Dental Bridges

Dental bridges - dental bridgework

The right lateral was congenitally missing and PFM bridgework was employed to replace it. The false tooth (pontic) was made to look as though it was growing out of the gum ridge. This patient wanted us to put all of the normal surface textures and micro-blemishes found in normal natural teeth. See before photos of this Gurnee resident.

Dentists replace missing or lost teeth with bridgework, implants, and / or removable partial dentures that can be undetectable to the eye. Choosing the best tooth replacement technique depends upon several factors, including the condition of the teeth adjacent to the space, the shape and the amount of shrinkage of the boney ridge after the extraction of the original tooth, the gum tissue thickness and continuity of symmetry with the other gum scallops, the esthetic display of the smile, the health of the gums, and budget considerations.

Dr. Fondriest works with his favorite surgical and or orthodontic specialists if necessary to make the false tooth in the future bridgework to appear as though it was never lost achieving amazing results.

WHAT IS A DENTAL BRIDGE

If you have missing teeth, your dentist can close — or bridge — the gaps in your smile with dental bridges. A dental bridge is a false tooth (called a pontic) that is held in place by the abutment teeth on either side of the gap. Bridges are affixed and permanent prosthetic devices that are bonded or cemented onto existing teeth or implants by a dentist or prosthodontist. Bridges are commonly used to cover a space if you’re missing one or more teeth. They are cemented to natural teeth or implants surrounding the space where the tooth once stood. Gaps left by missing teeth can cause the remaining teeth to shift, which can result in a bad bite. Bridges help prevent this from happening.

TYPES OF DENTAL BRIDGES

There are two mainstream types of fixed (meaning non-removeable) dental bridges:

1)  All-Porcelain Dental Bridge

When dental implants cannot be employed to replace a missing or extracted tooth, then a fixed or permanently cemented dental bridge is the next best solution.  These non-removeable tooth replacements can be constructed out of many materials.  It is easier to achieve a high level of esthetics when the restorations are entirely constructed of porcelain.  The design and overall strength of these restorations is evolving quickly. At this time, the most common porcelain varieties (e.g. Zirconium, Procera, E Max) used as substructures or frameworks still have lower flexural strength relative to metallic versions but their popularity is growning rapidly. The restorative dentist and patient must weigh the risk of occlusal forces and abuse against the ease of creating an esthetic result.

2)  Porcelain supported by a metal substructure (PFM) Dental Bridgework

Dental bridge

Dr. Fondriest was able to replace the missing front teeth of this high profile Chicago attorney with fixed bridgework, giving her a uniform and radiant look. Due to some occlusal concerns, this bridgework was supported by a gold framework for strength.
“My teeth look and feel perfectly natural, and I’m so proud to smile. Dr. Fondriest’s team made it happen!”

When the supporting substructure is placed under unusually heavy loads, veneering porcelain can chip or fracture off of any bridge or crown.  Porcelain is like glass; it has a low tensile strength.  If there is significant flexure, it will crack, chip, or break.  Adding a metallic substructure under the porcelain will reduce flexing under trauma or excessive loads.  If the patient is hard on their dentition with clenching or grinding, it is advisable to support the superficial veneering layer of ceramic with some sort of metal substructure. There are many types of metallic substructures which can be added when maximum strength is needed.  The patient rarely is advised of the choices being made on their behalf but these choices determine biocompatibility, tissue health, and longevity.  These metallic substructures are cast in the lab with various quality levels of metal alloys.  A non-precious alloy will not cast as well and will not be as biocompatible as a high noble alloy with high gold content.  Dr. Fondriest always chooses a very biocompatable “high-noble” precious alloy made primarily of gold.

There are also two more less mainstream types of bridges that can be used in certain circumstances

3. Cantilever Bridges

Cantilever bridges are another option for replacing missing teeth. They are very similar to traditional bridges, but the false tooth or pontic is supported by an abutment on only one side, rather than on both sides. So if there’s only one natural tooth or implant next to the gap, a bridge can still be secured.  This bridge option is NOT RECOMMENDED for back teeth. This is an option best used for a missing front tooth. The bite forces are much diminished in the anterior teeth and will be less likely to damage or dislodge the bridge.

Like traditional bridges, your dentist will need to prepare the adjacent tooth to support the bridge by removing its enamel. Because these restorations are only supported on one side, a lever action is applied to the supporting tooth or implant.This may lead to complications like fractured teeth or loosened crowns.

4. Maryland Bridges

Maryland bridges are considered a conservative alternative to traditional bridges. These bridges consist of a pontic (false tooth) that is held in place by a metal or porcelain framework in the shape of wings projecting on each side of the false tooth.. This framework is bonded onto the backs of the two teeth adjacent to the missing tooth. Since this type of bridge isn’t held in place by crowns, the adjacent teeth don’t need to be filed. This bridge option is used mainly for young adults who have not finished growing and are considered too young yet for a traditional bridge or an implant.  They are used as a temporary solution until adulthood.

While Maryland bridges are more conservative than traditional bridges, they do have their downsides. The strength of the bridge is limited by the strength of the resin that holds the wings in place, so it may not stay in place in areas of the mouth where the teeth are subjected to a lot of biting force, like the molars. Maryland bridges are usually only used to replace front teeth.

What does a dental bridge cost?

Dental bridge

This patient was missing her left lateral incisor or the second complete tooth visible from the right. There was not enough room for an implant so permanent PFM bridgework was created. Special attention was given to make a specific shape to the underside of the false tooth (ovate pontic) so that it would appear like a natural tooth growing out of the gum. Matching the surface textures of the other natural teeth was also a challenge.

There are many variables that can affect the price including:

  • The number of teeth needed to fill the gap
  • The strength of the adjoining abutment teeth
  • The type of bridge as described above
  • Complexity/difficulty of the placement
  • Additional treatments for other dental issues, such as the shape of the jaw ridge and the gum health
  • The location of the bridge in the mouth
  • Traditional all porcelain or PFM bridges typically cost $4,500 – $8,000 for one pontic and a crown for each abutment tooth.
  • Maryland bridges typically cost $1,500 – $2,500 for one pontic with the framework, or wings, attached to the abutment teeth.
  • An implant-supported bridge could cost $5,500 – $15,000 for a bridge with one or two dental implants spanning three or four teeth.

Hiding the dark metal margins at the gumline of bridges

It is rare for Dr. Fondriest not to elect the optional choice of prescribing butt-joint margins which cover the metal edges of your bridge with porcelain to prevent the dreaded “black line at gumline“.  Most of our PFM bridge versions totally enclose the gold within the ceramic so that the metal  is not exposed to the mouth.

 

 

Procera all-porcelain bridgework on the upper front 4 teeth.

Procera all-porcelain bridgework on the upper front 4 teeth.

 

Dental bridge

This patient was missing her upper lateral incisors with inadequate space for implants. The upper front 6 teeth were all part of the fixed all-ceramic bridgework that was created to give her a pretty smile.

See another before and after example.