A bridge is a prosthesis used to replace one or more missing teeth. Usually the teeth on either side of the empty space are ground down to help anchor the missing tooth (or multiple teeth). Pros:

1. The patient does not have to wear a removable appliance to replace the missing teeth.

Cons:

1. Sometimes perfect natural teeth have to be destroyed in order to anchor the bridge.

2. The bite force can destroy the integrity of the anchored teeth if it is inadequately controlled.

3. The strength of the roots of the anchored teeth can be compromised.

4. It can be difficult to keep the underside of the bridge clean.

5. The nerve inside the canal can be compromised from the trauma of the tooth preparation as well as the bite force when multiple teeth are splinted together.

As you can see, there are more "cons" then "pros".

Let's take a look at a real case:

In the case below a bridge was constructed by anchoring a root canal-treated molar to two smaller teeth in front. After a period of time, the molar roots were cracked into three pieces. The tooth structure underneath the restoration was also destroyed from decay and trauma. The xray also shows that one of the two anchored front teeth also has a small infection from the damaged nerve.

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Let's think about the problems behind this bridge:

1. Three teeth were affected at the expense of one missing tooth.

2. By anchoring one weak root canal-treated tooth to two strong teeth, the root canal treated tooth was the weak link.

3. The bite stability of this patient was not taken into consideration when this bridge was done.

If we can turn back the clock, a better treatment plan could have been:

1. Properly develop the bone at the site of the missing tooth.

2. Treat that site with an implant and a crown.

3. Crown the root canal-treated molar individually.

4. Leave the two natural teeth in front untouched.

With the advancements of implant dentistry, bridges should be considered as the last option in restoring a missing tooth.

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Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.