All about dental bridges – treatment procedure, variants, costs

What are dental bridges?

With a dental bridge, gaps between teeth are “bridged” by a replacement. In this case, the teeth bordering the gap are used as abutment teeth to which the dentist attaches the ends of the bridge. The pontics of the bridge replace the patient’s missing teeth.

The abutment teeth must be ground for this purpose so that the bridge can then be attached. In this case, 40-60% of the tooth substance of the abutment teeth is usually lost.

For whom are dental bridges suitable?

Bridges are used when a patient has small to medium-sized gaps between teeth. A bridge improves aesthetics and speech and chewing function in missing teeth.

The most common reasons for tooth loss are caries, periodontal disease and accidents.

The basic prerequisite for the use of a dental bridge is sufficient stability of the adjacent abutment teeth, as well as good oral hygiene.

What are the variants?

Fixation of the bridge in the mouth

The main distinction of dental bridges is made on the basis of how the bridge is fixed in the mouth:

• End abutment bridge: This is the most common type of bridge, here the bridge is attached to two existing teeth to the right and left of the gap – here there are two subtypes
  • Full crown bridge: Here, the abutment teeth are fully crowned because they are severely damaged anyway
  • Partial crown bridge: Here the abutment teeth are only partially crowned – disadvantage is that the bridge is less stable than a bridge supported by full crowns.
• Free-end bridge: When a bridge is located at the end of a row of teeth, a bridge can also be fixed on one side only. Here we speak of a “free-end bridge”.
• Adhesive bridge (also called adhesive bridge or Maryland bridge): This is a temporary solution that is only bonded. A metal framework is attached to the back of the adjacent teeth with thin adhesive plates
• Telescopic bridge:This is a so-called combined denture, i.e. a mixture of fixed and removable dentures. The dental bridge is not attached to the abutment teeth, but connected by means of telescopic crowns, with the inner telescopes firmly cemented to the supporting abutment teeth. The bridge is then removable and is connected to the inner telescopes via the so-called outer telescopes.
• Implant bridge:In this variant of the bridge, implants form the pillars for fixing the bridge. The implants form quasi artificial tooth roots on which the bridge can then be placed. This option is the best solution for a gap of at least three teeth.
• Hybrid bridge:In this type of bridge, an implant and a natural tooth are used as abutments

Material used

Furthermore, dental bridges can be differentiated according to the material used. The main factor here is whether the dental bridge is located in the visible or non-visible part of the mouth:

• Gold: Bridges made of gold are very stable, but are mostly used in non-visible parts of the mouth for aesthetic reasons. Bridge base is made of a gold-colored metal alloy on which a tooth-colored resin or ceramic abutment is placed
• Metal-ceramic: This bridge is often used in the visible part of the mouth. Inside it is made of metal, which is covered with a tooth-colored ceramic.
• All-ceramics: This option is the most aesthetically pleasing and is almost indistinguishable from natural teeth. It consists entirely of tooth-colored ceramic without a metal core

Shaping of the pontics

A further classification of dental bridges is made according to the bridge pontics, which can be designed in different ways:

• Tangential bridge: Here, the bridge pontics are heart-shaped and rest on the gums only at one point or strip
• Saddle bridge: A saddle bridge is curved inward and rests on the gum over a large area. The large contact surface makes cleaning more difficult, which is why saddle bridges are not normally used as fixed elements, but as removable elements for dental prostheses.
• Floating bridge: Here, there is no contact of the intermediate bridge elements with the gums – they float above the gums with a distance of approx. 3 mm, which simplifies cleaning, but the esthetics may suffer. Suspension bridges are mainly used in the lower jaw
• Gap bridge: Here, there is also no contact between the intermediate bridge elements and the gums, but the distance is smaller than with the floating bridge at approx. 1 mm. This makes the gap bridge more difficult to clean
• Ovate Pontic: Here, the intermediate bridge elements have an ovate shape and sink into the gums. For this, the gum must be prepared either surgically or with the help of a temporary restoration
• Attachment bridge: This type of bridge is used when the two abutment teeth are very different. In this case, the intermediate bridge elements are anchored to the pier on one side only and connected on the other side by means of an attachment.

How long does the treatment last?

For a bridge, two to four appointments are needed depending on the extent and type, the first appointments are 7-10 days apart, whereas the last appointment is usually 2-3 weeks later. Thus, the insertion of a bridge takes 2 to 5 weeks.

What is the course of treatment?

Step 1: Impression taking, tooth grinding and temporary denture

First, the dentist removes any decay or other damage from the abutment teeth to ensure that the bridge fits properly. In addition, the teeth that are to serve as abutments are ground and prepared accordingly.

Then the dentist takes impressions of the surrounding teeth, which are used to create a custom bridge.

Finally, a temporary denture is inserted to protect the teeth.

Step 2: Fabrication of the bridge and interim test

The bridge is fabricated by a dental technician in the laboratory.

Once the bridge is fabricated, the patient is fitted with the bridge in another session to ensure that the patient does not feel any tension. The dental laboratory completes the dental bridge after this second appointment, and ceramic veneering is also performed if necessary.

In some cases, another intermediate try-in is necessary (e.g. for large dental bridges) to limit the risk of changing the fit.

Step 3: Inserting the bridge

After the bridge is fitted, the dentist permanently attaches it to the abutment teeth with dental cement. This ensures a good fit to the abutment teeth and other adjacent teeth, as well as freedom from tension.

Step 4: Oral hygiene and follow-up visits

The patient must practice good oral hygiene to keep the abutment teeth and the bridged area healthy, and usually must return to the dentist regularly for follow-up visits to ensure that the bridge is in good condition.

What are advantages?

Less effort than implants: Since the teeth that delimit the gap are used as abutment teeth, no implants are required.

Long durability: A dental bridge usually lasts 10 to 20 years.

High treatment success:Dental bridges offer high esthetics as well as good dental function

What are disadvantages?

Grinding of healthy teeth: Healthy teeth that serve as abutment teeth must be ground for the attachment of the bridges. In extreme cases, there is also the risk of the abutment teeth dying.

Caries risk: Caries often develops at the edge of the bridge.

Bone resorption: Bone resorption may occur in the area of the replaced teeth due to the changed load during chewing.

Higher load for abutment teeth: The abutment teeth are additionally loaded by the bridge, which can lead to loss of the teeth in the worst case.

What costs should I expect?

In Switzerland

For a three-unit bridge, costs of approximately CHF 2,200 to CHF 3,300 must be expected in Switzerland.

In European foreign countries

Germany and Austria have a slightly lower price level for dental bridges than Switzerland. A three-unit bridge made of all-ceramics costs between EUR 500 and EUR 2,500 here.

Patients can save significantly on treatment costs if they seek treatment in Southern and Eastern Europe. In Greece, Hungary and the Czech Republic, a three-unit bridge made of all-ceramics costs between EUR 300 and EUR 1,400.

The following table provides an overview of the typical price levels for a three-unit dental bridge made of all-ceramics in the countries mentioned:

Country	Cost of a three-unit bridge made of all-ceramics
Switzerland	CHF 2’200 – 3’300
Germany	EUR 600 – 2’500
Austria	EUR 500 – 2’500
Greece	EUR 300 – 1’000
Czech Republic	EUr 300 – 1’100
Hungary	EUr 300 – 1,400

Source: Various dental practice websites

Who covers the cost of dental bridges?

In Switzerland, the basic insurance usually does not cover dental treatment costs, normally 100% of dental costs have to be paid by the patient. An exception exists if certain serious diseases of the masticatory system are present or if the consequences of serious diseases make dental treatment necessary.

Private supplementary dental insurance in Switzerland usually covers the costs of dental bridges. Most insurance companies offer different rates with reimbursements between 50% and 80%, but often there is a maximum reimbursement in one year.

In case of tooth loss as a result of an accident, the accident insurance will cover the cost of the dental bridges after clarification.

Last update: December 13, 2022