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Restorative Treatment: Fixed Partial Denture (Bridgework)
Our Restorative Treatment services include:
Click on one of the linked procedures to read more about our specific services.
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A “Bridge” or Fixed Partial Denture is a non-removable restoration that is used to replace missing teeth. By replacing a missing tooth or multiple teeth, the fixed bridge subsequently also aids in maintaining arch formation, preventing tooth drift and super-eruption, enhancing chewing function, restoring occlusion and balance chewing forces, preventing un-natural wear of natural teeth, reducing or eliminating speech impairment, all while filling the space where the original natural tooth had been lost. A fixed partial denture (fixed bridge) might also be an upgrade or replacement of a previously worn removable partial denture. There are several types of bridges in regards to both material from which they are fabricated as well as the bridge design configuration. The most popular types of bridges made today are: a) Porcelain fused to metal bridges and b) All-Porcelain Bridges. Both are fairly similar in design configuration, but the Porcelain fused to metal bridge over a long span of linear space will have strength advantages. The All-Porcelain Bridge is ideal for coverage of shorter spans of linear space and has a more natural, life-like appearance. The design configuration in simplest terms precludes that there must be natural teeth on either side of the gap to be bridged. These teeth are known as abutments and the bridged tooth that will ultimately fill the gap is known as the pontic. There can be multiple abutments and multiple pontics depending on the linear length of the span to be bridged.
Fixed Partial Denture/Bridgework fabrication typically requires three visits, but can require many more visits depending on the amount of teeth to be replaced and the amount of abutments deemed necessary to support them. There might also be a provision in the treatment plan to mix a Fixed Partial Denture with a Removable Partial Denture, requiring additional visits. For the sake of simplicity, we will limit this procedural explanation to a Three Unit Bridge, where we have two abutment teeth and one pontic. This procedure generally requires the administration of a local anesthetic prior to commencement. The abutment teeth are prepared in an identical fashion as previously described in crown preparation, namely, tooth reduction of approximately 1-2 mm on all sides of the tooth, with special care taken to remove only enough tooth structure to accomplish the objective of fitting a bridge, which requires1-2.5 mm of occlussal clearance. If there is decay detected, it will be removed and the subsequent defect restored at this time so as not to allow the decay to undermine the new bridge. Once the preparation has been completed and tooth debridement carefully completed, a final polyvinylsiloxane impression of the abutment teeth is taken and sent to a dental laboratory for bridge framework fabrication. The impressions we create here are multi-dimensional in that they capture not only the teeth to be bridged, but also the opposing dentition and neighboring teeth and tissues. The impression tray is so precise, it is totally patient friendly even for those with the most elevated gag reflex. The teeth are next temporized with a custom fitted tooth colored acrylic bridge that will serve to protect the abutment teeth for approximately two weeks until your next bridge appointment. The temporary bridge is temporarily cemented utilizing an anodyne adhesive containing Calcium Hydroxide which soothes and protects the teeth. The occlusion is then checked be sure the bite is both anatomically and functionally correct. At the second appointment, the temporary bridge is carefully removed, typically after a local anesthetic has been administered, and the metal or porcelain framework is carefully seated. The framework is scrutinized for fit, marginal integrity, arch form, occlussal clearance, structural integrity, and visual amenity. Adjustments are made, and after a bite confirmation registration, the bridge is sent back to the dental laboratory for final fabrication and finishing. The temporary bridge is again cemented utilizing an anodyne adhesive containing Calcium Hydroxide which acts to soothe and protect the teeth. The third visit commences again with local anesthetic administration, followed by temporary bridge removal. The bridge is now carefully checked for fit, form, function and visual amenity, test seated, and then finally seated with cement. Depending on the underlying amount of natural tooth structure, composite core or cast core, a cement will be chosen to maximize the bridgework’s retention to that underlying infrastructure. All excess cement will be removed with the patient advised not to eat or chew on the bridge for a minimum of one hour. Dental bridges are highly durable and will last many years, however like all dental restorations, they may require replacement or need to be re-cemented due to normal wear.