Bridging Gaps
- Dental and Social

Authored By: Greg Johnstone
Reviewed By: Gary Alex, DMD

One or more missing teeth can adversely affect the appearance and functionality of your smile. Missing teeth can cause a change in occlusion (bite), shifting of the teeth, temporomandibular joint disorder (TMJ), speech impediments, an increased risk for periodontal disease and a greater chance of tooth decay.

missing tooth

adjacent teeth

bridge created

bridge in place
Images Courtesy of Nucleus Medical Art © 2007. All rights reserved. www.nucleusinc.com

Dental bridges, like implants and partial dentures, are used to replace missing teeth. There are several types of fixed dental bridges (cannot be removed), including conventional fixed bridges, cantilever bridges and resin-bonded bridges. 
Typically, conventional and cantilever bridges require shaping of the teeth surrounding a missing tooth. Crowns are then placed on the shaped teeth and attached to an artificial tooth (called a pontic). 
A resin-bonded bridge requires less preparation of adjacent teeth. It is often used to replace front teeth, provided that the gums are healthy and the surrounding teeth do not have extensive dental fillings.

The Dental Bridge Procedure

During the first visit, your dentist examines the health of your gums and other teeth to evaluate if you are a candidate for a dental bridge. If you are a candidate for a dental bridge, you are given a local anesthetic so your dentist can prepare the teeth required to support the bridge. If the support teeth are decayed or badly broken down, your dentist may have to build them back up before they can be used as support teeth for a bridge.
Next, your dentist takes an impression of the prepared teeth with a putty-like material that is used to create a model of your teeth. Your bridge is fabricated based on this model by a skilled lab technician so that it precisely fits the prepared teeth. It is important that your restoration fit perfectly to avoid additional oral health problems such as tooth decay.
While your bridge is being fabricated, your dentist fits you with a temporary bridge so the teeth and gums can be protected from damage until your permanent bridge is ready.
To complete the dental bridge procedure, you must return to the dental office for a second visit to have the bridge fitted and cemented.

The Cost of Dental Bridges

The cost of dental bridges depends on several factors, including:

  • The potential need for additional procedures (such as fillings or root canals) in one or two of the adjoining teeth.
  • The artistic technique of the dentist and lab technician.
  • The location of the dentist.
  • The coverage provided by your dental insurance.
  • The type of material used in the bridge.
  • The preparation of teeth involved in the bridge procedure.

Thank you to Dr. A.M Dippenaar for the use of his pictures and information from
– TEETH – An owner’s manual.

Porcelain Inlays

By Dr Kailesh Solanki
One of the most commonly asked questions by a patient is what is the best way to close a gap between your teeth ? This depends on different factors and is different for each individual. Factors affecting the type of treatment that would be suitable are:

  • How large is the gap?
  • Is the gap a space between 2 adjacent teeth or due to missing teeth?
  • What is the desired cosmetic outcome for the patient?
  • What time frame does the patient want the treatment to be completed in?
  • How is the overall health of the mouth and adjacent teeth?

Cosmetic bonding or composite veneers 
If the gap between the two teeth is very small then closing the gap with composite bonding provides a quick solution to the problem. Bonding provides a minimally invasive solution to closing the gap. However, the drawbacks with bonding are that it does not last very long and will need to be redone eventually and also the boning material is susceptible to staining and may show up after some time.
Porcelain Veneers
Veneers are commonly used to close a gap between two front teeth (diastema), but one needs to consider if the gap is too large then the veneers used the close the gap will be disproportionately wide compared to the rest of the natural teeth. This could leave the smile looking un natural and one of the aims of cosmetic dentistry is to create a beautiful and natural look. Veneers offer a more robust solution than composite however the teeth need to be prepared which means that healthy tooth structure must be removed to allow the veneers to be fitted over the front surfaces of the teeth.
Orthodontics / braces / Invisalign
The most conservative and minimally invasive way to close a small gap is orthodontic treatment either using conventional fixed braces, or invisible braces such as the invisalign system. There are many different types of braces available on the market such as lingual braces, the Inman aligner, Damon braces etc.. The all serve one purpose which is to apply pressure to the teeth to encourage them to move closer together to close the gap. The main drawback to this method is that it takes time and you could be under going treatment for many months, when compared to veneers or bonding which is an instant solution.
Gaps due to missing teeth 
If the gap is due to a missing tooth then veneers, or orthodontic treatment would be inappropriate and the space between the teeth needs to be replaced both for aesthetic reasons and also functional – as a restoration would prevent the teeth either side of the gap from “shifting” towards the gap. Solutions to replace a gap due to missing teeth could be a partial denture a dental bridge or a dental implant.
Partial denture
This is a false tooth which is mounted on a plate and sits in your mouth to fill the gap. The main drawback to dentures are that they can come loose which can be embarrassing as well as making chewing tough foods and eating more difficult. 
Dental bridge
A fixed bridge relies on the structure of the neighbouring teeth adjacent to the gap to act as anchors for crowns to ”bridge” the gap. This requires reduction of health tooth tissue. The bridge is only as strong as the supporting teeth and if one of the supporting teeth were to be damaged in the future or undergo decay the integrity and strength of the bridge would also be lost.
Dental Implants
A dental implant is a replacement for the root portion of your tooth and it provides a long-term solution for the replacement of a missing tooth that does not rely on the adjacent teeth. The treatment is usually carried in 2 stages with the implant first placed into a hole drilled into the jawbone and then left to heal for a period of up to 6 months. The second stage involves placing a crown or bridge on the implant once it has fully integrated with the bone. 
There are many different ways in which dentistry can be used to close a gap between teeth but the most important part of the process is the initial assessment of the patient, what defines the “gap” and what the patient’s requirements are.

Thank you to Dr. A.M Dippenaar for the use of his pictures and information from
– TEETH – An owner’s manual.