Dr Anthony Mobasser is a top expert in dental bridges during his 35 years in practice, replacing missing teeth, and replacing tooth loss with Implant or conventional bridge in his Los Angeles based cosmetic and restorative dental practice. Dental bridge is the gold standard to replace missing teeth (the Pontics). It is a fixed prosthesis as opposed to removable prosthesis and it is used to replace one or more missing teeth. Bridges can be placed on two natural teeth (the abutments), or it can be placed on dental implants, in some cases combination of natural teeth and implant can also be used. In order to have a bridge the patient must have the adjacent teeth next to the missing tooth. Dr Mobasser is considered an expert since he has placed over 7000 bridges during his practice. When it comes to replacing missing teeth there are few options, which all must be considered. Options such as tooth implant or removable bridge are alternatives to having fixed bridge.
Besides the aesthetic benefit, in regards to total health aspect: whenever a tooth is lost, it is best to restore the missing tooth as soon as possible within one month of healing. If the time elapse is longer, the teeth next to the missing teeth will shift AND the opposing tooth can extrude down into the empty space. This domino effect causes interference on your bite, and due to shift on the axial inclination of teeth, gum or Periodontal disease can start, however none of these conditions reveal any discomfort to the patient, until it is in the advanced stage, and host of many other problems occur. Usually after extraction of teeth, It is highly advisable to even have a temporary bridge placed as soon as possible, within one or two weeks to stop shifting of teeth, and prevent bite damage, until the area of extraction heals, and the one is ready to replace the temporary bridge with the final permanent bridge.
Fixed Bridge vs Dental Implant
If the adjacent teeth next to missing tooth is virgin, meaning they are cavity free, and there is not any large fillings on them,and you have sufficient bone (after checking the xrays), dental implant is a good choice. However if the teeth next to missing tooth already have a dental crown, or very large restoration that require a crown anyway, or you want to avoid surgery, then the bridge will benefit your needs.
What Are The Pros and Cons of Dental bridges?
The pros include, but not limited to the following :
- Time, It takes usually a week to get the permanent bridge done.
- Aesthetics, In the hands of an Expert dentist, and Ceramist, the new bridge highly resembles your natural tooth structure,or if the patient desires a brighter color.
- No surgery is needed to replace missing teeth, No foreign object or Implant is necessary, and will not compromise the health of the individual, It is Bio compatible ( since now Ceramic bridges are available),
- Prevention of Occlusal Disease or bite problems can be corrected via porcelain bridge, avoiding shifted teeth or bite interference, causing TMJ, or Loose , mobile teeth.
The Cons include:
- The teeth holding the Bridge (The Abutments) must be reshaped and prepared all the way around, 360 degrees. Having said that, If the adjacent teeth next to the missing teeth already have dental crowns, then that is not a Disadvantage. With the same token , if the adjacent teeth have large leaking, unsatisfactory fillings, then that is also a favorable advantage to place a bridge, since the adjacent teeth will be requiring Crowns anyway!
- Bridges also must be placed on teeth that are not compromised, and have good bone Support ( meaning the crown to root ratio ) is favorable, and there is not much bone loss.
- The preparation of the teeth holding the bridge, is of vital importance, since preparation is needed, the expertise of the dentist, not to over prepare the teeth,and create parallelism and retention on the abutment teeth can bring success or failure! a dental bridge or crowns is usually cemented in, therefore if a bridge comes out, usually it is because of lack of retention during preparation. Over preparation of teeth usually results in failure or possibly root canals.
- The Cost of Dental bridge is usually more compared to a dental implant, or dental crown. Depending on how many teeth bridge is involved, or the location in the mouth, and the health of the existing teeth, and most importantly the expertise and the experience of the dentist.
What are the best types of Dental Bridges? Do I Have Options ?
Usually there are 4 types of bridges:
- Conventional bridges: They require preparation on the anchoring teeth and covers fully the anchor teeth to hold the missing teeth, they are the gold standard of dental bridges and more predictable, compared to others. they can be fabricated with porcelain fused to metal or gold ( PFM or PFG ), or with all porcelain or Ceramics.
- Maryland Bridges :They are much more conservative than conventional bridges, very little tooth structure is removed from the anchoring teeth, they conserve tooth structure, no sensitivity or discomfort with that type of bridges, however they can come out or dislodge. It works great as an interim bridge, between 3 to 5 years however per Dr Mobasser, there are Maryland bridges that have stayed in more than 15 years, again expertise, the when and where in the mouth to use them, adds to longevity.
- Cantaliver Bridges: These types of bridges can be great help when there is no tooth adjacent to the missing tooth or teeth. It must be used judiciously, and the health of the abutment teeth holding the missing teeth must be favorable. Cantilever bridges are also used with dental implants, if the dental implant is well osseo integrated and is long enough in the bone.
- Inlay Onlay Bridges; These are great service to patients in which the adjacent teeth have large fillings, and patient does not want much tooth structure to be removed. Works well, bit analysis and lack of para functional habit ( clenching and grinding) must be evaluated prior choosing this conservative bridge.
- Ceramic bridge or all porcelain bridge: it is utilized for short span restoration of missing teeth, such as one or 2 teeth, longer span missing teeth is usually not advisable to have ceramic or all porcelain bridges. Currently Zerconia or lava bridges are mostly used, however some disilicate lithium bridges, (Emax bridge) is also used on a short span bridges.
How Can a Porcelain Bridge Fail, or have pain?
The correct treatment plan is vital to longevity of the bridge, which depends on how many teeth are missing?, the number of teeth holding the bridge? the health of those teeth? the level of the bone, and the length of the roots of the teeth holding the bridge, the bite (occlusion) and the material used to construct the bridge. All dental restorations require proper oral hygiene, and maintenance treatment by the treating dentist, to insure lasting a long time survival of the dental restoration and eliminating pain. Most failures or pain from your bridge is due to heavy bite, para functional habits such as grinding, the wrong use of newly porcelain materials, such as zerconia, and trauma from heavy bite that can cause failure or fracture. Porcelain Bridges with long span, ( more than 4 teeth involved) using Zerconia, or lithinum disilicate materials ( lava, or Emax) is usually not recommended, since it has not been tested and usually is not recommended by the manufacturers. Conventional bridges using gold or other metals as substrate is recommended for long span bridges which has been tested over time. Possibility of recurrent decay on the root of anchoring teeth exists, if the patient does not use Bridge threaders , to clean the plaque which can cause decay to the root of anchoring tooth holding the bridge, and can cause failure. Bridges can come out if the teeth are over prepared by the doctor, or teeth are very short to begin with, and they might need replaced.
What are the reasons a person cannot have a Fixed bridge?
Some of reasons a fixed bridge will not be recommended for a patient are the following:
- Lack of bone to support the missing tooth or teeth, if you do not have ample bone on your anchor teeth to support the missing tooth, you can loose those anchor teeth also!
- Also if the bridge is a long span bridge, missing many teeth, and even though the bone around the supporting teeth are good, you can loose the anchor teeth, or cause mobility once the porcelain bridge is constructed, due to your bite and occlusion.
- If the patient wishes to floss each individual tooth, and do not want to use a bridge threader to clean underneath.
- If there is one missing tooth, and the teeth next to missing tooth is healthy and no large filling on them, it is best to preserve the tooth structure and simply do implant ( implant can have their own contraindication also).
Are cantilever bridges worth considering?
Cantilever bridge is a type that the missing tooth is supported in one end, without being anchored to the adjacent tooth behind it. Cantilever bridges works on many instances, the most important factor is the health of adjacent teeth in front which is supporting the bridge. The amount of bone and long roots concurrent with the occlusion must be considered prior to having a cantaliver bridge as one of the last options, since the patient is not a candidate for implant due to many reasons.
Cantilever bridge can also be an interim bridge treatment till the patient have an implant done! We usually evaluate if you are a candidate to receive this bridge treatment in case the missing tooth are on the upper back teeth, and due to proximity of sinus cavity, or other factors, patient does not want to have a dental implant or surgical intervention!
Root canal and new crown vs implant or bridge?
If you can salvage your tooth, it is always the best decision, even if you need to pay extra! If the prognosis of your tooth is good, meaning the dentist would do that to his own tooth first although not 100% ( nothing lasts forever), always go with saving your tooth, if down the future you need to extract, then you do! to either have a bridge or implanted supported crown. Porcelain bridge is immediate vs dental implants which is surgical intervention, and time is involved.
Please be advised you need to see an expert knowledgeable dentist that have done complete evaluation with clinical exam, bite analysis and xrays prior advising you for the pros,cons, risks, and benefits.