What is a Bridge?

Bridges typically replace one or two teeth and are supported by crowns on each end, called abutments. They are the conventional alternative to single tooth implant restorations and can be very comfortable, durable, and esthetic. Bridges—in contrast to “partials” or partial dentures—are not removable. Therefore, bridges are properly called fixed partial dentures, or FPDs.

Bridges require removal of sufficient tooth structure on the teeth on both sides of the space caused by the missing tooth or teeth to create restorations that are strong enough to support more than one tooth but able to meet the esthetic demands of the patient. Typically, this is not much different than would be prepared for crowns. An artificial tooth between the abutments is called a pontic.

How is a Bridge Created?

Bridges usually require a preparation appointment, making impressions that are sent to a dental laboratory for the making of the bridge, and a seating appointment. Sometimes, more visits are needed depending on the complexity of the case. Alternatively, some bridges can be made in the office (see one-visit dentistry). Bridges can be made of full cast gold alloy, gold alloy with porcelain used to it, full contour zirconium, or even lithium disilicate in select cases. Zirconium and lithium disilicate are metal-free, tooth-colored materials. Provisional, or “temporary”, bridges are usually tooth-colored plastic.

In areas that show during a full smile, the goal is usually to create pontics that look like natural teeth, especially where the pontic meets the ridge. This is best done by developing a pontic space at the time a tooth is extracted with a phased temporary bridge and grafting of bone in the fresh extraction site so that excess bone is not lost during healing of the extraction site. If the extraction site is well-controlled and developed with a provisional bridge with proper pontic form, the definitive bridge that is typically placed about 3-4 months after the extraction, can mimic the appearance of natural teeth. However, when grafting for ridge preservation with pontic site development is not possible because of previous tooth loss, loss of the bone around the loss tooth, etc., esthetics can be improved with artificial “gums” created with pink porcelain sculpted as part of the pontic.

Advantages of Bridges include but are not limited to:

• “Conventional” techniques with long-term proven history of use
• Typically shorter treatment time
• Predictable esthetics
• Treatment costs may be less than implant alternatives
• Enable pontic site development in esthetic cases where a tooth must be extracted

Disadvantages of Bridges include but are not limited to:

• Require removal of tooth structure on teeth around the tooth to be replaced
• Require meticulous home hygiene to prevent recurrent decay
• If one of the abutment teeth are compromised due to decay, gum disease, etc., the entire bridge must be replaced.

Alternatives to bridges include removable partial dentures and dental implant-supported restorations. In some situations, bridges can be made using implants as abutments on each end of a toothless space.

Single-tooth implant-supported restorations have the advantage of not requiring tooth preparation of adjacent teeth. However, esthetics can be more challenging with single tooth implant replacement, and costs of treatment tend to be significantly greater with implant therapy. While both implant-supported single restorations and bridges are both excellent treatment options to manage an edentulous space, the decision about which is best for any given situation should be based on careful consideration of the risks and benefits of each as they apply to that situation.

VIDEO: Bridge Versus an Implant

What is a Partial?

Partial dentures are a removable prosthesis that replace multiple teeth. Typically they are made of acrylic denture teeth molded to a metal framework that uses natural teeth or dental implants to support it.

When made properly, they can be very functional and esthetic, and they may be a viable economical alternative to other tooth replacement options.

Sometimes, all acrylic partial dentures are used as a temporary, or “provisional,” prosthesis during healing or until a definitive treatment plan can be developed.

An example esthetic and stable removable partial denture using implants and crowns to retain it.