adjusting the bite. These bridges fit seamlessly into the rest of the dentition. However, on a technical note it should be ensured that the zirconia veneering ceramic is applied only on the outside facing the cheek, since the veneering otherwise often chips.

Since zirconium bridges are designed and manufactured by computer-aided systems, they impress with their high accuracy of fit and material purity.

Which bridge is the right one?
Ask yourself the following questions: is a tooth-colored restoration necessary, for example because the gap is in the visible range? Do you prefer metal-free materials? In these cases, a full ceramic or a zirconia bridge could be the right choice. If the margin of the bridge is not visible, in rare circumstances a metal-ceramic bridge can also be considered.


More questions?

Find answers to the most frequently asked ones below, or contact us for a personal consultation.

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