Case study – replacing a front missing tooth with a bridge

Case study: replacing a front missing tooth with a bridge

This patient had a tooth which had been damaged after an accident / trauma which 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 shaped in order to make space for the bridge.

This photo shows the tooth having been extracted and the tooth next door to it having been trimmed back for a bridge.

Before dental bridge pfm2
After this, the bridge was cemented on. The photos show the final result.

 

After dental bridge pfm

After dental bridge pfm2

Discussion

The effects of removing a tooth

Removing teeth causes gum shrinkage/receding gums the bone shrinkage too. The time it takes for the bone and gum to shrink varies between 3 and 12 months.

As the gum shrinks the patient may notice a gap between the top of the pontic (the fake denture tooth) and the gum. This maybe unnoticeable or noticeable. The patient, if she is unhappy with the aesthetics with the bridge over time might need to have a new bridge made and fitted.

The other option was to have a cheaper option, such as a denture to replace the missing teeth for the first 3-12 months whilst the gum heals, and once it has all settled, to make a permanent bridge.

Other options

The patient was also given other options to replace the missing tooth:

Removable dentures:

Advantages:

Completed in a few weeks

Unlikely to need surgery

Low cost

Disadvantages:

Maybe unstable

Sometimes cannot be tolerated

Needs to be removed every night and reinserted every morning

Accumulates plaque or food more easily

Does not prevent bone loss.

 

Fixed bridges:

Advantages:

Completed in a few visits

Unlikely to need surgery

Teeth are fixed and immovable

Disadvantages:

May require cutting healthy teeth

If the supporting tooth is compromised the entire bridge will need to be discarded.

Does not prevent bone loss

Implants:

Advantages:

Teeth are fixed and do not move

No chance of further dental decay

Does not require cutting into healthy teeth

Prevents bone loss

Disadvantages:

Prolonged treatment time

Requires surgery

What is a dental bridge?

A dental bridge is fitted when you have a gap made by one or more missing teeth. A bridge is made up of a crown and a false tooth attached to ‘fill’ the gap.

The patients supporting tooth was prepared and will shaped into a peg and then an impression was taken so your bridge can be made using this.

Aesthetics whilst having the bridge made:

The patient was not left with a gap and a peg, The Dentist placed a temporary in its place, so that the patient can still work and socialise without embarrassment.

Options of materials:

Our patient opted for a PFM (porcelain fused metal) bridge which is porcelain over metal.

PFM bridge – Porcelain Fused to Metal

PFM bridges can be more bulky, metal margins can show, they can be more opaque.

Zirconia bridge

Zirconia bridges are thinner yet stronger (so require less drilling of the supporting tooth), more aesthetic (they do not contain metal and have more translucent properties to match natural teeth), but more expensive.

Maintenance of your bridge

A bridge should be looked after the same way as your natural teeth, brush your teeth 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: Here is how to floss your teeth using super floss.

Pain

As always our top priority is to make treatment as safe, comfortable and pain free as possible. This dental treatment was carried out in such a way.

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