The steps below describe the traditional process for a bridge to replace one missing tooth. You should expect two office visits to complete the treatment; one to prepare your teeth and build a temporary bridge, and another to install your permanent bridge. If there are additional problems with your tooth structure, or if the bridge is replacing multiple teeth, your procedure time and steps may vary.
At your initial appointment
- Review your health status: You will share information that will help ensure that your dentist and their staff can provide safe and effective treatment, and provide appropriate post-care guidance. Get important information here: Health history and current health status.
- X-ray images: Your dentist may take X-ray images to determine whether a bridge is your best option for replacing a missing tooth. For example, your dentist may want to determine if the abutment teeth are sound enough to support the bridge or if additional treatment is needed.
- Treatment review: Your dentist will review the procedure with you, including its risks, benefits, and options you may have. Understanding the process and alternatives will lead to the best treatment outcome. Ask any questions you have before your dentist begins the procedure.
- Anti-anxiety medication: If you are anxious about dental procedures, your dentist may recommend sedation.
- Impressions: Your dentist will take an impression (called a "stent") or digital scan of your teeth before preparing the abutment teeth that will anchor your bridge. A plaster or 3D printed cast made from the impression or scan is the first of two steps that will form the shape of the retainer crowns to fit onto your prepared abutment teeth. The impression will also provide a form to create a replacement tooth for your temporary bridge. You will wear your temporary bridge until your permanent bridge is prepared and installed. This may take a few weeks, depending on how the permanent bridge is prepared.
During the procedure
- Anesthetic: The abutment teeth are usually numbed by injecting a local anesthetic around the nerve or nerves that supply sensation to those teeth. Your dentist may also apply a topical numbing gel to the site to reduce discomfort from the injection.
- Shade matching: For the tooth-colored portion of the bridge, your dentist will use a shade guide to ensure the bridge matches the color of your natural teeth. Dental ceramics and other materials to make your bridge can produce a precise match to your natural tooth enamel. If you plan on having tooth whitening done, you should do so before the shade matching occurs. Whitening products or procedures will not whiten bridge materials.
- Tooth isolation: The tooth is usually isolated from your tongue and cheeks with a barrier known as a rubber dam. Other isolation devices may be used that incorporate suction and comfortably hold the mouth open.
- Preparing the abutment teeth:
- If necessary, your dentist will remove old restorative materials and decay, and then fill in deep holes or missing corners of your abutment teeth.
- Your dentist will then reduce the outer surfaces of the abutment teeth to make room for the retainer crowns that will be placed over them. This includes creating a ledge around each abutment tooth against which the retainer crowns will tightly seal. It also provides a tapered form to allow insertion and removal of the bridge.
- Final impression: The gum tissue will be moved away from the prepared finish lines of the abutment teeth. This is usually done with slim cords tucked into the pocket between the abutment teeth and gums. The cords are removed when the final impression is made. A digital scan or final impression will be made to capture the position and shape of the prepared teeth. Your permanent bridge will be made using this impression or scan.
- Temporary bridge: Your dentist will create a temporary bridge using the stent made from the preliminary cast that was made before preparing the abutment teeth. This involves the following steps:
- Filling the stent with a tooth-colored resin and placing it over the prepared teeth, and allowing it to harden for a few minutes. This closes the spaces between your unprepared teeth and their shape after they were prepared for the bridge.
- Refining the temporary bridge's shape to fit in your mouth correctly.
- Polishing and cementing the temporary bridge onto your prepared abutment teeth using temporary cement.
- Permanent bridge: A technician in a laboratory will create your permanent bridge using the final impression or digital scan that recorded the shape of your prepared abutment teeth and the replacement tooth. This process can take up to a few weeks.
After the procedure
Your dental team will give you instructions on how to take care of both your temporary and permanent bridges. You should request a copy of the instructions. Although the instructions may seem straightforward at the time of your dental appointment, you may have questions and need to refer to them later.
After you leave your dentist's office and while you are still numb:
- Do not eat or drink hot beverages while your lips, cheeks, or tongue are numb. It is possible to bite or burn yourself without realizing it.
- Do not pull on or poke at the numb areas in an attempt to make the feeling return. There is no way to reduce the period of numbness. Sensation usually returns within 1-2 hours. The amount of time that passes until feeling returns depends on the type of anesthetic used and other factors.
- You may experience slight difficulty with speech until the anesthetic wears off.
Avoiding problems with your temporary bridge
Temporary cement is not as strong as permanent cement. It allows the temporary bridge to be removed by your dentist without damaging your abutment teeth. Because the temporary cement is not as strong as permanent cement, a temporary bridge may become loose or detached. To reduce the risk of this happening, avoid chewing hard or sticky foods.
When you floss, pull the floss gently out the sides between the temporary bridge and the adjacent teeth rather than pulling it upwards. You will not be able to floss between the connected teeth of the bridge. Still, it will be necessary to clean under it using either specially shaped brushes provided by your dentist or a floss threader. The most common reason that bridges fail is tooth decay on the abutment teeth, which generally begins to form beneath the replacement tooth. This is why it is essential to thoroughly clean under your temporary bridge every day as directed by your dental team. This is true of the permanent bridge as well.
If a temporary bridge loosens, detaches, or breaks, your natural teeth may drift. As a result, your permanent bridge may require adjustments to fit properly. This movement can begin to occur as quickly as 24 hours after your temporary bridge is placed. If you feel your temporary bridge is loose or broken, contact your dentist to get it back into position or repaired as soon as possible.
Additional fitting and placement appointments
- Fitting appointment: Some bridges require a separate appointment while your permanent bridge is being created. Your dentist will ensure there is an accurate fit of the bridge framework before the lab technician sculpts the ceramic portion of the bridge. Once adjustments are made, the bridge will be completed, and you will come in again for the final placement.
- Permanent bridge placement: When your permanent bridge is ready, you will visit your dentist again to remove the temporary bridge and replace it with the permanent bridge. Your dentist may give you a local anesthetic to avoid any discomfort associated with removing the temporary bridge and cleaning the temporary cement from the prepared teeth. After adjusting your permanent bridge for a proper bite relationship between your opposing teeth and the bridge, it will be cemented tightly against your prepared abutment teeth.
- Final polish: After adjustments are completed, your dentist may need to re-polish the bridge. This typically takes just a few minutes.
Additional treatments you may need
- Clinical crown lengthening: Your dentist may need to expose more of a tooth before preparing it for a retainer crown if one or more of the abutment teeth has decay or damage that extends below the gum level.
- Core buildup: If a large portion of an abutment tooth is damaged or decayed, your dentist may need to rebuild the tooth's core to ensure there is enough solid tooth structure on which to attach the bridge.
- Your abutment teeth may need root canal therapy before or after a bridge is placed. This may be necessary if:
- The original tooth has significant damage or decay.
- The abutment teeth become irreversibly inflamed as a result of procedures performed on them.
- You don't practice good oral hygiene after the bridge is placed and develop tooth decay around the bridge. If this occurs, the bridge may also need to be repaired or replaced.
- Bite adjustment: Sometimes, an occlusal adjustment is necessary to establish an even force distribution among the teeth before placing your new bridge. This helps prevent excess chewing forces from damaging or destroying the bridge.
- Occlusal guard: Your dentist may recommend that you wear an occlusal guard to protect your new bridge if heavy bite stresses contribute to tooth damage or muscle and jaw pain.
