Dental bridge: what it is, types of bridges & who needs it

Tooth loss in adults is a common problem faced by an increasing number of people daily. Unfortunately, factors such as aging, poor dental care, accidents, and hereditary predispositions often result in partial edentulism (missing teeth). This defect can only be corrected through dental implants or tooth-supported prosthetics.

This article provides comprehensive information about dental bridges — a popular type of tooth-supported prosthetic — including its indications, advantages, and disadvantages.

What is a Dental Bridge

A dental bridge is a fixed prosthetic structure consisting of artificial teeth (pontics) and crowns, attached to the natural teeth on both sides. For a bridge to be installed, there must be two healthy abutment teeth that anchor the bridge securely. These abutment teeth must be reshaped according to technical parameters required by the chosen prosthetic material, allowing the crowns to fit snugly.

This type of construction allows replacement of one or several missing teeth without dental implants in a relatively short period.

However, the more teeth that need replacement, the more complex the bridge becomes, as additional technical considerations are required to prevent breakage and ensure stability.

Types and Classification of Dental Bridges

Dental bridges vary according to material, fixation method, shape, manufacturing process, and other factors.

Based on materials, dental bridges include:

Metal-ceramic

These consist of a metal framework covered with ceramic. They are particularly useful for complex situations involving 2-5 missing teeth. Metal-ceramic bridges are recommended for molars due to their durability. Various metals can be used, each with distinct properties.

Zirconia Bridges

Typically recommended for replacing 1-2 missing teeth. Longer zirconia bridges require significant tooth-to-tooth connection areas, making them prone to fractures in larger constructions. However, they offer superior aesthetics and biocompatibility, making them ideal for front teeth and small gaps in lateral teeth.

All-Ceramic Lithium Disilicate (Emax) Bridges

These offer the best balance between aesthetics and functionality but should generally be avoided for molars due to the risk of breakage under high masticatory forces.

Acrylic Bridges

Used temporarily while waiting for a permanent bridge made from more durable materials, as acrylic cannot withstand significant masticatory forces.

By manufacturing method, dental bridges include:

• Layered
• Cast bridges
• Maryland (adhesive bridge, composite-based without tooth preparation).

Cast bridges are the most reliable, offering increased strength and tighter fitting to the abutment teeth.

By shape, bridges are classified as straight or arched, depending on the number and position of missing teeth.

Which Dental Bridge is Best?

The best type of bridge depends on each patient’s specific situation.

Metal Ceramic Dental Bridge

Metal-ceramic bridges are more reliable for multiple missing teeth. As mentioned previously, if the question arises about the best bridge for molars, metal-ceramic is preferable for larger gaps, while solid zirconia is better for smaller gaps.

However, a metal-ceramic bridge consists of three layers (metal, primer, ceramic veneer). Over time, the ceramic layer wears away, exposing the primer, which is rougher and may abrade opposing teeth. This abrasion gradually lowers the bite height, potentially requiring additional procedures to restore proper occlusion.

Zirconia Bridge Prosthesis

Unlike metal-ceramic, polished zirconia bridges do not abrade opposing teeth. However, their primary drawback is susceptibility to breakage with longer spans (three or more missing teeth).

Ceramic bridge prosthesis

These bridges offer a middle ground, combining aesthetics comparable to zirconia with strength similar to metal-ceramic. However, they are generally unsuitable for molars and are increasingly replaced by zirconia for single crowns due to zirconia’s strength.

Can a Dental Bridge be Placed on Front Teeth?

As previously discussed, if there are healthy abutment teeth, a bridge can be installed on front teeth. However, patient satisfaction may be compromised if the gum line has receded significantly after tooth extraction. Gingival surgery (soft-tissue grafting) may be necessary to enhance aesthetics and prevent food impaction and inflammation.

Fabrication and Installation of Dental Bridges

Before installation, the following steps occur:

• Clinical Stage: Cleaning and treating teeth (if necessary), anesthesia, tooth reshaping, impression-taking, and sending impressions to the laboratory.
• Fabrication: In the laboratory, a framework is made from zirconia, ceramic, or metal. The framework is then test-fitted if necessary. Digital protocols may include fitting a plastic prototype for checking aesthetics and fit, after which the prototype is returned to the laboratory.
• Veneering and Fitting: Veneering (for metal frameworks) occurs in the laboratory, followed by another fitting session to verify color, aesthetics, shape, and fit. (In digital workflows, the patient may receive the finalized version at this stage.)
• Installation: After final adjustments, temporary bridges are removed, and permanent bridges are installed.

Frequently Asked Questions about Dental Bridges

Patients frequently ask additional questions regarding dental bridges.  Here are some of the most popular ones, but if you don’t find your question here, you can make an appointment for a consultation, where your case and all related questions regarding prosthetics and more will be discussed individually.

What to Do if the Bridge is Loose?

Possible causes:

• The bridge has simply detached.
• The abutment tooth has decayed.
• The abutment tooth has fractured.

In the first case, simply visit your dentist to have the bridge reattached. Replacement usually isn’t necessary.

In the second or third cases, a longer bridge including additional teeth or implants may be required. Consult your dentist for detailed planning.

What should I do if I have tooth pain under my bridge?

You need to understand what is wrong with the tooth, so x-rays will need to be taken to assess the situation. If the tooth is alive, there is a high probability that it is pulpitis or periodontitis. If this is the case, nerve removal and root canal treatment will be required. The doctor may decide to treat the tooth through a crown (without removing the bridge), but this results in the bridge having to be “compromised” in some ways, but it will not break and will not need to be re-installed. Otherwise, there is a high chance of breaking the neighbouring teeth, after which you will only have to go through the implants.

What to Do if a Dental Bridge Falls Out??

Visit your dentist to evaluate the condition of abutment teeth. If they are in good condition, a new prosthesis can replace the old one. If not, treatment or alternative solutions such as implants or longer bridges may be necessary.

A dental bridge has broken – what to do?

If a bridge is broken, you have to remove it anyway, file it down and assess the teeth to see if they are suitable for re-dentures.

Which is Better: an Implant or a Bridge?

This decision depends on individual patient conditions. Implants are preferable if possible. However, bridges are a suitable alternative if complications arise, such as insufficient bone volume.

Is Removing a Dental Bridge Painful?

No, bridge removal is painless since the procedure is performed under anesthesia.

What is the Lifespan of a Dental Bridge?

The lifespan of a dental bridge depends on individual factors, hygiene, and care. On average, bridges last around 10 years but may vary significantly.

Should Front Teeth Have Separate Crowns or a Bridge?

This depends on clinical evaluation and patient preferences. Separate crowns generally provide superior aesthetics. However, bridges may be necessary if specific technical conditions require enhanced stability. Implants are typically preferred if conditions permit.