Case study: replacing a front missing tooth with a bridge
This patient had a tooth that was damaged after 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 that suited her budget.
The tooth adjacent to the missing tooth was used as a ‘retainer’ (i.e., a support for the bridge). This tooth had to be 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 teeth causes gum shrinkage (receding gums) and bone loss. The time required for the bone and gum to shrink varies between 3 and 12 months.
As the gums recede, a gap may form between the top of the pontic (the false denture tooth) and the gum. This gap can be noticeable or subtle. If the aesthetics are compromised over time, the patient may need a new bridge.
Alternatively, a temporary denture could replace the missing tooth during the healing phase (typically 3–12 months), with a permanent bridge fitted once the gum has settled.
Other options
The patient was also given other options to replace the missing tooth:
Removable dentures:
Advantages: Completed in a few weeks, unlikely to require surgery, and low cost.
Disadvantages: May be unstable, sometimes intolerable, need to 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 require surgery, and provide fixed, immovable support.
Disadvantages: May require cutting healthy teeth; if the supporting tooth is compromised, the entire bridge may need to be redone; and do not prevent bone loss.
Implants:
Advantages: Provide fixed support that does not move, eliminate the chance of further dental decay, do not require cutting into healthy teeth, and prevent bone loss.
Disadvantages: Have a prolonged treatment time and require surgery.
What is a dental bridge?
A dental bridge is fitted to close the gap left by one or more missing teeth. It consists of a crown and an attached false tooth that ‘bridges’ 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 whilst having the bridge made:
To ensure the patient isn’t left with an unsightly gap and peg, a temporary restoration was placed, allowing the patient to work and socialize without embarrassment.
Options of materials:
Our patient opted for a PFM (porcelain fused metal) bridge, which is made by fusing porcelain over metal.
PFM bridge – Porcelain Fused to Metal. PFM bridges can be bulkier, with visible metal margins and a more opaque appearance.
Zirconia bridge
Zirconia bridges are thinner yet stronger (requiring less drilling of the supporting tooth) and more aesthetic, as they do not contain metal and have translucent properties that closely mimic natural teeth, though they are more expensive.
Maintenance of your bridge
A bridge should be cared for just 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 floss using superfloss.
Pain
Our top priority is to ensure that treatment is safe, comfortable, and pain-free. This dental treatment was carried out with those principles in mind.