Dental Bridge for a Missing Tooth: How Does It Work?

 How Does a Dental Bridge Replace a Missing Tooth?

Patients Ask Series: Part 4

By Mariam from OralTalkWithMariam 💙

A dental bridge fills the gap left by a missing tooth with an artificial tooth. Depending on the type of bridge, it can get its support from your neighbouring teeth or from dental implants placed in your jawbone. This support keeps your bridge fixed in place, which means it stays in your mouth while you clean around and underneath it.

The way a dental bridge is supported can affect what happens to the teeth around the gap. I'll explain how the different types of dental bridges work, what the procedure may involve and what your dentist checks before recommending one.

What Is a Dental Bridge?

A dental bridge is a fixed replacement for one or more missing teeth. It includes an artificial tooth to replace what is missing and support to hold it in place.

The replacement tooth (pontic): 

This is the artificial tooth that takes the place of your missing natural tooth and sits in the gap where it used to be.

The support (abutment): 

This is what holds your replacement tooth steady. Depending on the type of bridge, an abutment can be your natural tooth next to the gap or a dental implant.

What Types of Dental Bridges Are Available?

Dental bridges are designed based on one simple question: where does the new tooth get its support?

Here are the four main ways a dental bridge can be held in place:

1. Conventional Bridge (Supported from Both Sides)

This is the most common design. It uses the natural teeth on both sides of your gap as solid support posts.

To make this work, your dentist needs to trim down the two supporting teeth so that protective caps, called crowns, can fit closely over them. The new artificial tooth is joined right in the middle between those two crowns.

Think of a footbridge across a stream. The path you walk on is held up by solid pillars on both riverbanks. In the same way, your new tooth sits over the empty space while the crowned teeth on either side support it.

2. Cantilever Bridge (Supported from One Side Only)

A cantilever bridge gets its support from a tooth on only one side of the gap. The replacement tooth extends out from that single supporting tooth, rather than being held from both ends.

Because the bridge is supported from only one side, the supporting tooth may take more pressure when you bite and chew. This means a cantilever bridge may not be suitable for every part of the mouth, especially areas that take heavier chewing forces. Your dentist will check where the gap is and check whether the supporting tooth can handle the pressure.

3. Maryland Bridge (Resin-Bonded: Supported from Behind)

A Maryland bridge usually needs much less trimming of your neighbouring teeth than a conventional bridge. Instead of using crowns for support, the replacement tooth has one or more thin “wings” attached to it, which may be made from metal or tooth-coloured material.

With a Maryland bridge, your dentist bonds these wings to the backs of the supporting teeth, where they are mostly out of sight when you smile. The wings help hold the replacement tooth in place without covering the supporting teeth with crowns. This means little or sometimes no natural tooth structure needs to be removed. Maryland bridges are often used to replace missing front teeth.

4. Implant-Supported Bridge (Supported from Below)

An implant-supported bridge gets its support from dental implants rather than neighbouring natural teeth. These implants act as artificial tooth roots and are placed in your jawbone, with the bridge attached to them.

Because the implants support the bridge, your neighbouring teeth do not need to be trimmed for supporting crowns. An implant-supported bridge may be considered when you have several missing teeth together, depending on factors such as your oral health and the amount of bone available to support the implants.

If you're wondering how an implant stays inside your jawbone, I explained that in part 3 of this series on how dental implants work.

What Happens During a Dental Bridge Procedure?

1. The Examination

Your dentist examines the gap and checks that the surrounding teeth and gums are healthy enough to support a bridge. X-rays or digital scans can provide more information about the teeth and surrounding bone.

The dental bridge procedure described here uses a conventional bridge as the main example. Other types of bridges involve different steps, and your dentist will plan the procedure around your mouth.

2. Trimming the Supporting Teeth

Your dentist uses a local anaesthetic to numb the area and reduce pain while the supporting teeth are being trimmed. The teeth on either side of the gap are then trimmed to create enough space for the new caps, called crowns, to fit over them without feeling bulky.

3. Taking a Mould or Digital Scan

Once the supporting teeth are trimmed, your dentist takes either a soft putty mould or a 3D digital scan of your mouth. This records the shape of your teeth and how they meet when you bite, providing the information needed to make your bridge fit accurately. Your dentist also chooses a tooth colour, called a shade, before the final bridge is made so it can match your surrounding teeth as closely as possible.

4. The Temporary Bridge

A temporary bridge may be placed over your prepared teeth because your final bridge takes time to make. While you wait, the temporary bridge covers the gap and protects the prepared teeth, which can also help reduce sensitivity to hot and cold.

5. Fitting the Final Bridge

When your final bridge is ready, your dentist takes off the temporary one and tests the new bridge in your mouth. They check how it fits, how it looks when you smile and how your teeth meet when you chew. If any adjustments are needed, your dentist can make them first. Once the fit is comfortable, dental cement is used to hold the bridge in place.

What Are the Advantages and Disadvantages of a Dental Bridge?

​Advantages

• It stays firmly in place: A dental bridge is fixed to its supporting teeth or implants, which helps it stay stable when you eat, talk or laugh.

• It can improve your smile and chewing: By filling the gap, a bridge can improve how your smile looks and make chewing more comfortable.

Disadvantages 

• Trimming neighbouring teeth: For a conventional bridge, your dentist needs to trim the teeth on both sides of the gap so the caps can fit over them. Even if those teeth are healthy, some natural tooth structure still has to be removed, and it does not grow back. This means the change to those teeth cannot be reversed.

• Cleaning underneath takes extra care: The artificial tooth sits over the gum rather than growing from it like a natural tooth, so you need to clean underneath it as well as around the bridge. Floss threaders or small interdental brushes can help you reach this area.

• It does not replace the tooth root: After a tooth is removed, the jawbone in that area begins to shrink because it no longer has a tooth root to stimulate it. Since a conventional bridge does not replace that root, it cannot stop the bone loss that follows the extraction. I explained what happens to your jawbone after an extraction in Part 2 of this series.

Am I Suitable for a Dental Bridge?

Whether a dental bridge is right for you really comes down to the condition of your mouth and the gap left by your missing tooth. Your dentist will take a close look at the teeth and gums around that space before helping you decide which bridge design may suit your situation.

For a conventional bridge, the neighbouring teeth have an important job because they will carry the bridge when you bite and chew. They need to be able to handle that pressure before they can be used as support.

The number of teeth you are replacing also matters. Your dentist will then sit with you to discuss if a bridge is still a good option or if another way of replacing the missing teeth may work better for you.

How Long Does a Dental Bridge Last?

A dental bridge can last for many years. According to the Cleveland Clinic, dental bridges last between five and 15 years on average, although some can last longer with proper care.

How long yours lasts also depends on the health of the teeth holding it. With a conventional bridge, those supporting teeth are covered by caps(crowns), but the natural teeth underneath can still get cavities. Plaque can build up around the edges where the caps meet your natural teeth, which is why cleaning that area every day is so important. If one of the supporting teeth develops decay or becomes damaged, it can affect the bridge it is holding.

Consistent daily cleaning and showing up for routine dental check-ups also matter. It gives your dentist a chance to catch small problems with the bridge or the supporting teeth before they turn into painful surprises.

Questions Patients Ask About Dental Bridges

How many missing teeth can a dental bridge replace?

A dental bridge can replace one or more missing teeth in a row in the same area. But how many teeth a single bridge can replace depends on where the gap is, how strong the neighbouring teeth are, and the bridge design being used. Your dentist will check your mouth and let you know what may work best for you.

Is Getting a Dental Bridge Painful?

You shouldn't feel pain while your dentist is preparing your teeth for a dental bridge because the area is numbed with a local anaesthetic. You may notice some pressure or vibration from the dental handpiece while they work.

After your teeth have been prepared for a dental bridge and the local anaesthetic wears off, the trimmed teeth or surrounding gums may feel slightly tender or sensitive for a few days. This often settles as your mouth adjusts, but if the pain gets worse or does not settle, let your dentist know.

How Do You Clean Under a Dental Bridge?

You should brush your teeth twice a day as usual, but you'll also need to clean underneath your dental bridge to remove plaque and food remains that your toothbrush can't reach.

You can use a floss threader, which works a bit like a needle and thread. You use it to guide floss underneath the replacement tooth, then gently move the floss along the gumline to clean the area. Superfloss works in a similar way but has a firmer end that makes it easier to feed underneath the bridge.

A small interdental brush can also be useful if it fits comfortably underneath your bridge. You gently guide the brush through the space to clean underneath the replacement tooth and along the gumline.

Can a Dental Bridge Replace a Front Tooth?

Yes, you can replace a missing front tooth with a dental bridge. A Maryland bridge is one option that may be considered for a front tooth because it usually needs little or sometimes no trimming of your neighbouring teeth.

The new tooth can also be made to match the colour and shape of your surrounding teeth as closely as possible, so it blends in naturally with your smile.

Can I Get a Dental Bridge Immediately After an Extraction?

Not usually. You may have to wait a few months after an extraction before getting your permanent dental bridge. That way, your gums and the bone underneath have time to heal before the bridge is made to fit the area. Exactly how long that takes depends on how the socket where your tooth was removed heals and the type of bridge you're getting.

Mariam's Wrap

Smile Squad, if there's one thing I want you to remember about dental bridges, it's that they don't all replace a missing tooth in the same way. Where the bridge gets its support matters, and that's one reason the type of bridge recommended for you may be different from the one recommended for someone else.

So, the goal isn't just to fill the gap. It's to find a way of replacing your missing tooth that works with the teeth and support available in your mouth.

Is there something about dental bridges you still don't understand, or another dental question you'd like me to explain? Leave your question in the comments. It might become the next topic I cover on OralTalkWithMariam.