Dental Bridges

When a bridge is considered

• One tooth, or a few teeth next to each other, are missing. There are sound teeth and healthy gums at both ends of the gap.
• The teeth next to the gap already have large fillings or need crowns. In that case, the reduction done for the bridge overlaps with treatment those teeth need anyway.
• You do not want surgery, or cannot have it. You also do not want a removable tooth.

When another option is considered

• The neighbouring teeth are sound and have no fillings. A conventional bridge removes healthy tissue from these teeth. If suitable, a resin-bonded bridge or an implant is discussed.
• The supporting teeth have untreated decay or gum disease. These are treated first. See the gum disease page for details. If the teeth cannot carry a bridge, a different plan is made.
• The gap is long, or there is no tooth at one end. There may not be enough teeth to carry a bridge. In that case, an implant or a partial denture is discussed.
• You clench or grind your teeth. Your dentist takes this into account when designing the bridge and deciding whether you need a night guard.

• Doing nothing. If a single back tooth is missing, leaving the gap is also an option. One study followed 116 untreated gaps at the back of the mouth on X-rays. On average, the gap changed by less than 1 millimetre in the first year¹. Later movement was mostly slow and small. When the front teeth and premolars are in place and only molars at the back are missing, this is called a shortened dental arch. A review of adults in this situation reported that not replacing the missing molars was promising for chewing and satisfaction². On the other hand, tooth loss has been linked with poorer oral health-related quality of life³. This is an association; it has not been shown to be the cause. If you leave the gap, have it monitored at regular check-ups.
• Conventional bridge. The teeth on either side of the gap are reduced on every surface and crowned. The artificial tooth is attached to these two crowns. No surgery is needed. The tissue removed does not grow back. This matters most when the neighbouring teeth are sound and have no fillings. If these teeth need crowns anyway, the balance changes.
• Resin-bonded bridge (Maryland bridge). The artificial tooth has a thin wing at its side. This wing is bonded to the inner surface of the neighbouring tooth. Some types have a single wing bonded to one neighbouring tooth only. The tooth needs little or no drilling, and no surgery is needed. Depending on your bite, it suits some single-tooth gaps. It can come loose and may need to be bonded again. The reviews this page draws on give no survival rate for these bridges.
• Cantilever bridge. The artificial tooth is attached to a tooth on one side only. This supporting tooth is reduced and crowned. In a 2007 review, about 80 in every 100 bridges supported from one side were still in the mouth after ten years⁴. For bridges supported at both ends, the figure was about 89⁴. These two rates come from separate groups of studies. The review's authors regard this design as a second choice.
• Partial denture. It is removable and needs no surgery. The supporting teeth usually need little or no drilling. In a review of 46 studies, of every 100 cast-clasp partial dentures, about 95 were still in use after five years⁵. The denture's effect on the supporting teeth, and more details, are on the dentures page.
• Implant. An implant is placed in the jawbone in place of the missing tooth, and a crown is made on top. The neighbouring teeth are not touched. It is a surgical procedure, and there is a wait while the bone heals. A review of 46 studies looked at implants carrying a single crown. Of every 100 implants, about 97 were in the mouth after five years and 95 after ten⁶. The crown on the implant is a separate part. In the same review, of every 100 crowns, about 96 were in use after five years and 89 after ten⁶. Staying in the mouth does not mean trouble-free use. A 2007 review found no study⁷ that compared a single implant directly with a bridge. So these rates do not show which is better for you. The types of problem also differ. With bridges, decay and nerve problems in the supporting teeth are more common. With teeth on implants, technical problems such as screw loosening and porcelain chipping were significantly more common⁴. Gum problems and bone loss⁶ can also occur around an implant. See the dental implants page for details. Our article on alternatives to dental implants, which compares the options, may also help.

The steps below are for a conventional bridge. After the examination, your dentist plans how many appointments you need and how much time passes between them.

For a resin-bonded bridge, the supporting tooth needs little or no drilling. The wing is bonded to the inner surface of the tooth.

Risks and drawbacks

• Tissue loss that cannot be undone. In a conventional bridge, the supporting teeth are reduced on every surface. The enamel and dentine removed do not grow back. These teeth will depend on a crown for life.
• Decay and loss of nerve vitality in the supporting teeth. In long-term studies, the main problems with conventional bridges were decay and loss of vitality of the nerve⁴ in the teeth that carry the bridge. In a 2004 review, of every 100 bridges, about 3 were lost to decay over ten years⁸.
• The tooth's nerve. The pooled results of 37 studies cover teeth that were vital at the start. These teeth were then treated with indirect restorations such as crowns, partial restorations or bridge supports. In about 5 in every 100 of these teeth⁹, the nerve lost its vitality. In studies with more than ten years of follow-up, the figure was about 7. The certainty of the evidence is low. If this happens, root canal treatment is needed to keep the tooth.
• Coming loose. In the same 2004 review, about 6 in every 100 bridges lost their cement bond⁸ over ten years. Resin-bonded bridges can also come loose. If a bridge is loose or has come out, the dentist looks for the cause and examines the supporting teeth.
• Fracture. The porcelain can crack or chip. Clenching raises this risk. A supporting tooth can also break; the bridge may then need replacing, or a different treatment may be needed.
• Gums. A crown edge that fits poorly at the gum line can cause gum inflammation. If the area under the bridge is not cleaned, plaque builds up there.
• Sensitivity. Temporary sensitivity to cold and heat is common after preparation. If it lasts or gets worse, it is assessed.

Benefits

• It is fixed; it does not come out.
• It needs no surgery.
• It fills the space of the missing tooth and helps with chewing and appearance.
• If the supporting teeth need crowns anyway, they are restored in the same treatment.

Until the anaesthetic wears off, take care not to bite your cheek or lip. There may be sensitivity to cold and heat in the first few days. If you have a temporary bridge, avoid hard and sticky foods.

Cleaning under the bridge

A toothbrush cannot reach between the underside of the artificial tooth and the gum. Clean this area every day with bridge floss, with ordinary floss passed through with a floss threader, or with a small interdental brush. Bridge floss is a special floss with one stiff end that can be passed under the bridge. Your dentist or a member of the dental team will show you which suits your bridge.

In studies of cleaning between the teeth, floss and interdental brushes used in addition to toothbrushing may reduce plaque and gum inflammation¹⁰. However, the certainty of the evidence is low. These studies did not look at cleaning under bridges separately.

Daily care

• Brush twice a day with a fluoride toothpaste. Clean carefully where the crown edge meets the gum.
• Do not bite on hard objects such as ice, pens or fingernails.
• If you clench or grind your teeth, a night guard may be recommended.
• Go for regular check-ups. The crown edges, the supporting teeth and the gums are checked, and X-rays are taken when needed.

The rates below describe how long bridges stay in the mouth. They do not mean that no problems occurred during that time. They are averages across many studies and do not predict the outcome for any one person. A bridge has no fixed lifespan.

Conventional bridge. In a 2004 review that pooled 19 studies, of every 100 bridges, about 89 were still in the mouth after ten years⁸. In the same review, about 71 in every 100 bridges had no problems and needed no repair⁸ over ten years. This second rate rests on only four studies, and its uncertainty is wide. These data come from reviews published between 2004 and 2007.

Cantilever bridge. The ten-year rate was lower for bridges supported from one side. The figures are above, in the options section.

Material. A 2026 review of 41 studies looked at metal-ceramic and all-ceramic bridges. After five years, about 91 in every 100 metal-ceramic bridges were in place, against about 83 of lithium disilicate glass-ceramic bridges¹¹. This difference was significant. Decay at the edges and loosening were more common with all-ceramic bridges¹¹. So it cannot be said that all ceramics last equally well. Your dentist will recommend a material based on where the gap is and on your bite.

Resin-bonded bridge. The reviews this page draws on give no rate for these bridges, so no figure is given here.

If you have a bridge, see your dentist about:

• The bridge is loose or has come out (keep it; do not glue it back yourself)
• A bad taste or smell around the bridge
• Pain in one of the supporting teeth, pain when you bite, or pain that starts with heat and lingers
• A crack or chip in the crown
• Gums at the edge of the bridge that bleed, swell or pull back
• Sensitivity that lasts longer than a week or gets worse

If you have toothache together with swelling in the gum, face or jaw, or a fever, get an urgent dental appointment. A dental abscess needs urgent treatment by a dentist¹².

Emergencies. The following need urgent medical help¹². Do not wait for a dental appointment; go to an emergency department or call 112:

• Swelling that makes it hard to breathe, speak or swallow
• Swelling that spreads quickly across your face, around your eye or into your neck
• Swelling or pain in the eye, or sudden problems with your sight
• Major swelling inside the mouth, or difficulty opening your mouth
• You think you have swallowed or breathed in the bridge or a piece of it

This page carries no prices. The treatment plan is prepared for you after an examination. The main factors that shape it are:

• The type of bridge and how many teeth it spans
• The chosen material
• Any filling, root canal treatment or gum treatment the supporting teeth need before the bridge
• A temporary bridge and X-rays
• Later check-ups, re-cementing or repair

Ask for your plan in writing, including what it covers. Also ask what is covered if the bridge comes out or breaks.