A dental bridge is a fixed prosthetic that replaces one or more missing teeth, effectively bridging the gap in the smile. This restoration involves a false tooth (pontic) anchored by crowns cemented onto the natural teeth on either side, known as abutment teeth. Braces are an orthodontic method used to systematically move and align teeth across the dental arch. The treatments can generally coexist, but this requires extensive and careful coordination between the restorative dentist and the orthodontist.
Feasibility Based on Bridge Design and Location
The ability to proceed with orthodontic treatment is heavily influenced by the bridge’s specific design and location. A bridge is engineered as a rigid, stable unit that resists movement, which is the direct opposite of what orthodontic forces attempt. The natural teeth connected to the pontic are splinted together, making individual or group movement of this unit virtually impossible or highly risky.
In a traditional bridge, the abutment teeth create a fixed anchor that cannot be shifted. Attempting to move them could shear the cement bond, damage the underlying natural teeth, or fracture the bridge material itself. The bridge unit must therefore be treated as a permanent, immovable fixture in the orthodontic treatment plan.
A cantilever bridge, anchored on only one side, presents a different biomechanical challenge. This design is generally weaker and more prone to rotational forces, which orthodontic wires and pressure can amplify. The location of the bridge also matters; a molar bridge must withstand higher chewing forces, which influences the orthodontic force direction.
Specialized Techniques for Moving Adjacent Teeth
Orthodontists employ specific methods to align surrounding natural teeth without jeopardizing the bridge’s stability. A primary consideration is the challenge of bonding brackets directly onto the bridge material, which is often porcelain or ceramic fused to metal. Since these materials do not etch like natural tooth enamel, a bracket bonded to the bridge may fail or damage the restoration upon removal. To navigate this, the orthodontist often avoids placing brackets on the bridge entirely, concentrating all movement on the adjacent natural teeth.
In cases where precise, localized movement is needed, sectional archwires may be used. These are short, localized wire segments that apply force to a small group of teeth instead of running a continuous archwire across the entire mouth. This allows for highly controlled movement near the bridge without engaging the fixed abutment teeth.
Temporary Anchorage Devices (TADs) represent another valuable tool in these complex cases. These tiny mini-screws are temporarily placed into the jawbone to serve as absolute anchorage. Using a TAD as a stable anchor allows the orthodontist to apply force to pull or push adjacent teeth into their correct positions independently of the bridge unit.
The Fate of the Dental Bridge After Orthodontics
A key aspect of having braces with a bridge is the near-certain need to replace the existing prosthetic once orthodontic treatment concludes. The primary goal of the braces is to shift the positions of the natural teeth, which inevitably changes the dimensions of the space where the pontic currently sits. Even minor movements in the surrounding teeth can alter the necessary width and contour of the replacement tooth.
The original bridge was custom-fabricated to fit the exact size and alignment of the mouth before any orthodontic forces were applied. Once the teeth have been straightened, the abutment teeth may have shifted slightly, or the gap spanned by the pontic may be wider or narrower than before. Consequently, the old bridge will no longer fit properly, making a new restoration necessary to ensure correct bite function and a seamless aesthetic result.
Planning for the new bridge begins before the braces are removed, with the orthodontist and restorative dentist working together to determine the final prosthetic size. Patients must factor the cost of a new bridge into the overall treatment budget. Replacing the bridge is the final step in a successful, coordinated treatment plan.