Conventional or Porcelain Fused to Metal Dental Bridge

There was a time when losing teeth meant total loss of function and esthetics. Many ideas have evolved over the years to provide patients with the best possible care. Dentistry has come a long way. These days dental bridge has become a basic treatment option with the improvement in dental techniques and increase in dental awareness. Most of my patients decide to get bridges done as opposed to getting removable dentures if the clinical condition permits the placement of such prosthesis.

However, as a practicing dentist I routinely face the same question in regards to the time commitment for the service. On many occasions the expectations of the patients are not realistic because they are not aware of the actual steps involved in the fabrication of a dental bridge.

I have not found any web site where the entire process of bridge fabrication has been explained according to my satisfaction. Here I will take it upon myself to provide you with the information on the steps involved (with the time frame) to make it easier for you to understand what goes on throughout the process : (click here for a diagram of a dental bridge) :

1. Visit # 1 :

If you are scheduled to get the initial impression taken that is a good thing. The dentist will send the case to the laboratory to have the temporary / provisional bridge fabricated even before he starts to prepare the teeth.

Advantages :

a) That saves you and them some time that would otherwise be needed during that visit.

b) That will give you a better esthetic result until you get the final bridge.

Now let us look at the rest of the steps needed :

2. Visit # 2 (about 7 -10 days from Visit # 1) :

a) Preparing the teeth,

b) relining and inserting the provisional bridge

c) taking the impression for the fabrication of the bridge

If it is one of the smallest bridges (i.e., replacing only 1 missing tooth with the preparation of 2 teeth ....1 in the front and 1 in the back of the gap .............it can roughly take up to 2 hours if everything goes well.

The impression will then be sent to the laboratory. Most of the dental practices do not have an in-house lab. That adds to the time required, as I will explain later.

3. Visit # 3: (after about 7-10 business days from Visit # 2) :

a) The provisional bridge is removed

b) the lab usually sends the metal framework in pieces and that is tried in. The reason is :

i) if the whole thing is fabricated in one piece and God forbid, one tooth does not fit properly, then the whole thing needs to be replaced; keeping those separate makes the process easier

ii) the orientation / angulation of individual tooth has to be recorded precisely. the separate pieces are tried in to see how those fir and then the proper alignment is determined.

c) Also, the bite has to be checked. Once everything looks fine, the pieces are attached together with an epoxy / GC resin. So, that records the entire framework at its final position.

d) Another impression is then taken to pick the whole framework into that to record that alignment. This is called solder transfer, which allows the soldering of the pieces together to be done right.

e) Bite registration : The bite has to be recorded also to see how your top and bottom teeth meet. Sometimes the pickup impression and the bite registration are done together

f) The temporary bridge is again cemented in.

g) You also then select the shade of the porcelain on the final bridge.

h) This whole process can again take between 1 - 2 hours

i) The new impression is then sent back to the laboratory.

4. Visit # 4 (again, 7 - 10 days after visit # 3) :

a) The final bridge is tried in,

b) the contacts, occlusion (bite) and fit is checked,

c) adjustments are made as necessary,

d) the bridge is then polished and refinished,

e) the bridge is then cemented in with a stronger cement,

f) the residual cement is removed,

g) The dentist / hygienist / dental assistant then goes over the basic oral hygiene instructions / maintenance tips for the bridge,

h) this whole visit can take up to 90 minutes.

Hope this elaborate explanation will help you fully understand the process.

COUPLE OF POINTS TO REMEMBER :

a) Some dentists combine visit #1 and # 2. They prepare the teeth and fabricate the provisional bridge on the same day, if possible. In that case that combined visit naturally can take up to 2 - 3 hours.

b) You have to allow at least 2 or 3 more days every time that case is sent to and from the lab for shipping and handling. You also have to consider the holidays and weekends when the laboratory will be closed. Sometimes the dentist cannot bring you in even if (s)he wants to because of these factors.

c) You will get done according to the schedule described above ONLY if all of the steps get done without any glitch.

d) All of the steps are usually done under local anesthesia, especially if the teeth being worked on are vital. Sometimes (NOT always) the anesthetization can be skipped for the teeth that had root canal treatment done.

d) The sooner you get started with the 1st visit, the sooner you will get done. However, most of the time that is not possible because you need to get the pre-authorization done through your insurance company. Without getting that out of the way you will get stuck with the entire bill, unless that is not your concern because you are paying the entire cost out of pocket.

e) Dental bridge is considered a major dental work and even with insurance coverage you WILL have a copay.

f) If you have a trip planned or social commitment, don't feel bad. You will have the provisional bridge in there which will be just as good. Only make sure that you don't eat anything very hard that might break it. Also, don't eat anything very gummy / chewy which can make it come off easily.

g) If your dentist has those mini pack temporary cement materials, ask him to give you a pack or two when you go away. You will be able to put it back in yourself with that. Just make sure you use very little amount of cement, very quickly mix it, use a Q-tip to put it inside the bridge teeth and put it into proper position very quickly. Otherwise, because of the hot summer day the cement will too quickly. The bridge won't go all the way in and your bite will become off.