A dental bridge is a fixed solution for replacing missing teeth, offering benefits over dentures by not requiring removal for cleaning. However, it involves significant modification of adjacent teeth, which can lead to long-term issues such as decay and aesthetic concerns due to visible metal over time. Despite its drawbacks, a bridge can be a cost-effective and practical alternative to implants, especially in cases where implants are not viable.

1. Dr Muzzafar Zaman - Bridges to replace missing teeth.
A dental bridge, a Fixed bridge or bridgework is one of the ways to replace a missing
tooth or teeth. Although a denture is easily the most commonly used method due to
its low cost, it is not fixed in and one has to take dentures out at night time and for
cleaning after meals. A bridge is the most common way to have a fixed tooth so
unlike a denture, it does not need to come out for cleaning etc. It's fixed and stays in.
A bridge is a false tooth to replace the tooth that has been extracted and is missing.
It is held in using one or more of the patient's own neighbouring natural teeth. For
the neighbouring tooth to provide this attachment, it must be of good stable
condition and the natural tooth has be quite extensively modified or trimmed down
in the same way a crown is placed over a tooth before the bridge can be attached on.
There is a sub-category in this type of fixed tooth replacement and it's called an
"adhesive bridge" or an "acid etch bridge." The main advantage of this sub-category
of bridge is that there is much less modification needed on the adjacent teeth to hold
the fixed tooth in position. In some cases no tooth preparation is required at all. They
are however less strong and are prone to dislodging much more than a conventional
type of bridge. In general, adhesive bridges are used only for the replacement of
one front tooth where the biting forces are less compared to the heavy pressures on
the big molars at the back of the mouth. The biggest disadvantages of a dental bridge
is that once the adjacent teeth have been modified or trimmed, then they have been
altered forever. There is no going back even if the anchor teeth were totally healthy
beforehand. Decay can occur under bridge teeth and quite often when it does occur,
the decay has gone so deep that further teeth end up being lost. Once this happens,
the costs and inconvenience to put everything right again goes up hugely and
sometimes when this scenario happens, another fixed bridge is not even possible
again. You are then back to wearing a denture or to consider dental implants. The
other issue with bridgework is one of aesthetics. It is not possible to produce an
exact likeness of the replacement tooth or teeth to what it was like naturally. At the
back of the mouth, this is not too much of a big deal but it can be a big issue at the
front in the smile zone. Furthermore, a bridge gets it's strength from a layer of metal
underneath the covering porcelain. This metal can become apparent when over a
passage of time, the gum around the neck of the tooth shrinks hence exposing a
black line showing up of the metal. If the metal is unsightly then the only option is to
take off the old bridge and make a new bridge with margins under the gum line. This
procedure does have risks because of the damage that can occur to your tooth
underneath. Patient's also have to be aware that the pulp or nerve of a tooth can die
or become infected. This is surprisingly common and studies put this at about 10%.

2. Should this happen, a root canal treatment has to be performed by drilling through
the back of the bridge. Although the above disadvantages of having a bridge to
replace a missing tooth seem bad, this is still a good method as a bridge can produce
good results lasting many years. A bridge is also much less costly than an implant and
can be done in far fewer visits. Quite often a dental implant cannot be placed due to
lack of bone height and width so here is where a bridge is indicated.