Case study: replacing a front missing tooth with a bridge
This patient had a tooth that was damaged in an accident/trauma and could not be saved. We discussed options to replace the missing tooth, and the patient opted for a bridge as it was the most comfortable and aesthetic option within her budget.
The tooth adjacent to the missing tooth was used as a ‘retainer’ (a support for the bridge). This tooth was reshaped to create space for the bridge.
This photo shows the extracted tooth and the adjacent tooth trimmed back for a bridge.
After this, the bridge was cemented on. The photos show the final result.Discussion
The effects of removing a tooth
Removing a tooth causes both gum recession and bone loss. The time it takes for these changes to occur varies between 3 and 12 months.
As the gum recedes, a gap may appear between the top of the pontic (the false denture tooth) and the gum. This gap may be noticeable or subtle. If aesthetics become a concern over time, the patient may require a new bridge.
Alternatively, a temporary denture can replace the missing tooth during the healing phase (3–12 months), with a permanent bridge fitted once the gum has fully settled.
Other options
The patient was also presented with other options to replace the missing tooth:
Removable dentures:
Advantages: Completed in a few weeks, unlikely to need surgery, and low cost.
Disadvantages: May be unstable, sometimes intolerable, must be removed every night and reinserted every morning, accumulate plaque easily, and do not prevent bone loss.
Fixed bridges:
Advantages: Completed in a few visits, unlikely to need surgery, and provide fixed, immovable support.
Disadvantages: May require cutting into healthy teeth; if the supporting tooth is compromised, the entire bridge may need to be replaced; and does not prevent bone loss.
Implants:
Advantages: Provide fixed support that does not move, eliminate the chance of further decay, do not require cutting into healthy teeth, and prevent bone loss.
Disadvantages: Involve a prolonged treatment time and require surgery.
What is a dental bridge?
A dental bridge is used to close a gap created by one or more missing teeth. It consists of a crown and an attached false tooth that fills the gap. The supporting tooth is prepared and reshaped into a peg, and an impression is taken so that a custom bridge can be fabricated.
Aesthetics while having the bridge made
To ensure the patient was not left with an unsightly gap and peg, a temporary restoration was placed so she could continue working and socializing without embarrassment.
Options of materials
Our patient opted for a PFM (porcelain fused metal) bridge, where porcelain is fused over metal.
PFM bridge – Porcelain Fused to Metal. PFM bridges can be bulkier, with visible metal margins, and tend to appear more opaque.
Zirconia bridge
Zirconia bridges are thinner yet stronger, requiring less drilling of the supporting tooth. They are more aesthetic, as they do not contain metal and offer translucency that mimics natural teeth, although they are more expensive.
Maintenance of your bridge
A dental bridge should be maintained like your natural teeth: brush twice a day with fluoride toothpaste and visit your dentist or hygienist regularly.
Cleaning under the bridge is best done with superfloss, which requires a special technique. Learn how to use superfloss.
Pain
Our top priority is to ensure that treatment is as safe, comfortable, and pain-free as possible. This case was managed with that principle in mind.