Bridge prosthesis - Network of dental clinics in St. Petersburg

If you are reading the article, then you are interested in the stages of making a bridge. People have been doing dental prosthetics for decades. Today, revolutionary changes are taking place in this area. New discoveries help find solutions for patients with complex diagnoses.

For those who have no idea what a bridge is and what it is needed for, let us bring some clarity. A dental bridge is a non-removable structure that consists of artificial teeth. The main use of bridges is to restore multiple missing teeth. The support is provided by healthy teeth or implants.

Let's look at the advantages of the design:

Completes the natural appearance from an aesthetic point of view, gives confidence;
Preserve chewing function (a person may not deny himself when choosing foods and preparing his favorite dishes);
Speech and diction are preserved;
Average price tag;
From a hygiene point of view, they are easy to care for.

Grinding healthy teeth to secure the structure is the only drawback. Because of this, there may be a risk of destruction of the natural teeth that serve as support. A team consisting of two people works with the patient: a dental technician and an orthopedic dentist.

What are bridges?

If several teeth in a row are severely damaged or missing, a bridge can be used to restore them.
This is a non-removable orthopedic structure, which consists of several artificial teeth connected in a row. It is fixed on supporting teeth located on both sides of the destroyed ones, or on specially installed implants. A bridge is a permanent structure consisting of dental crowns connected into a single unit, which is used to replace missing teeth. Fixation of this prosthesis can be done both on teeth rotated under crowns (located on the sides of the dentition defect) and supported by dental implants. As for the length of bridges, they can range from 3 to 14 units (the number of crowns in the prosthesis).

Construction of bridges

The main parts of a bridge are artificial teeth (sometimes simulating part of the gum) and attachments in the form of dental crowns, inlays or clasps. In appearance, all this resembles a bridge, hence the name of the prosthesis. Bridges are used to replace 1 to 4 consecutive missing teeth, depending on their type. At the same time, there must be healthy teeth to the right and left of the dentition defect, which can become a support for the prosthesis and withstand additional chewing pressure, which can reach several tens of kilograms.

The intermediate part of the bridge may have different principles of connection with the mucous membrane:

Flushing. When there is space between the mucous membrane and the bridge. The washable bridge allows food to pass freely under the structure, facilitating hygienic care.
Tangent. When the denture body touches the mucous membrane on one side, this is important for the anterior part of the teeth, where it is important from a functional, linguistic and esthetic point of view. A bridge of this design is usually installed on the front teeth.
Saddle-shaped. When the bridge is completely connected to the mucosa, the joint is connected to the joint. This is not the best option in terms of functionality and reliability, but there are cases when you cannot do without it, for example, in the area of the front teeth.

Materials for the manufacture of bridges

Dental bridges are usually made from the following materials:

Metal is a classic durable option and has been the only option for many years. It lasts a long time, easily adapts to different chewing loads, but it is too unsightly, so it is mainly placed only on the back teeth. It's the cheapest;
Sintered metal is a more expensive option with better aesthetics. It is a metal frame with a ceramic coating that makes the structure white and similar to natural teeth. Still quite durable, although inferior in aesthetics to other options;
All-ceramic dentures are very aesthetic prostheses, but they are expensive and fragile. Due to their lack of structure, they can create natural color and translucency of teeth, but cannot withstand heavy chewing loads. Recommended to be placed in the front of the jaw;
Zirconium dioxide is a modern material, but at the same time extremely durable and aesthetic. Unfortunately, it is very expensive, but it lasts a long time and, as a result, is quite inexpensive.
Combined designs: combine metal and metal-ceramics. They are placed if part of the teeth falls into the smile area, then they are covered with ceramics for better aesthetics, leaving metal teeth invisible to save money;
Metal-plastic is an inexpensive option in which the metal is covered with white plastic to match the color of the teeth. It does not provide sufficient aesthetics and deteriorates quickly, so it is rarely used;
Plastic is a material for temporary bridges that are installed before making permanent ones. Not suitable for regular wear due to its fragility and tendency to accumulate harmful bacteria.

The material is usually selected in accordance with the wishes and financial capabilities of the patient, as well as depending on the area of prosthetics.

Advantages of metal-ceramic dental bridges

Among the main advantages:

Strength. Metal-ceramic structures are very durable. This is due to the metal frame, which can withstand heavy loads even when replacing several missing teeth in a row.
Low cost. This option is the most inexpensive of all modern solutions in this category.
Possibility of installation on implants. Not every structure can be installed on an artificial root. Metal-ceramic bridges are excellent for implant prosthetics.
This is an excellent option for prosthetics of chewing teeth.

Indications and contraindications for the installation of bridges

Direct indications for the installation of bridges are the absence of a chewing tooth or one to four front teeth with supporting teeth on either side of them that can withstand heavy loads. Dentures with a bridge have a number of relative and absolute contraindications. This includes:

no more than 4 incisors, 2 premolars, 1 molar in a row;
bruxism (involuntary grinding of teeth, the damage of which can be neutralized by wearing special mouthguards);
bite pathology (in this case, orthodontic treatment will have to be carried out before prosthetics);
periodontitis and severe periodontal disease;
pathological abrasion of hard dental tissues;
diseases of the bone tissue of the upper jaw (for example, osteoporosis, osteomyelitis);
acute inflammatory diseases of the oral cavity;
poor oral hygiene.

This may also include general contraindications to surgery itself: for example, problems with blood clotting, allergies to painkillers, acute chronic diseases, taking anticoagulants, mental illness and much more.

What's wrong with dental bridges?

Despite the obvious advantages, bridges have very serious disadvantages. Among them is the need for depulpation and grinding of supporting teeth, even if they are completely healthy. In addition, bridges do not eliminate such an unpleasant consequence of tooth loss as bone loss. Those with bridges will have to pay special attention to the care of their dentures. But the most serious disadvantage of this type of prosthetics is the excessive load on the supporting teeth, as a result of which they deteriorate and become loose. As a rule, in the future this leads to their complete loss.

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Voronkov Sergey Sergeevich

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Stages of installing a dental bridge

Examination and diagnosis.

This stage is very important. This allows you to eliminate any restrictions and determine the type of bridge the patient needs. The doctor will examine the entire mouth. He will direct you to a targeted x-ray if it is a specific tooth, or rather a CT scan (images that are more precise and less radial) to see the teeth in all projections. You may also need a panoramic x-ray to see the entire situation. These technologies are available at the Implantmaster clinic. Our specialists have the ability to model a new smile in 3D. This way, the patient will see the results that can be achieved. Additional tests may be prescribed. Based on the data obtained, a further treatment plan is formed.

Preparing the oral cavity for prosthetics.

The design will last a long time if the patient does not have untreated teeth, gum inflammation, tartar and soft plaque. Preliminary treatment of caries and cleaning of the oral cavity is carried out, during which all dental deposits are qualitatively removed.

Prepare your teeth before placing a bridge.

The selected teeth are ground under the holder and, if necessary, wiped down. Depulpation is a procedure for removing the neurovascular bundle from a tooth. Why is this necessary before installing a bridge? During tooth rotation, overheating of the pulp is possible, causing the development of pulpitis. In this regard, the pulp is sometimes pre-squeezed.

Receiving a fingerprint (scanning).

In our clinic, ground down teeth are scanned instead of taking impressions. The 3Shape trios scanner scans everything in the mouth, individual teeth and bridge spaces. The workflow becomes more efficient and comfortable for patients. It makes it easy to take full-color 3D impressions for subsequent creation of prosthetics. When the bridge is ready, the patient is asked to try it on.

Fitting

If during fitting no manufacturing inaccuracies are found: it fits tightly, fits well over the bite and the patient likes the appearance of the prosthesis, the bridge in the oral cavity is installed with special dental cement. After this, the doctor conducts a detailed consultation and gives recommendations on how to properly care for the oral cavity and the product.

Bridge-like fixed prostheses

Let us describe a bridge-like fixed permanent prosthesis. Its name very eloquently explains its meaning; it acts as a bridge between adjacent teeth. The supports of the bridge are your own teeth or stump inlays. The materials used for such prostheses can be different: metal alloys, often noble, ceramics, zirconium dioxide.

The thickness of the bridge frame is 1.5 mm, add a layer of ceramics and glaze and we draw the logical conclusion that the abutment teeth should be ground (prepared) to at least this thickness. Preparing teeth for a bridge is carried out under anesthesia. Afterwards, the orthopedist makes an impression of the already ground teeth and sends it to the laboratory. It is very important to take into account the location of the antagonist teeth located on the opposite jaw. Based on the cast, a plaster model is created, from which the frame of the bridge is made. The frame is tried on the patient, then covered with ceramics and glaze. As a result, no one will be able to understand your teeth or artificial ones.

To prevent the patient from walking without teeth while this prosthesis is being made, the orthopedist installs temporary plastic crowns on the prepared teeth and inlays. They serve to protect teeth from the unwanted effects of bacteria, temperature, and acids. This design also has an aesthetic purpose, especially in the case of prosthetics for the front teeth. The temporary prosthesis is attached using special cement, which will be easy to remove when installing a permanent structure.

An important point in the process of creating a bridge is the selection of color. The doctor selects from the available color scale the color and tone of the material that best matches the color of your teeth. The more accurately he does this, the more natural your teeth will look.

As soon as the technician makes the bridge, the orthopedist will begin a new stage - installation of the structure. The internal cavity of the prosthesis is filled with dental cement, after which the structure is rigidly fixed to the ground teeth.

Caring for bridges

When replacing teeth with bridges, dentists recommend the following measures:

Daily hygiene morning and evening. You need to use a brush and paste. After each meal, rinse your mouth with clean water or mouthwash and use dental floss (floss).
Hard-to-reach places and interdental spaces are cleaned with wide movements, without pressing on the crowns.
It is important to exclude hard nuts, seeds and other foods that can cause chips and cracks.
For the first time after installation, you should not drink coffee and tea, red wine, or freshly squeezed juice.
At least once every six months, visit the dental clinic for preventive examinations and undergo professional cleaning.
All structures have a certain duration. It depends on the material used and manufacturing technology. This period ranges from 5 to 15 years. Sooner or later the product will need to be replaced, otherwise it may simply break and fall off.

What material to choose a bridge from?

Metal-ceramic bridges

The next stage of construction is metal-ceramic bridges. This type of “bridge” has made it possible to significantly expand the scope of application of bridges in solid castings by covering them with ceramics. The statement “cover them with ceramics” is not entirely true, since this design of the prosthesis implies not only an all-metal coating, but also a modification of the design, due to which the metal-ceramic bridge consists of a metal frame and a ceramic coating. This led to its advantages and disadvantages.

Advantages:

Significant improvement in aesthetic performance compared to permanent bridges
Expanding the scope of application, which implies the possibility of using such a design when restoring defects in the anterior group of teeth
The almost complete correspondence of this type of prosthesis to the natural appearance of the teeth allows the patient to quickly psychologically adapt to them, which largely restores the level of quality of life.

Flaws:

The absence of a chemical bond between the metal structure and the ceramic veneer suggests the possibility of the ceramic cracking
The presence of metal in the oral cavity can cause allergic reactions, galvanic effects and negative effects of metal on dental tissue and staining.

The aesthetics of metal-ceramic prostheses is relative. Compared to solid bridges, the design of the prosthesis is much wider, however, the passage of metal through ceramic masses and designs with a “garland” do not allow comparing the aesthetic qualities of such a prosthesis with an all-ceramic one.

However, it is important to note that replacing the cobalt-chromium alloy more commonly used in metal frames with noble high-gold alloys provides superior aesthetics.

The natural color of gold, which shines through the ceramic masses, allows you to recreate the natural color of your teeth. Together with the advantages of metal-ceramic prostheses and the absence of the disadvantages of all-ceramic bridges, this design occupies a leading position in terms of aesthetics and functionality.

All-ceramic bridges

All-ceramic bridges have firmly established themselves as one of the most aesthetically pleasing and functional designs. This explains that manufacturing companies often improve methods for making just such prostheses. Computer modeling and milling are increasingly being introduced into everyday dental practice. The development of these technologies makes it possible to increasingly reduce the time required to build bridges, right down to visiting the dentist.

Methods of layering ceramic masses with restoration of the smallest dental structures make it possible to create prostheses that are as close as possible to natural teeth. Thanks to the strength characteristics of modern ceramic materials, metal-free bridges have excellent functional characteristics, but this also has a downside.

While metal-ceramic implants have a certain degree of flexibility, all-ceramic implants have a much lower elastic modulus. For this reason, loads that lead to chipping of ceramics in metal-ceramic structures can lead to rupture of metal-free “bridges” with the need for their complete replacement, and ceramic fragments can be repaired in a clinical setting.

And yet, despite this drawback, all-ceramic bridge designs are the most progressive and will be the vector for the development of materials and production technologies.

Adhesive bridges

An alternative to the work of a prosthodontist is increasingly offering adhesive bridges, which can also be made by appointment with a dentist, if he has sufficient skills. Adhesive bridges are made of composite materials using fiberglass tape, similar to the construction of a bridge, or using conventional orthodontic wire.

This combination allows dentures to be made directly in the patient’s mouth in one visit with minimal preparation of the supporting teeth, which significantly reduces the financial component of the problem.

However, the functional qualities of such prostheses are not always satisfactory, and the aesthetic qualities of composite materials often cannot compete with ceramic materials due to the impeccable polishing and natural shine of the latter. But with the correct choice of such a treatment method for the restoration of short-length defects in the dentition in the lateral areas extending beyond the aesthetic zone, in areas with less functional load, this design of bridge prostheses turns out to be extremely logical and convenient: the dentures have a long service life, providing patients with a beautiful appearance view.

Types of prostheses based on the principle of fixation

The bridge is fixed in the mouth in different ways. If there are teeth to which it can be attached, they are pre-treated. The supporting elements of the prosthesis are made for specifically prepared teeth - for healthy supporting teeth, fixation is used on half-crowns or on inlays. In case of severe destruction of the crown of supporting teeth, pins are used, and in the absence of such teeth, implants are used.

Important! The method of fixing the prosthesis in the mouth is determined by the doctor, taking into account the clinical picture and the condition of the patient’s dental system. If it is possible to choose a fixation method, our specialists discuss all options with the patient, giving him the right to choose.

Dentures on crowns and inlays

When crowns are used as a supporting element, the “native” crowns of abutment teeth are completely replaced. This method is suitable for patients whose teeth are quite damaged. If the teeth are in good condition, half-crowns are used - that is, structures that replace only part (½-⅓) of your own dental crown.

An even more optimal option for fixation is the use of inlays: in this case, there is no radical grinding of the teeth - the doctor forms a stepped depression on the chewing surface, into which the inlay (fixing element) is placed. Our specialists prefer, whenever possible, to use methods with minimal destruction of supporting teeth

Pin prostheses

When the outer part of the supporting teeth is completely destroyed, but their teeth are relatively intact, the optimal option for fixing the bridge in the mouth is pins. A pin is a rod-shaped structure inserted into the tooth canal. It can be made of metal, glass or carbon fiber. The purpose of the pin is to strengthen the tooth roots. Subsequently, the prosthesis is attached to the pin, and the attached part is also made in the form of a tooth crown. This allows you to achieve such an aesthetic effect that the prosthesis is indistinguishable from natural teeth.

Bridges on implants

An alternative to post dentures are dental bridges placed on implants. These structures are used in the complete absence of supporting teeth. with marginal defects of the dentition. This type has a significant advantage - with their help you can use prosthetics for defects of almost any extent. Other advantages include the strength and durability of such prostheses.

A relative disadvantage of this type of prosthesis is the significantly longer preparatory stage, but the final result outweighs this disadvantage. The cost of bridges on implants is certainly higher compared to other types, but their quality and service life differ for the better.

Cantilever prostheses

Bridges with a cantilever type of fastening are a kind of exception among the entire group: cantilever prostheses are attached only on one side - this creates a “single-support” bridge. This type of prosthesis is suitable for prosthetics of the anterior teeth (incisors and canines), since they bear minimal chewing load. Occasionally, they are used to replace the first premolar; for this purpose, the support is installed on the second premolar and first molars.

Adhesive bridges

This is a type of denture that is “glued” to the supporting teeth using composite compounds. In dentistry, Academy Dent, fixation of such prostheses is carried out using light-curing polymers. The advantage of adhesive dentures is that their installation either does not require preliminary preparation of the supporting teeth, or this preparation is minimal. Therefore, the adhesive prosthesis is installed in one clinic visit.

Advantages of adhesive dentures:

hardly noticeable from the outside;
easy to replace;
the supporting teeth are not pulpless;
the elasticity of the composite support does not interfere with micromovements of the supporting teeth;
easy to repair.

Unfortunately, they are applicable for replacing only one tooth.