A lady came to our clinic complained that she wanted an immediate replacement of her front teeth that were just extracted a week ago due to gum problem. She said that she didn’t dare to go out of her house due to her disfigured appearance. She was sad and embarrassed
There reason why she lost her front teeth was due to deep-bite (her lower teeth were biting at the back of her upper front teeth) which result in stripping of the gum on the palate (traumatic occlusion). Eventually, this lead to periodontitis (gum disease) and loosening of her teeth. Sadly, she had to have her upper teeth removed.
After examination and assessment of her teeth, we came out with a few treatment plans:
Correction of the occlusion (biting) by means of orthodontic treatment followed by orthognathic surgery to correct her jaw misalignment — which will takes her 2-4 years
Dental implant to replace the missing front teeth — Required bone block to build back resorbed alveolar ridge and the implant might not be lasting due to the occlusion problem
A dental bridge from her canine to the other canine (a 6 unit bridge)
After discussed with her, she decided to go for the third option – a dental bridge. She preferred the zicornia type of material for aesthetic reason.
For a mean time to allow gum healing, we prepare a ‘vacuum formed’ denture which she used to cover the missing teeth.
A temporary denture
She wear the denture while waiting for the gum to heal
Final outcome, a 6 unit zicornia bridge was cemented onto her teeth…
6 unit zicornia bridge
Possible problems/risks for a dental bridge:
Possibility of devitalizing the teeth during preparation of teeth ending up needed root canal treatment.
Nowadays, more and more people want to replace their missing teeth with the material that is as near as possible to their natural teeth. Porcelain fused to metal bridge is one of the conventional choice. However, because of the presence of metal in this type of material, the bridge somehow look dull, opaque and non-translucent. On top of that, it has a ‘dark’ margin due to the thinning of porcelain at that area especially dark gum line that is very obvious when patient smile.
Porcelain bridge is invented to over come all the problems above. Because of its metal-free property, porcelain bridge can look like ‘real’ teeth and strong enough to withstand the biting force. The preparation on the teeth prior to porcelain bridge placement is same with the conventional bridge. Currently, for missing single tooth, we provide glass type of porcelain (eg. IPS e.max®) while for multiple missing teeth, zirconia bridge (eg. Procera®) will be used.
Cases of porcelain bridge
Case one: Missing front tooth
This young lady had a missing upper front tooth. She wanted replacement which looked as natural as possible. A porcelain bridge was suggested.
Unfortunately, the space for the front left central incisor was inadequate for a front tooth!!
Impression of her upper jaw and a study model was fabricated for assessment.
Diagnostic wax-up of the her bridge was made on the study model. Then, the patient’s teeth were prepared for bridge construction.
The porcelain bridge was constructed by laboratory technician. Back view of the bridge (below).
Full porcelain bridge IPS e.max®.
The porcelain bridge was cemented with transparent resin cement.
She was very pleased with the final outcome. Now she can smile!
Case 2: Badly decay front teeth
This young man presented with a badly decay front teeth with both lateral incisor placed behind. He wanted to make over all his front teeth.
In the assessment, we found numerous problems: decay front teeth, lateral front teeth placed backward and the canines looked unnatural. We started with root canal treatment on his front teeth. Due to backward position of the lateral incisors, we have the teeth extracted and after healing, he was ready for bridge construction. We proposed to him to have 2 porcelain bridge (each consist of 3 unit tooth) from his canine to the other side of his canine. (Want to know more about root canal treatment click here).
An study model was duplicated from his mouth and diagnostic wax-up was done to reassemble the final outcome of his bridges.
The teeth was prepared for bridges construction under local anaesthesia.
A provisional bridge was fabricated for him to wear while waiting for the final bridge
Finally, the porcelain bridges were cemented with transparent resin cement
The back view of the bridges with healing socket of the extracted lateral incisors.
Now, he can smile confidently!!
Most people want a gap in their mouth filled for cosmetic reasons, and understandably so: beautiful smile is a very important part of the impression you make to the outside world. However, there is a more important reason to close gaps in your mouth where teeth are missing; it is actually harmful to have a missing tooth, because teeth tend to drift out of place when there is a gap and move forward into the space that has been created. This leads to all kinds of serious problems, including bone loss, and, if left untreated, you can loose more teeth. Therefore, replacing a tooth is important!! Usually it can be done by fabricating a denture, bridge or implant.
What is a dental bridge?
A bridge is a way of replacing one or more missing teeth in the mouth. It is also known as fixed partial denture, which used to replace a missing tooth by joining permanently to adjacent teeth or dental implants. Unlike traditional removable dentures, a dental bridge is permanent as it’s anchored to the teeth at one, or both, sides using metal bands held in place by resin or cement. If well cared for, a dental bridge should last for 10 to 15 years.
Anatomy of a dental bridge
A bridge consist of a ‘false teeth/tooth which is called pontic connected by connectors to retainers. Bothe retainers sit on the abutment teeth: Retainers. Part of the bridge will have metal castings, called retainers. They are made to fit onto what the dentist has cut away on the abutment teeth. Retainers also secure and support the bridge’s artificial tooth or teeth. Pontics. A pontic is an artificial tooth that is suspended from the retainer casting. A pontic occupies the space formerly filled by the crown of a natural tooth. Connectors. A pontic is attached to a retainer by a connector. Connectors can be rigid or nonrigid. Nonrigid connectors take the form of male- and female-locking arrangements. Rigid connectors are classified as either cast or soldered. Abutments. The teeth that support and hold the retainer are called abutments. It is almost mandatory that an bridge be supported by an abutment at both ends. This requirement is waived in special situations. When a pontic is suspended from only one retainer, it is cantilevered.
Composition of a dental bridge
The materials used for the bridges include gold, porcelain fused to metal, or in the correct situation porcelain alone (full porcelain). The amount and type of reduction done to the abutment teeth varies slightly with the different materials used. The recipient of such a bridge must be careful to clean well under this prosthesis.
Types of dental bridge
There are three types of dental bridge: fixed, resin bonded, and cantilever. The type of bridge used will depend on the quality of the teeth on either side of the gap, as well as the position of the gap. 1.) Fixed Bridges With a fixed bridge, the false tooth, or pontic, is anchored to new crowns attached to the teeth either side of the gap. These crowns are usually made from porcelain with the new tooth made from either ceramic or porcelain. This forms a very strong bridge that can be used anywhere in the mouth. 2) Resin Bonded Bridges Sometimes called Maryland Bonded, these dental bridges do not involve crowning the adjacent teeth, so are useful where these show little or no previous damage. The new tooth is generally made from plastic and is attached via metal bands bonded to the adjacent teeth using resin. This type of bridge is particularly suitable for front teeth where stress is minimal, and the bond can be made out of view behind the teeth. 3) Cantilever Bridges These dental bridges are used where there is a healthy tooth only on one side of the gap. The bridge is anchored to one or more teeth on just one side. As a result, this type of bridge is generally only suitable for low stress bridges such as front teeth.
How your bridge is fitted
Getting a bridge usually requires two or more visits. While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown. Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated. In addition, a temporary bridge will be made and worn for several weeks until your next appointment. At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit. Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge. The new bridge will be permanently cemented at a later time.
Cases done in our clinic:
Case One: Multiple missing teeth This patient was a young female, wearing denture for more many years. She came to us, wanted something fix or permanent which looked more natural than her denture. She presented with multiple missing (below). After assessing her, we suggested a 9 unit bridge extending from upper left canine to her upper right molar with non-rigid connector between her upper right canine and first premolar. We also suggested her to have a implant-supported bridge for her upper left quadrant. Shade or colour selection was chosen and the remaining teeth were prepared for bridge construction under local anaesthesia. Impression of her teeth were taken and a dental model was fabricated. The laboratory technician construction the bridge on the model. The non-rigid connector just behind the right canine used to connect the rest of the bridge a the posterior right (above) The connector at the back of the upper right canine was covered properly with porcelain. The anterior part of the bridge was cemented onto patient’s mouth (above and below – the back view) Finally, the back portion of the bridge is cemented to the back molar Final result!! Case Two: Multiple missing teeth This gentleman complained that his old denture was getting shorten and he wanted something permanent His denture looked really old with discolouration over the ‘pink’ part of the denture On the palatal view showed multiple missing teeth involving the upper front and right side. A 9 unit bridge was constructed and cemented onto patient’s mouth. Due to bone resorption at the front part, ‘pink’ porcelain was added to supported his upper lip giving him a youthful look. Palatal view: the bridge extended from left canine to right molar Final result!!
Maintenance of dental bridge
Dental hygiene becomes a little more complicated if you have a bridge, making normal flossing impossible in that area, nevertheless you do have to take care that the teeth adjoining the artificial tooth are thoroughly cleaned. Even the best fitting bridge will still have gaps around and beneath it, and these can quickly accumulate damaging debris if you do not follow a strict hygiene regime.Your dentist can show you how to do this, using special floss (eg. superfloss) or flossing needles. These floss go ‘under’ the pontic area and area near to the abutment to remove the food usually stagnant there.
How Long do Bridges Last?
While crowns and bridges can last a lifetime, they do sometimes come loose or fall out. The most important step you can take to ensure the longevity of your crown or bridge is to practice good oral hygiene. A bridge can lose its support if the teeth or bone holding it in place are damaged by dental disease. Keep your gums and teeth healthy by brushing with fluoride toothpaste twice a day and flossing daily. Also see your dentist and hygienist regularly for checkups and professional cleanings. To prevent damage to your new crown or bridge, avoid chewing hard foods, ice or other hard objects.