Dental bridge complications: the loose bridge

 

A dental bridge is a cemented appliance used to replace missing teeth. In the traditional technique, the teeth (abutment) used to support the missing teeth (pontic) are drilled just like for a dental crown. When the drilling is done, the laboratory fabricates the bridge out of metal alloys or zirconium which can have porcelain baked on to it for esthetics. There is a limit to the number of teeth that can be replaced on a bridge before the supporting teeth do not hold up.

 

Today I saw a patient who has a loose upper bridge replacing 2 teeth in the back. This patient, now in her earlier 60s had the bridge done 8 years ago. Now the cement seal has come loose on the back tooth with the front tooth pretty secure. What is the solution?

 

The standard procedure is to apply pressure at the secured end to get the cement seal to release. Then the bridge can be cleaned up (old cement removed) and the old bridge recemented. The complication on this is that the cement can’t be broken. What then? If the dentist applies too much pressure on the bridge where the secure tooth is located, the tooth structure holding the crown can break off inside the crown, rendering the tooth not only useless but it must then be extracted and be replaced in a longer bridge, if possible, or even having a removable partial or dental implants. I have a patient who saw a dentist and, when he went to remove the bridge, had BOTH of the supporting teeth come off inside the crown. She has been wearing a partial denture since then.

 

Another choice is to cut the bridge off the teeth. This has the down side of having to replace the bridge. If there is known decay on one of the supporting teeth, or if the bridge needs to be replaced for some other reason such as esthetics, then cutting off the bridge is a good option.

So, keep in mind that the dental cements do not last forever and may need some attention down the road.