Dental Health Library Article
Cantilevers: Most Teeth - Fewest Implants
Restorative and Reconstructive Bridgework Dentistry
Dental bridges are a popular treatment choice for replacing one, a few or all teeth on a given jaw structure. Bridgework is available for the maxilla as well as the mandible.
The most common examples are those used to replace one or two teeth that are either missing or need to be extracted. These types of bridges are usually cemented to adjacent, healthy tooth structures, which serve as an abutment. In other instances, they may be supported by dental implants.
Cemented bridges pose the threat of becoming loose, and, in extreme cases, cause failure of the anchoring teeth. Implant supported bridges overcome this limitation.
|Click picture to watch bridge cementation
Each replacement tooth, or pontic, is attached to the crowns that cover the abutments or anchor ends of the bridge. As the span of a bridge increases (replaces 2-3-4 or more teeth) additional pontics are used to create the desired cosmetic result.
Metallic and Ceramic (Porcelain) Bridges
The infrastructure of the bridge will vary, depending on the length of the span. Most bridge substructures are either metallic or ceramic. Where the bridge is to be used plays a determining role in how the bridge is designed.
The Lava Bridge has become a well known and popular choice for attractive cosmetic outcomes since the entire structure is porcelain. Some dentists, nonetheless, may recommend a metallic bridge in areas of the jaw where biting and physical forces are significant.
For some patients, unnatural lateral forces arising from disturbed occlusal factors may be better suited for metallic bridgework. These same lateral forces can cause common bridgework to fail due to bonding leakages occuring at the anchor points of the bridge. As bacteria seep into and accumulate between the bonding surfaces, decay begins and makes eventual bridge replacement almost inevitable.
Treatment of missing teeth is normally recommended for all patients. Wisdom teeth are rarely treated... but may be required for some patients. Open gaps between teeth can cause teeth to shift and rotate. Occlusion can become disrupted. Severe movements and rotations of teeth can lead to tooth breakage if left untreated.
Going a step further, it is not uncommon for patients with malaligned or shifted teeth to develop disorders of the tmjoints. In extreme cases jaw positioning and jaw movement becomes affected which can create additional symptoms for one side or both sides of the jaw.
Missing teeth can also accelerate bone loss in the immediate area. Bone stimulation is required for maintaining healthy jawbone. When a tooth is removed, bone tissue in the extraction site typically begins to deteriorate eventually. The opposing tooth will typically super erupt, simulataneously causing the threat of bone and tooth loss issues for the opposing tooth.
A popular bridge used primarily for cosmetic reasons. A pontic (restorative tooth replacement) is fabricated to replace a missing tooth yet is configured to use a cementation process that attaches to the lingual surfaces of adjacent teeth.
Maryland Bridges are frequently used to bridge a missing tooth gap with an attractive tooth that nearly defies detection while underlying tissues are healing from bone and tissue graft surgeries.
As new bone (tooth extraction site is filled with bone matrix or a graft plug) becomes regenerated and stable, the bridge is replaced with a traditional dental implant, thereby recreating properties of bone stimulation that were lost when the tooth was extracted (avulsed, damaged, traumatized, etc.)
Because of intrinsic design and methods of cementation - attachment to anchor teeth, a bridge of this type is not particularly suited for areas of the jaw where occlusal forces are significant, as in chewing.
Articulation Analysis and Diagnostic Waxups
With good attention to detail and thorough articulation studies, bridgework can be fabricated to produce excellent aesthetics and dental function. Sizing and color shading requires close scrutiny. The use of temporary crowns and bridges can provide the ability to make adjustments in color shading.
|Ara Nazarian DDS, Troy MI|
Patients undergoing bridge and crown work are advised to view temporaries and final color shading selections under different light sources. Office lighting (fluorescent, incadescent) creates different effects, compared to sunlight or daylight.
Endurance levels for bridgework are highly varied and are affected by life style, eating habits, occlusal factors, oral health habits and the frequency of maintaining regular dental check ups. Bridgework has been known to fail in 2-3 years ... but has also been known to last 25 years and more.
Anchor teeth for a non implant supported bridge are prepared to be fitted with crowns, to which the missing teeth are attached. The anchor teeth are reduced in size and prepared with specialized bonding compounds.
Implant supported bridgework is the preferred treatment of choice for some, although cost can be a factor. For large spans or the entire length of the jawbone, fixed bridges are popular, but are serviced typically by the dentist.
|Click picture: One Day Bridge
Immediate Function or one day implant surgery enable some patients to have a full arch reconstruction started and completed in one treatment session. Watch this graphic video showcasing a Maxillary Arch reconstructive surgery involving extractions, grafting and implant placements... all completed in one office visit.
As with cemented bridgework, fixed bridges are subject to the same bacteria and decay issues. Thorough cleaning and inspection is usually performed by the dentist.
A newly developed fixed bridge, called the Marius Bridge, is reportedly designed to make a fixed bridge servicable by the patient.
|Click picture to watch fixed bridge animation
Once the implant framework is in place, the prosthetic portion, is inserted and locked into place with lock pins. Click here to watch an animated video demonstrating the procedure.
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