Prosthetics

Bridges are fixed prosthetic restorations whose purpose is to rebuild the missing teeth of the patient. The bridge fills the gap after the loss of a tooth or teeth, restoring the function of chewing and clear speech and improving the aesthetics of the smile. The above-mentioned bridge reconstruction goals show that the loss of teeth cause a number of problems, not only aesthetic ones, whose solution significantly improves the quality of life. The prosthetic bridge consists of crowns fixed on teeth present in the mouth (abutments of the bridge) and the pontic, i.e. the missing tooth attached to the abutment crowns. Usually, the pontic is made of the same materials as crowns, and its construction depends on the number of teeth lost and their location in the dental arch. The most typical example of a bridge are two abutment crowns, with a single pontic tooth between them. The combinations of the number of crowns and teeth in the pontic is enormous, and it all depends on number of missing teeth and the remaining natural teeth. This is because the occlusal forces are transmitted throughout all the teeth in the oral cavity, which is why their condition determines the possibility of making a bridge.

The materials from which the bridges are made of are combinations of metal with a top layer of porcelain or all-ceramic bridges, characterized by great aesthetics. An unquestionable advantage of prosthetic bridges is the possibility of rebuilding missing teeth in a permanent way without the need for, or even the possibility of removing them from the oral cavity. It is a great alternative for partial cast-metal removable dentures. However, bridges have the disadvantage of having to remove natural tooth structure, as described in the crown tab. For this reason, when it is desired to preserve the tissues of natural teeth, when they are alive and do not have a large number of fillings, modern dentistry proposes solutions in the form of implant-prosthetic restorations. In this case, a single tooth can be reconstructed using a crown on the implant, but more extensive tooth loss can also be restored with the help of an implant-based bridge.

The cost of a prosthetic bridge depends on the length of the bridge and the type of material used.

The number of teeth in the bridge should be multiplied by the cost of making a single crown:

• 1000 PLN - porcelain-fused-to metal (PFM) crown,
• 1800 PLN - all-ceramic crown

An exemplary price for a 3-point PFM bridge restoring one missing tooth is PLN 3000. A similar all-ceramic bridge would cost PLN 5,400.

The crowns and bridges produced at Dorotowska Dental Clinic are produced in CAD / CAM technology (computer-aided design and milling) in a high-class dental technician laboratory. These restorations are milled from one block of material (metal or ceramic). Such production technology eliminates casting shrinkage, the main disadvantage of cheaper cast-metal bridges used in many offices.

Bridges made using CAD / CAM technology compared to those made using traditional methods have the following advantages:

• higher precision
• better adhesion to the abutment teeth
• greater tightness, protecting against the development of secondary caries
• potentially greater longevity, which reduces the risk of having to replace the bridge quickly with a new one

An example of a PFM bridge made using the CAD / CAM technique at Dorotowska Dental Clinic.

Doctor: Piotr Jurkowski DMD,

Technician: Elżbieta Szczuka

Another type of bridge are unconventional-adhesive (Maryland) bridges. It is a type of restoration that consists of a pontic attached to adjacent teeth through "wings" that are chemically bonded to the natural teeth. Therefore, this procedure does not require any teeth to be prepared for crowns, but due to the lower bonding strength, it can only be used in certain cases of single missing teeth.

Bridges step by step:

1. The first step is a detailed examination and qualification for treatment using a bridge restoration. The position and condition of the teeth on both sides of the gap is very important. Teeth with healthy pulp and surrounding bone are the most desired situation (this aspect is largely assessed on the X-ray, hence the need to perform it before treatment). However, the teeth also need to be eligible for crown reconstruction, i.e. teeth with existing extensive fillings. Then it can be said that both the teeth present in the oral cavity, as well as the gap between them will be treated simultaneously. Crowns will rebuild the abutment teeth, and the pontic will replace the missing tooth in-between. In the case of completely healthy abutment teeth surrounding the gap, without caries and fillings, a different form of treatment, including implant-prosthetic procedures, will be more desirable. As in the case of individual crowns, the doctor assesses the need for root canal treatment. If it is necessary, before inserting the bridge, crown-root posts are placed in the abutment teeth.
2. The second step is the tooth preparation under local anesthesia. It does not differ significantly from the preparation of a single crown. For the patient the main difference will be the longer duration - a minimum of two and sometimes more teeth are prepared. The doctor takes the impression of both dental arches using an impression material, and then, together with the patient, selects the color of the future bridge. The visit ends with the reconstruction of the prepared teeth and the gap with a temporary bridge so that the patient can freely smile, speak and chew food for a few days.
3. The next step, needed in the case of extensive bridges, is the try-in control of the restoration - the extent, adhesion and tightness are checked, and in case of imperfections, the doctor in cooperation with the technician eliminates them so as to obtain the perfect parameters of the completed restoration.
4. The last stage of treatment is the final control and cementing of work. It is a painless procedure that guarantees the perfect stability of the restoration. The visit is ended with detailed instructions about the proper hygienic care needed. Due to the presence of a pontic in contact with the gingiva, special floss must be used daily to clean this space. After the patient practices using this floss under the supervision of the doctor, it is a relatively simple task, but it is one of the key factors affecting the longevity and lack of problems with the prosthetic bridge.