Procedure

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Effects of Tooth Loss

An adult tooth may be lost for a variety of reasons, such as periodontal disease, decay or trauma.  If a missing tooth is not replaced, the position of the adjacent teeth in the arch can begin to shift over time.  If a tooth is missing in the lower arch, the upper tooth which contacts that area may drift downward.  This Super Erupted tooth will eventually interfere with the patient's bite or damage the gingival tissue below.  A bridge is a fixed restorative structure used to replace missing teeth.  A bridge consists of a Pontic (false tooth) held in place by Abutments (crowns) which are cemented to the teeth on both sides of the space.  The materials used to create the bridge provide structural support to the arch and replicate the shade and contour of natural teeth, dramatically improving the patient's bite and smile.

Typically, local anesthesia is used.  The teeth on both ends of the space are reduced by 3-4 mm to accommodate the thickness of the bridge needed to withstand the pressures of chewing.  Every side of the prepared teeth must be parallel so the bridge will be able to slide over the remaining tooth structure as one unit.  This takes time, especially if more than two teeth are involved.

Once completed, a thin cord is placed around the prepared teeth between the edge of the prep and the adjacent gingival tissue.  The Retraction Cord temporarily pushes the gingiva off the tooth so the impression material can flow below the gum line.  It is removed just prior to the impression.  A full arch impression is made of the area.  An impression of the opposing arch and a bite impression are also taken so the dental lab can match the bite of the bridge to the existing dentition.  Depending on the case, a temporary bridge or temporary crowns are made for the patient to wear while the lab fabricates the final product.

If requested by the Dental Lab Technician of the Dentist, an additional visit may be required for a Metal Try-In.  Prior to this appointment, the lab will have casted a thin layer of metal called a Coping to fit directly over the prepared teeth.  The Dentist removes the patient's temporary and gently sets the coping to place, checking the margins and making sure the framework fits properly.  A new bite impression is taken with the coping in place.  It is then removed and the temporary re-cemented.  This extra step ensures a proper fit at the final appointment and is essential on large or complicated cases.

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Three Unit Bridge

Next appointment, the patient returns for bridge delivery.  At this appointment, anesthesia is not necessary, but available to the patient if they wish.  The temporary is removed, and the prepared teeth are cleaned of cement and debris.  The new bridge is placed, and all aspects of its fit are checked by the Dentist.  Minor adjustments are made chairside to allow for the best fit and most natural feel.  Then the final bridge is cemented in place, restoring the arch back to its natural function and appearance.

 

Types Of Bridges

At the offices of Dr. Mark Freeman & Associates, our bridges are created by trained dental lab technicians which we work very closely with to get the best results for our patients.  The technicians are truly artists who make sure a bridge not only functions in the patient's arch, but looks like natural tooth structure.  Today, modern dentistry is capable of providing the patient with several different types of bridges to choose from based on the needs of their particular case.

Conventional Fixed Bridge

Conventional Fixed Bridges are historically the most common type of bridge produced.  It is composed of a Pontic (false tooth) with Abutment Crowns attached to either side.  A thin layer of metal is casted by the lab to fit directly over the prepared teeth.  This Coping can be made out of many different metals;  however, our Doctors use only Nobel or High Nobel metals to lessen the chance of patients having metal allergies to the substance.  The metal coping increases the strength of the bridge and internally connects the units together as one.  Onto the coping, porcelain is layered to shape the bridge and create the look of natural tooth structure.

Cantilever Bridge

Occasionally when planning a fixed bridge, it is impossible to end the bridge with an abutment crown.  In this case, a Pontic (false tooth) may extend off the end of a cemented Abutment Crown without an attachment on the other side.  For this to be possible, the Cantilever Bridge must have the support of more than one Abutment Crown on one side of the Pontic or the tooth the Pontic is attached to must be larger and stronger than the Cantilever Pontic itself.  Also, it is best if the Pontic is a smaller, non-functioning tooth and kept out of heavy occlusal (chewing) forces.

All Ceramic Bridge

All Ceramic Bridges are becoming more common in modern dentistry, especially with Anterior (front) teeth.  As new materials develop, their strength and esthetics continue to improve.  Made completely out of various glass and porcelains, the lab technicians are able to create beautiful three-dimensional esthetics.  All Ceramic Bridges are recommended for areas of light occlusal (chewing) forces and minimal excursion (side-to-side) movements.

Resin Retained Bridge (Maryland Bridge)

In some cases, it may not be necessary to prep all sides of the adjacent teeth for Abutment Crowns.  Resin Retained Bridges are bonded to the lingual (tongue) side of the teeth adjacent to the missing tooth.  In these cases, only the lingual sides of the adjacent teeth are prepped before the impression.  The dental lab technician creates a Pontic (false tooth) with thin metal Wings projecting from either side.  When in place, these wings set against the lingual side of the adjacent teeth and do not affect the esthetics of the area.  A mild etching solution is applied to the lingual enamel of the adjacent teeth.  This solution roughens the surface microscopically which allows for a stronger bond between the tooth and the resin cement.  Next, a bonding agent is placed on both the tooth and the wings of the Resin Retained Bridge.  The wings are loaded with resin cement and pressed into the correct position.  The excess resin is removed, and ultra-violet light is used to harden the material.  The area is then polished.  Resin Retained Bridges can only be used in areas of low occlusal (chewing) forces.  Although less in initial cost, patients should be aware that the life expectancy of Resin Retained Bridges in not that of a Conventional Fixed Bridge.

 
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