A bridge is used to fill a gap left by a missing tooth or teeth. It is fixed in place, unlike a denture, so once it has been fitted, you don’t take it out.

You might choose a bridge if you have a tooth or teeth missing. There are various reasons why people lose teeth: for example, you might have had extensive dental decay or severe gum disease that ultimately lead to you having teeth extracted; or you might have had a traumatic injury where a tooth was knocked out. Bridges aren’t the only option. It’s probably easiest to explain the relative merits of the different treatment choices by looking at them all together:

Don’t – This means accepting the space as it is. It’s not a very good option for various reasons. If the gap is near the front of the mouth it’ll be visible when you smile or speak. Many people regard this as unacceptable and disfiguring. A gap at the back of the mouth may make a real difference to your eating. Either can affect your speech; and in both cases the teeth either side may lean over into the space, changing the way you bite together and giving rise to other problems.

A denture– This is usually the cheapest treatment option. It’s also least invasive – IE you don’t need to cut into the teeth or bone to make it – and conserving tooth structure is regarded by dentists as a very good thing. However, it’s not so good for your dental health. Dentures tend to accumulate food debris which can lead to more decay and gum disease unless you maintain excellent oral hygiene. They can also be difficult to live with because they affect what you can eat and can move when you’re speaking. Then there’s the fact that many of us just hate the idea of a removable denture: it’s synonymous with old age for most people.

Implants – Implants are usually the most expensive treatment option because they involve a difficult surgical procedure. However, they are drilled directly into the jaw bone or maxilla so there’s no need to prepare the teeth either side of space, which conserves tooth structure. Implants have a high success rate and generally have a good long term prognosis. Nonetheless, there are risks associated with them. Sometimes they fail because the bone around them begins to disappear. They’re also vulnerable to gum disease – peri-implantitis is not uncommon and extremely difficult to treat, meaning that they have to be kept meticulously clean. Depending on the system used it often takes months to complete the treatment. They’re also unsuitable for people with bone loss (which is not uncommon) or a history of gum disease.

A “Conventional fixed-fixed” or “Cantilever” bridge – Here, the teeth either side of space (just one in the case of a cantilever) are used to anchor the bridge in place. Dentists call them “abutments” or “retainers”. They act as the supports and the gap left by the missing tooth or teeth is filled in with an artificial tooth called a “pontic”. The abutments are prepared for crowns. The bridge is a single piece, with the crowns joined to the pontic(s). The bridge is permanently bonded in place by the dentist, so it is not removable. Because the retainers are prepared for crowns, some tooth structure is lost; though this may not be so important if those teeth already have fillings or decay in them. A conventional bridge is more expensive but quicker to make than a denture. It is quicker and cheaper than an implant. The long term survival rates for conventional fixed bridges are good and they are likely to last many years1.

A “Maryland” or “Adhesive” or “Resin bonded” bridge– Here, the missing tooth or “pontic” isn’t connected to crowns but instead it has “wings” that are bonded to the back of the neighbouring teeth. That means the teeth either side are not heavily prepared, so most of the tooth structure is preserved. The bridge is bonded in place and the procedure is non-invasive so often you don’t even need anaesthetic. It is a quick and simple process and usually the cheapest option for a “fixed” restoration. Adhesive bridges can de-bond, though if they do it’s fairly easy to put them back in. They’re about the same price as a partial denture but quicker to make. They’re both quicker and cheaper than an implant; though they probably won’t last as long before they need to be bonded back in found here.

Porcelain Bonded (sometimes called Porcelain Fused to Metal or “PFM”) – This is a traditional type of dental bridge construction. It’s slightly cheaper but has a metal base so the aesthetics are less good and the margin may begin to show in the longer term. It used to be thought that PFM bridges were stronger than all-porcelain but materials science has advanced to the point where that’s no longer really true, so we recommend all-porcelain designs in almost all situations.

All-porcelain – Is slightly more expensive but has better aesthetics – because there is no metal, the margin is less visible and the finished bridge has greater translucency and depth of colour, meaning that it looks even more realistic. It is particularly good for anterior (front) teeth because a bridge on your front teeth is very visible and needs to look realistic. All-porcelain bridges are as strong as PFM bridges these days, meaning they are the bridge of choice in almost all cases.

With an adhesive bridge, the choice is between metal wings (which are cheaper but can shine through the neighbouring tooth and make it look a little grey) and tooth-coloured wings (which are more costly but effectively invisible to anyone looking at you).

This depends on the type of bridge chosen and how many missing teeth are being replaced (it’s sometimes more than one). Current prices are given on our website and on display in reception. The cost of your bridge will be given on your personalised estimate / treatment plan.

As a rough guide, conventional fixed-fixed bridges start from £3,750; conventional cantilever designs start from £2,500 and adhesive bridges start from £1,950.

Bridges are generally very durable and hard-wearing – they usually last over 10 years and we have patients whose bridges have lasted 20 years or even longer. We guarantee them for the first year.

Published studies show that for conventional fixed-fixed bridges, survival rates are 93.8% at 5 years and 89.2% at 10 years (1).

For cantilever designs (only attached at one end) the survival rates are 91.4% at 5 years and 80.3% at 10 years (1).

For adhesive bridges, the survival rate is 87.7% at 5 years (2).

Many factors affect the longevity of bridges. For example:

• How good your oral hygiene is;
• Grinding your teeth;
• Where the bridge is located in your mouth; and
• How heavily your teeth come together when you bite.

It’s impossible to predict with certainty how long a bridge will last.

References:

1 Pjetursson, BE, Brägger, U, Lang, NP and Zwahlen, M (2007). Comparison of survival and complication rates of tooth-supported fixed dental prostheses (FDPs) and implant-supported FDPs and single crowns (SCs). Clinical Oral Implants Research 18 Suppl. 3, 97-113.

2 Pjetursson, BE, Tan, WC, Tan, K, Brägger, U, Zwahlen, M and Lang, NP (2008). A systematic review of the survival and complication rates of resin-bonded bridges after an observation period of at least 5 years. Clinical Oral Implants Research 19, 131-141.

An existing bridge may need to be replaced because:

• A retainer may have secondary decay around or beneath the bridge. This requires treatment to deal with the decay; also the “margins” of the bridge may begin to look dark and will no longer be aesthetically acceptable.
• An old bridge may have broken or chipped.
• The bridge may no longer be the right shade – for example, the other teeth may have darkened so the bridge is no longer a match and looks out of place.

It could be left untreated, but any damage or decay will get worse and the tooth may end up needing root canal therapy (RCT) if left unrestored. Any colour mismatch will also probably worsen.

If the bridge is replaced, then the different types of new bridge to choose from, their pros and cons, the cost and their expected longevity are the same as for a first bridge (see above).

Brush your teeth with fluoride toothpaste last thing at night and at least one other time during the day and cut down on how often you have sugary foods & drinks. Also, visit your dentist regularly – as often as they recommend. This will help keep all your teeth in good condition.