Occlusal and Periodontal factors to consider when a dentist decides a patient needs a bridge.

When planning the construction of a dental bridge, consideration must be given to the occlusion and periodontal aspects.

Periodontal aspects

The patient should have good oral hygiene as this is going to be an indirect restoration which should last the patient many years at more expense than a conventional removable denture.

The abutment tooth should have good bone support and be free of active periodontal disease.

The remaining dentition should not have any untreated periodontal disease.

One should also consider the longevity of the patient’s remaining teeth as you do not want to be making a bridge for a patient if there are other teeth which have a poor prognosis.

The bridge design and construction should have good accurate fitting margins without any overhangs.

Supra- gingival margins are easier to clean for the patient but many patients want sub-gingival margins as they cannot be seen especially if they have a high lip line in the aesthetic zone.

The pontic of the bridge should be designed so that it is easier for the patient to clean and reduces the risk of periodontal disease.

Occlusion

The bridge should try to conform with the patient’s existing occlusion. However sometimes it is necessary to modify a patient existing bite especially if teeth have over erupted or tilted excessively.

Once the bridge has been fitted, the occlusion should be checked to make sure that it is balanced in centric occlusion.

It should be free from interferences or premature contacts.

Patients who have parafunctions, bruxism or clenching, may need to be provided with a night guard in order to protect the bridge from fracture.

When treatment planning a patient for bridgework, the periodontal tissues and occlusion needs to be assessed. Any issues identified should be treated beforehand so that the periodontal condition is stabilised and the occlusion envisaged prior to commencing the restorative treatment.