A dental bridge is a fixed prosthetic device designed to replace one or more missing teeth, effectively “bridging” the gap. It consists of an artificial tooth, called a pontic, held in place by crowns cemented onto natural teeth or implants (abutment teeth) on either side of the space. While these restorations are intended to be long-lasting and semi-permanent, they can and sometimes must be taken out by a dental professional. Removal is generally a controlled procedure necessary when the bridge or its underlying supporting structures begin to fail, requiring intervention for the overall health of the mouth.
Common Reasons Dental Bridges Need Removal
The longevity of a dental bridge averages between five and fifteen years, but its lifespan can be cut short by several issues requiring professional removal. The most frequent reason a bridge must be taken out is the development of tooth decay (secondary caries) underneath the crowns covering the abutment teeth. If bacteria infiltrate the margin where the crown meets the tooth, the decay compromises the supporting tooth’s integrity, necessitating removal to treat the underlying cavity.
Poor fit or marginal leakage over time can also lead to failure. A restoration that does not seal tightly allows oral bacteria and fluids to seep underneath, causing decay of the prepared tooth or inflammation in the surrounding gum tissue. Mechanical failures, such as a fracture or chip in the bridge’s material or framework, can also mandate removal, especially if the damage affects structural integrity or causes irritation.
Changes in the surrounding oral anatomy, such as gingival recession, may expose the tooth root or crown margin. This often necessitates removing the bridge for aesthetic reasons or to prevent future biological issues. Furthermore, a bridge that has become loose because the dental cement bond has worn down may need to be removed to be thoroughly cleaned, inspected, and then recemented, provided the bridge and the abutment teeth are still in good condition. Ultimately, removal is typically required to access and treat an underlying biological or structural problem that cannot be fixed while the fixed restoration remains in place.
Techniques Dentists Use to Remove a Bridge
Removing a dental bridge requires specialized instruments and techniques designed to minimize trauma to the abutment teeth and surrounding tissues. The approach depends on the cement strength, the bridge’s condition, and whether the restoration will be reused or replaced. If the cement bond is weak or the bridge is loose, the dentist may attempt a non-destructive removal using devices that apply controlled force.
These conservative methods often involve tools used to disrupt the cement seal. Specialized crown and bridge removal pliers grip the restoration and apply a controlled tug parallel to the tooth’s long axis. Pneumatic or air-driven devices, such as the CORONAflex system, apply mechanical impacts or vibrations to disrupt the luting cement without damaging the bridge material.
Another non-destructive technique involves the use of ultrasonic energy. Vibration applied at the crown margin helps break down the cement lute, allowing the bridge to be gently lifted.
However, if the bridge is securely bonded with a strong resin cement or must be removed to treat decay, a destructive removal method is often required. This involves a controlled cutting of the bridge material, typically performed with a high-speed dental handpiece and a carbide or diamond bur. The dentist carefully sections the bridge—often by cutting through the pontic-to-retainer connector and then through the crown itself—to create a space to leverage the pieces apart. Local anesthesia is administered beforehand to ensure the patient is comfortable throughout the process.
What Happens After the Bridge is Removed
Once the dental bridge is removed, the focus shifts to assessing the condition of the exposed abutment teeth. The dentist thoroughly cleans the prepared teeth, removing all remnants of old cement and debris. A detailed examination and new X-rays are performed to check for decay, structural cracks, or fractures that necessitated the removal.
Treatment of the abutment teeth is then completed, which may range from placing a simple filling to address minor decay, to performing root canal therapy, or in severe cases of damage or bone loss, extracting the tooth entirely. To protect the exposed, prepared teeth and maintain the spacing in the arch while a new long-term solution is planned, the dentist will place a temporary restoration. This temporary appliance might be a temporary crown, a temporary bridge, or a partial denture.
The final step involves deciding on the permanent replacement, determined by the health of the abutment teeth and the patient’s overall needs. Options include fabricating a new traditional bridge or transitioning to an alternative like a dental implant. Implants are often preferred because they do not rely on adjacent teeth for support, preserving more natural tooth structure.