When you’re missing a tooth, you have a couple of options for tooth replacement. One option is to do an implant, and a single-tooth implant is often the best solution. The advantage of a single-tooth implant is that it goes right into the space that you’re missing. We don’t have to touch the adjacent teeth, and it’s just a single solution for that problem. A lot of times, however, if an implant is not an option, whether it’s due to bone loss, medical history, or just the location of that missing tooth, we have to look at other options. And so, your other option to have something restored that stays in your mouth and doesn’t come in and out is called a dental bridge.
Types of Dental Bridges
A dental bridge has a variety of different types depending on the location of the missing tooth, the material that we use, and the kind of attachment we use to the adjacent teeth.
Maryland Bridge
We’ll start with the simplest, the least invasive type of dental bridge, called a Maryland Bridge. The technical term for this is a resin-bonded fixed dental prosthesis, which is basically what this is. Usually, we use it when you’re missing a lateral tooth. So the two big teeth in the middle are your two centrals, it’s very, very common. In fact, the most common missing teeth are the lateral teeth.
Application and Procedure
A lot of times, we’ll see it in children. They get the primary, the baby tooth on the side, and they get the two big teeth that are on either side of it. And as they get older, all of a sudden, that baby tooth comes out, and they don’t have their permanent tooth behind it. And we don’t do implants. We try to avoid implants on anyone under the age of 21 guys, even what, 22, 23? Just because we don’t know where the growth is and we don’t want to put something in that’s not going to last for a long time aesthetically and functionally, the solution there is to do a Maryland bridge.
Benefits and Considerations
Basically, we reduce the backside of the teeth on either side or sometimes just one tooth next to that missing space. And we make a fake tooth typically out of either zirconia, which is a white metal, or sometimes we use gold, which is a foundation gold, which is a silver-looking metal. You have a tooth-colored fake tooth, and then you have a wing that hangs off the backside, and that wing is bonded to the backside of the tooth next to it. So when you smile, it looks like you’ve got a natural tooth sitting there, but it’s adhered to the backside.
The advantage of a Maryland bridge is that we don’t have to change the front of either one of the adjacent teeth.
Conventional Dental Bridge
So that brings us to the next style of bridge, which would be just your conventional dental bridge. These are very common on the front, but also on the back teeth.
Application and Procedure
So if you’re missing a molar or missing a premolar, a lot of times what we can do is if the teeth on either side of that gap have big fillings, would benefit from having a crown, have an old crown that’s either chipped, porcelain, breaking down, there’s a little bit of decay under there, and you have to replace that crown anyway. We can kind of kill two birds with one stone by protecting those adjacent teeth with the fake tooth in the middle.
Materials and Process
So the process is we come in, we get you nice and numb. We kind of prepare down those two adjacent teeth, and by preparing, I mean we remove a little bit of tooth structure. So you’re looking at about one millimeter, which is very, very minimal but enough to give us the thickness of our restorative material. So we remove that little bit of tooth structure, and we’ll make an impression. We usually do digital impressions in our office, which involve an intraoral scanner. So we’ve pretty much eliminated the need for the mouthful of goo and the five minutes of waiting for it to set up and the choking feeling. Now, we can do a digital scan.
Your Temporary Bridge
We send that off to our lab, and then, in the meantime, I make you a temporary bridge. So, that day, you’ll go home with a temporary crown over those adjacent teeth and a fake tooth in the middle. It’s all kind of one piece. And then, about three weeks later, we’ll get you back, and we will have the actual permanent bridge ready to go.
Advantages of Using Zirconia
Most of our crowns nowadays are zirconia, with white metal and porcelain layered on top. The advantage of that is twofold. Number one, the zirconia, is a white metal. And so when we place the margins, the edges of where that crown meets the tooth, we always place it right at the gum line or just slightly below so it’s not visible. But inevitably, over time, as you get older, the bone’s going to drop a little bit, and the tissue’s going to drop. So, sometimes, you might see the edge of where that crown meets the tooth, but the advantage of the white zirconia is that it looks like a natural tooth structure. So, it’s really not an aesthetic concern.
Esthetic and Strength Considerations
I mean, I think everybody has either in their mouth or sees other people that when they smile right at their gum line, they see that darkness, they see that black line and that’s because the older style of doing crown and bridge work was a silver metal underneath and then tooth layered on top. And so that’s what you’re seeing a lot of times when people smile with older crowns: as that tissue pulls back, you’re seeing the edge. And it can be an aesthetic, something that’s unpleasant aesthetically, but back to the bridge.
So, with the zirconia bridge, we’ve got zirconia, which is the strongest metal that we use in the mouth. So it’s very durable, it’s very strong. As long as you have the proper dimensions and thickness, you’re not going to be able to break it. And then we’ve got porcelain layered on top, and that gives us the ability – I worked with some phenomenal dental labs and some master technicians – that can craft the anatomy and the light refraction and the light reflection and the color and the shading to really blend in and mimic your natural tooth.
With the white core underneath it, it looks a lot more natural, so it doesn’t look dingy. You don’t have dark crowns, and we can make ’em look very lifelike and natural.
Adapting for Different Situations
So typically bridges will span one missing tooth. Occasionally we can do two fake teeth, but it does get a little bit more complicated and each situation is different. One of the most common bridges we do is from canine to canine on the bottom. A lot of times people will have these lower front teeth either decay or break down or lose bone, and they start to get mobile and they lose those teeth.
Customized Treatment Plans
So it’s very common to do a bridge from this tooth to this tooth with four fake teeth across the middle. But again, every bridge is custom. Every person we treat has a customized treatment plan. So when you come and see us, I’ll talk you through your options. We can look at everything. We’ve got lots of pictures and models, and we can show you what specifically is the best solution for you.
Implant Supported Bridges
Along the same vein of a typical dental tooth-supported bridge, we also do implant-supported bridges as well. It is essentially the same concept, but instead of two natural teeth, we’ve got two implants, sometimes three and occasionally four implants depending on the arch and the spacing of how much we have to restore, but the implants are in the bone.
Procedure and Maintenance
Then, we have a custom piece that goes through the tissue and kind of mimics a natural tooth. And then we’ve got the bridge that gets supported. And again, it gets cemented in place, stays in place. You just brush floss and clean it like your regular teeth. I will tell you it takes a little bit more maintenance because you’re no longer allowed to floss in between the teeth. You have to use a floss threader or super floss to kind of go in between the fake tooth and the gum tissue and then kind of clean under there.
Cantilever Bridge
Another bridge solution that we have in our pocket that we don’t use as often but which is available to us is something called a cantilever bridge. So sometimes, when you’ve got a missing tooth, and you don’t want to impact or touch the tooth next to that missing tooth, you can do a bridge being supported by teeth on the other side of the arch. They kind of hangover and support that missing tooth because this is a little bit more involved. You have to take your time and make sure you do it right because if you do a cantilever bridge and you put that fake tooth in an area where it’s under a lot of stress or under a lot of force, it doesn’t have the stabilizing balance on both sides to protect it, so it can damage those adjacent teeth.
Planning for a Cantilever Bridge
So, I don’t say that to scare you or to say that cantilever bridges aren’t a great solution. It’s just something that has to be planned out, and you want to make sure you go to somebody who knows what they’re doing. With so many options available for us, such as bridge style, design, and material, it’s really important to make sure you have a customized plan for your mouth.
Choosing the Right Bridge
There are certain limitations and certain advantages to different kinds of bridges. With the Maryland Bridge, we don’t want to put it anywhere where you’re going to have a lot of force on it because we’re asking a lot of that wing. Maryland bridges are more cosmetic. They’re more for areas where you’re not going to be putting a lot of impact. Conventional bridges, when done correctly, can support tooth structure and can really function in the back of the mouth where you’re doing a lot of force and a lot of grinding.
Material and Location Considerations
And a cantilever bridge kind of falls in between there. When done correctly, you can make sure that that fake tooth isn’t put under a lot of duress. You want to design properly. At the end of the day, it’s all about making sure you have the right bridge, the right bridge material, and the right design for your mouth, depending on where you’re missing that tooth. That kind of guides us to the best decision for how to replace that missing tooth. The same goes for materials, whether we do a full zirconia bridge, whether we do a bridge made of regular yellow gold, whether we do a tooth color bridge with a zirconia wing, all the options are kind of guided by where that tooth is.
Tailored Solutions for Your Needs
Not only that, but your mouth and the remaining teeth are also affected. If you don’t have a lot of teeth and we’re putting a bridge in an area where you’re going to be doing all your functioning, that’s going to guide us away from something like a Maryland Bridge and put us to something that’s stronger and more durable and can withstand the forces that you’re going to create in that area.
Practical Considerations
So I know I’m using a lot of technical jargon, force impact, function, grinding, duress, stress, but at the end of the day, we need to be able to build something that can withstand the things that you chew and eat on a daily basis. So if you chew things that you shouldn’t eat, like ice, we’ll cross that bridge later. It’s going to cause a lot more force in those areas. So, normal eating, like carrots, steak, chicken, is something that sometimes you have to really put a lot of force and grind and chew on. We want to make sure that any solution we provide you is going to stand up to the test of your diet.
Conclusion
If you find yourself in a situation where you’re missing a tooth, whether it’s a back tooth, front tooth, or wherever, or if you’re concerned that a tooth might be going downhill and needs to be replaced soon, come see us. We’ll sit down, and we’ll make a very customized plan. We’ll go through and look at all your options, and I’ll talk you through the best solution for your mouth. Come see us. I’m Dr. Brett Langston, prosthodontist and owner of Dental Implant and Aesthetic Specialist, and I’m here to help you watch your mouth.
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