A fixed dental bridge is a non-removable dental restoration designed to replace one or more missing teeth by bridging the gap in the dental arch. This method restores function, helps maintain the natural shape of the face, and prevents remaining teeth from shifting into the empty space. It is cemented into place and cannot be removed by the patient. The bridge unit is held securely by the teeth or implants adjacent to the missing tooth space.
Defining the Fixed Dental Bridge
A traditional fixed dental bridge consists of three primary components. The missing tooth is replaced by an artificial tooth called a pontic. This pontic is supported by crowns placed over the natural teeth or implants on either side of the gap, which are known as abutment teeth. The crowns act as anchors, securing the structure firmly in the mouth.
The bridge is fixed because it is permanently cemented onto the prepared abutment teeth. A variety of materials are used, chosen for their strength, durability, and aesthetic qualities. Common materials include porcelain fused to metal (PFM), which offers a balance of strength and natural appearance, or all-ceramic options like zirconia. Gold and other metal alloys may also be used, particularly in areas of the mouth where strong biting forces are exerted and aesthetics are less of a concern.
Different Types of Fixed Bridges
Other designs exist to accommodate different clinical situations. The Cantilever bridge is used when a strong, healthy abutment tooth is available on only one side of the missing tooth gap. This design is reserved for areas of the mouth that receive less stress from chewing, such as the front teeth.
A Maryland bonded bridge, also called a resin-bonded bridge, is a more conservative option that requires minimal alteration of the adjacent natural teeth. Instead of full crowns, this type of bridge uses a metal or porcelain framework with wings that are bonded to the back surfaces of the adjacent teeth. This approach is used to replace single front teeth where biting forces are lower, but it is less structurally durable than a traditional bridge.
When natural teeth are not suitable to support a bridge, an implant-supported bridge utilizes dental implants as the anchors. The implants, which are surgically placed into the jawbone, serve as the abutment structures instead of natural tooth roots. This method is recommended when multiple teeth are missing in a row and offers a high degree of stability and preservation of the jawbone.
The Process of Bridge Placement
The placement of a traditional fixed bridge typically requires two appointments spaced about two weeks apart, allowing time for the custom fabrication of the restoration. During the initial appointment, the dentist prepares the abutment teeth by reshaping and reducing their enamel. This preparation is an irreversible step necessary to create a foundation for the bridge.
After the teeth are prepared, the dentist takes an accurate impression of the area, which is then sent to a dental laboratory. This impression serves as the blueprint for the lab technicians to craft the final, custom-fitted bridge, matching the color and shape to the patient’s existing teeth. A temporary bridge is then placed over the prepared teeth to protect them and maintain the space.
The second appointment involves the fit and cementation of the final prosthesis. The temporary bridge is removed, and the dentist checks the fit, bite alignment, and appearance of the permanent bridge. Once all adjustments are complete, the fixed bridge is permanently bonded to the abutment teeth with a strong dental cement.
Daily Care and Longevity
Proper daily maintenance is a factor in extending the functional life of a fixed bridge, which can range from 5 to 15 years with optimal care. Brushing twice daily with fluoride toothpaste helps maintain the health of the abutment teeth and surrounding gum tissue. However, the area directly under the pontic, where the artificial tooth meets the gumline, is inaccessible to standard dental floss.
To clean this specific area, specialized tools are necessary to thread under the bridge and remove plaque and food debris. These include floss threaders, which are plastic loops used to guide regular floss beneath the pontic, or interdental brushes, which are small tapered brushes designed to clean tight spaces. Water flossers are also highly effective at flushing debris from beneath the restoration and around the supporting teeth. Regular dental check-ups are important, allowing the dentist to monitor the bridge’s integrity and the health of the supporting teeth and gums.