This short article is the abstract of the part of the "Crown and Bridge 3-day practical course" for ADC practical examination
A variety of factors have to be considered for the construction of a bridge.
- Span of the edentulous area
- Type of the teeth being replaced
- Quality of supporting teeth
- Conditions of the teeth in the opposing arch
- Age of the patient
- Patients’ ability to bear the treatment cost
Span of the edentulous area means how many teeth have to be replaced by bridge. The greater number of teeth to be replaced, the longer will be the bridge; that in turn, will cause more stress in the bridge itself as well as onto the supporting teeth known as abutments. More stressed bridge will get more fractured ceramic from the metal part.
Type of the teeth decides as to how much masticatory load will have to be borne by the abutments. In case of the lateral incisor pontic, supported by one central incision and one canine, the masticatory load over abutments will be minimum. As we move from the Canines through Premolars to Molars, the quantity of masticatory load increases. Accordingly, we need to increase the number of abutments.
Quality of supporting teeth means how healthy the attachment apparatus of the supporting teeth is present. The healthier the apparatus, the better will be the masticatory load bearing ability of the abutments. It will result in a relatively longer life span of the bridge with minimum number of abutments. If the available healthy root surface area of the abutments will be less than the root surface area of the tooth or teeth being replaced, then a greater number of teeth should be used as abutment to prevent the overloading of any particular abutment tooth and ultimately bridge failure.
Conditions of the teeth present in the opposite dental arch includes the considerations of occlusal surface of the tooth and whether it is extruded. Is it causing mandible deviation during chewing?
Age wise a very young patient cannot be given crown and bridge as their pulp chambers are usually large, and the trauma caused by heat during crown preparation or acids of luring agents may render the pulp tissue dead. This may lead to pulpal or periapical pathology ultimately leading to the failure of the bridge.
Ability to bear treatment cost: The complete cost of the treatment should be explained to the patients before the commencement of the treatment. It would be best if a written consent/acceptance could be arranged regarding the payment. There should always remain a clause of modification in the treatment cost, should the nature of the disease changes during the course of the treatment.