What occurs at the final appointment in the crown and bridge process?

First up, like any treatment, is diagnosis and treatment planning which is done at the initial consultation or examination.

Here we are assuming all that has been done, the different options discussed and the decision made to have a bridge to replace your missing tooth.

In general, unless part of a more complicated treatment plan involving other teeth or the whole mouth- two appointments are required. The first to prepare the tooth and take the impression. The second to stick the bridge in. Additional visits may be needed if the cores on the abutment teeth need to be replaced for any reason or a tooth requires a root canal and post beforehand .

The actual preparation will depend on the type of bridge and the design that is chosen.

The first appointment involves:

• Anaesthetic – This is generally required but may not be in the case of a resin-retained or sticky bridge which requires only a very light preparation in enamel
• Preparation of the teeth – This takes the majority of the time (and is discussed below)
• Impressions– To accurately provide the lab with a mould of your teeth that they can use to make the bridge on
• Shade– The dentist will take the shade of your teeth to match the bridge as best as possible to the natural teeth either side
• Temporaries crowns or bridge.

The second appointment involves:

• Anaesthetic
• Removal of the temporary bridge- and any temporary cement on the teeth to be bridge
• Try in– to check the fit, the margins, the bite and make sure you are happy with the colour
• Final cementation- The dentist will use his choice of cement to stick or bond in the bridge
• Aftercare instructions. (see below)

Each dentist is likely to have their own preferred way of doing each of these things so whilst the general concept is the same, the details will vary from dentist to dentist.

The procedure is just like the procedure for a crown (as essentially that’s what it is) if it’s a fixed-fixed bridge design; except for the following differences:

• The preparation

For a bridge, the two teeth either side of the gap will need preparing. These single crown preparations must actually be parallel to each other to allow a good impression to be made and a bridge that will fit simultaneously down onto both teeth. If more than two teeth are involved in the bridge- these must also be prepared parallel.

The only exception to this is if the abutment teeth are at very different angles and attempting to make them parallel may expose the nerve inside one of the teeth, or reduce the retention of the bridge. In this case, a special joint known as a precision attachment or a telescopic crown can be used which allows two separate parts to be stuck in at different angles instead of the one solid bridge.

• The bite

If the bridge is a simple case of replacing one or two teeth without changing the way you bite together- we dentists call it a ‘conformative approach‘- meaning the bridge will ‘conform’ to your existing bite or occlusion, then the bite described in the crown section will be fine.

However, if the bridge is part of a full mouth reconstruction involving many other teeth; we call this a ‘re-organised approach‘, then a ‘facebow’ record may be necessary. This is a more accurate way of recording how you bite together, which allows the models of your teeth (from the impressions) to be put on an adjustable articulator. This allows the dentist to consider how best to change your bite as part of the proposed treatment.

• The temporary 

The temporary bridge is made of the same material as a temporary crown or veneer for that matter. If it is made on an impression of the diagnostic wax up, it will mimic the shape of the final bridge. This is important for a re-organised approach to see how it functions in the mouth. In these circumstances, you may be required to wear the temporary bridge for some time first to ensure everything is ok.

Otherwise, if it is just a routine bridge- the temporary will simply be put on for a week or two whilst the lab make the real thing in order to maintain the space and protect against sensitivity. If the bridge is in the back of the mouth and no diagnostic wax up has been done, two separate temporary crowns may be made instead of a temporary bridge.

Bridge Aftercare?

You will need to clean your bridge in a special way…

Superfloss by Oral B is a specially designed floss, that anyone who has a bridge should be using to keep it clean and make sure it lasts as long as possible.

Now because the fake tooth is attached solidly to the abutments, it is not possible to floss in the way you normally would i.e. pass the floss down the sides of the teeth. Superfloss was designed with this in mind and has a firmer plastic end, which can be threaded beneath the bridge. This is then pulled through from the other side until the thicker part of the floss rests on the gum under the bridge.

The floss is now taken all the way underneath the bridge from one side to the other to remove the plaque and food that has built up there. By doing this regularly – at least every few days you will help prevent decay or gum disease starting on the abutment teeth.

Is there Anything I Should or Shouldn’t do After having a Dental Bridge?

A dental bridge will allow you smile, eat and chew as normal assuming it is the fixed-fixed type. You need to be extra careful with the resin retained bridges as these are notoriously weaker, so you should be careful about putting lots of pressure on them. It is sensible to cut up apples, chocolate bars etc and be conscious when eating any hard foods.

If you are a bruxist and grind or clench your teeth, you should be wearing a night splint anyway, but if you have had crown and bridge work it is even more important you get one made and wear it!

Anaesthetic will take a few hours to wear off so just be careful during this period straight after it has been fitted.

It is a good idea to reflect briefly on why the bridge was needed to begin with. Why did you need a tooth extracted- was it decay, a cracked tooth, gum disease etc? What could prevent you potentially needing this type of treatment again in the future? Maybe: more frequent dental visits, better cleaning, flossing, an improved diet, extra fluoride, a night guard…

Sometimes when you’re numb, it’s not that easy to get you to bite in your natural position, so the bridge’s bite may not be adjusted fully. If after the anaesthetic has worn off, the bridge feels high, give it a few days to settle down. If the feeling persists, return to your dentist who will make the necessary adjustments and polish it down to the correct level.

It is also possible the bridge feels a little rough after being placed. This will often smooth down on its own, after a couple of days of normal eating and chewing. If the feeling persists pop back to your dentist as there may be a little bit of excess cement remaining that needs to be cleaned up.

Will I get Pain After the Bridge?

Not really, sometimes you can get a bit of soreness from the gum or perhaps a bit of sensitivity if the tooth hasn’t had a root canal filling. Everything should be back to normal within a few days.

Since a traditional fixed bridge essentially contains two crowns, there will be a certain % of teeth that actually die off from the trauma of preparing the tooth. The chances are minimised if the dentist is not overly destructive when preparing the teeth and places a good temporary in between appointments. However, at some point in the future, the theoretical risk exists that this could happen and one of the teeth supporting your bridge might die off and become painful. If this happens a root canal through the bridge would be the most likely course of treatment.