A lot has changed with time. New dental technologies and forms of treatment have come up to rescue people from declining oral health. In today’s world, losing teeth does not imply one has to simply accept the consequences. There are many types of dental treatments that can take the place of missing teeth and support the remaining. Let us get some knowledge about one of the frequently availed dental treatment options.
Fixed partial denture, commonly known as a dental bridge is a restorative option suited for people with one or more missing teeth. The artificial dental crown or cap restores the esthetics as well as functionality of the missing tooth/teeth. It successfully does so by occupying the toothless space and supporting itself by the adjacent teeth (known as abutment) or implant body.
Procedure for Dental Bridge
Assessment of the Gingival and Periodontal Status
The very first step involved in fabrication of a dental bridge is a thorough inspection and dental assessment of the area of interest. This is critical and helps decide if the patient is a favourable candidate for the multi-stepped bridge procedure. Besides establishing the above, the condition of the teeth, alignment of neighbouring tooth structures and the extent of edentulous space to be substituted is observed. These factors along with the gingival status (inflammation, recession) allow the dental practitioner to draw a conclusion regarding the design of the intended bridge.
Dental X rays may also be taken along with details of past and present dental or medical history. The neighbouring teeth or abutment, which will provide, support to the pontic (replaced tooth) needs attention. For example, if one of the abutment teeth is carious, it needs to be treated (restoration or Root canal treatment, depending on the pulp involvement) first. Suppose, the abutment is already a restored one or considerably weak, it may require some form of dental treatment to reinforce its structure. If fortunately, the abutment teeth are completely healthy, the next procedure begins.
In the next scheduled appointment, methodical preparation of the abutment teeth needs to be done. By ‘preparation’, we are referring to re-contouring of the teeth structure on either side of the edentulous span. This is done by carefully stripping off the enamel and dentine layer to permit the placement of the dental bridge. It is in fact, an important procedure which needs a lot of precision, controlled movement and thus, more time. A well executed tooth preparation ensures that the non removable bridge will be retentive as well as comfortably fit.
The extent of tooth cutting required is decided on by the dentist, taking into consideration the material being used for bridge fabrication. A resin bonded bridgework requires less removal of the tooth structure. To carry out this dental procedure, the targeted area is injected with a safe amount of local anesthesia. This makes the procedure comfortable and psychologically calms the patient. Once the apt thickness of space has been created (usually varies from 1.5 to 2 mm) on all the surfaces of the supporting teeth, the next procedure begins right away.
Recording an Impression
Next, an accurate replica of the reduced teeth structure and that of the opposing arch needs to be recorded. Using a high quality, compatible dental material, mostly putty, an impression is made by placing the material loaded impression tray in the desired area of the patient’s arch.
A dental cast is then poured and sent over to the dental laboratory for fabrication of the dental bridge. In the meanwhile, the dentist will place a temporary bridge so as to cover the prepared tooth surfaces which being brittle, are more prone to damage due to increased pressure.
Placement of the Fixed Partial Denture
In the next visit, the dentist will remove the temporarily cemented bridge and evaluate the newly fabricated one prior to cementing it permanently. Minor adjustments are done, keeping in mind three basic criteria. These include esthetic appeal; its fit and functional ability. The dentist closely verifies the fit of the crowns, especially in relation to the margins.
The patient is asked to bite on to the framework and make chewing movements so as to identify and locate the high points (using carbon paper). Once both, the patient and dentist, are thoroughly satisfied with all of the above factors, preparation for the last and final procedure begins.
Post the finishing touches, a high strength dental cement is used to complete the final step.
Once the bridge is placed atop the abutment, the patient is asked to occlude on the cotton sandwiched between the upper and lower arch for a few minutes. When the cement sets, the excess amount, is cleaned off, and the detailed instructions regarding maintenance of the dental bridge is given.
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