Bridges- Biomechanics

Sumamry
There are some important principles we need to be aware of when considering bridges as the
definitive treatment option.

Abutment Assessment:

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When assessing the adjacent teeth to the edentulous span, we need to work out if they are going to
be suitable abutments and cope with the extra demands that come with a prosthetic restoration.
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Below is a guide in addition to carrying out a tooth-by-tooth prognosis (see restorative lessons)
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The Periodontium:
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Periodontal status should be stable, free from inflammation and minimal history of bone resorption
(<25% bone loss). Consider root length as well.
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Mobility: This should be scored ideally as 0 but (in some texts, a score of 1 can be acceptable)

PDL Surface Area: The loss of PDL support due to root resorption is not as critical as the loss of
PDL support due to crestal bone loss, as seen in periodontitis.

Ante's Law: Although not commonly used, because it only considers the PDL, it is still good to have
an awareness of this concept as exams still may ask about it. This law compares the Root Surface
Area (PDL attachment) to the Surface Area of the edentulous ridge span. The law stated, that the
root surface area should equal or exceed that of the span being replaced by the pontics.

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Diagram showing Ante's Law

The Roots:

Crown:Root ratios - the ideal is 2:3 respectively; however, 1:1 can be acceptable if minimal bone loss
has occurred and occlusal factors have been accounted for e.g. the opposing teeth are artificial.

Average Occlusal Force Guide - imposed by the opposing teeth:

- 150lbs natural teeth
- 54lbs Fixed bridge
- 26lbs RPD

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Root configuration: divergent roots anchor a larger surface area and can provide a sturdier
foundation. A broad bucco-lingual (sometimes referred to as facio-lingual) diameter "oval" root
cross-section is preferred when considering resistance to rotational forces, compared to a circular
cross-section.

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Diagram showing differing Crown:Root ratios

Endodontics Status:

Ideally the tooth should be vital and free from any apical infection signs and symptoms. A pulp

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capped tooth shouldn't be used for fixed prosthodontics. Root treated teeth should be flawless if to
serve as an abutment with a minimal access used (small core). Post crowned teeth are best avoided
as abutments.

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Restorability:
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Does the abutment require a crown/ form of cuspal coverage? If this is the case then a fixed option
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may be appropriate to replace the adjacent space.

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If bonding is to be carried out, high quality enamel should be present.

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Biomechanics:

Ridge Span Rules:

Longer Spans are LESS Rigid; but by how much?
The results shown clinically by longer spans, is that the bend and deflect more than a shorter
spanned bridge.

The CUBE of the span length is DIRECTLY proportionate to the increase in deflection and bending
shown by the bridge.

Examples:
Single Pontic: 1x1x1 = 1
Two Pontic: 2x2x2 = 8

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Three Pontic: 3x3x3 = 27

The affect of the bridge span exponentially affects the bending shown clinically and increase the risk

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of bridge failure.

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Diagram showing the affects on flexibility of a long-span bridge.

Occlusal Gingival Height - Thickness of the Prosthesis:

The height of the pontic(s) and connectors also affects the amount of bending the bridge will show

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clinically.

The CUBE of the occlusal-gingival (height) is INVERSELY proportionate to the flex/ bending shown

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by the bridge

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Example: t = Pontic height (occlusal-gingival dimensions)
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t1/2 = 2x2x2 = 8 times more likely to bend and flex
t1/3 = 3x3x3 = 27 times more likely to bend and flex
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Material choice regarding their rigidity properties in thin section are essential for bridge success,
balancing embrasure aesthetics and mechanical robustness.
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Diagram depicting the difference in flexion of different occlusal gingival pontic heights.

Forces to the fixed prosthesis:

The forces acting on the pontic create a flexing movement that stresses the prosthesis in a Mesio-

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distal direction (see ridge span diagram). As the pontic takes occlusal forces it is pressed downwards
which creates stress on the abutments dislodging them towards one another. When linking this to
material choices and clinical application, the preparations we carry out will need to have tall axial
walls and the cement able to cope with shearing forces.

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Comparing this to a single restored tooth which receives force on oblique angles and displacement is
more likely to occur in a bucco-lingual direction.
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This is important when assessing if groove placement is necessary to resist rotation and
displacement forces.
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Arch Curvature:
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The Inter-abutment axis: This is a straight line drawn between the abutments. We know the
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mandible and maxilla aren't straight lines, they are arches. Therefore, sometimes the pontic teeth
will fall outside of this axis. The easiest example to provide is a Fixed-Fixed bridge replacing all four
upper incisors with the canines as the abutments. The line drawn between the canines will go
straight across the palate and none of the pontic teeth will fall upon this axis.

When pontics fall outside of the inter-abutment axis there is an increased risk of torquing forces
applied to the supporting teeth. In the scenario above, when we protrude the jaw forward against
the four pontics, we are pushing them forward, which causes hinging forces on the abutments as the
pontics lever outward.
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Double Abutments:
Rarely used
They may be seen in circumstances where crown height was limited and extra retention was
required. If a secondary abutment is to be used the general principles are:

The secondary abutment has equal to or greater than C:R ratio and PDL surface area to the
primary abutment.
The retention from the preparations must equal that of the primary abutment.
Gingival clearance around the margins of the restoration is required, as forces are applied,
entrapment of the interdental tissues can occur.

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Pier Abutments:

E.g. 5 Unit Bridge

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Terminal Abutment - pontic - Pier abutment - pontic - Terminal Abutment
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To apply a fixed rigid bridge in this circumstance would be unwise. We have the inter-abutment axis
to consider, the retentive differences in the crown preparations, and unwanted tooth movements,
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both physiological and when in function.

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When masticatory forces are applied to the pier abutment tooth it becomes a fulcrum. This places
unwanted stresses on the terminal abutments. As the cement becomes fatigued, the marginal seals
deteriorates, resulting in undetected caries and restorative failure.
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Therefore, in the scenario above, non-rigid mechanisms have been created to combat these potential
problems - "stress Breakers"
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Diagram showing a Pier Abutment.

Non-Rigid Appliances:

The aim of a non-rigid connector is to decrease the mesio-distal displacement forces. These types of
prothesis will have a "male" mechanism and a "female" mechanism. (Slot and Groove - like a dove
tail joint). This will also be called the major connector (male pontic) and the minor connector (female
abutment)

The female mechanism is placed distal on the pier abutment and the male slot is on the mesial of the
pontic. The reasons behind this layout is due to both the natural mesial drift of the teeth and during
function the forces will bring the pontic closer to the pier. Therefore, the mechanism "locks"

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together during force rather than being pulled apart. If the abutments are unopposed, and the
mechanisms were placed the other way around, unwanted eruption could occur without the
"locking" effect from mesial drift.

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The only time when a minor connector holds the male mechanism is on a mixed bridge design.
Bridge design is discussed in the next lesson. This is for ease of retrieval if the bridge was too fail.
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Diagram of a Fixed-Moveable Bridge.

The Titled Molar:

This scenario is an abstract one, but has been considered for the sake of completion. A tilted molar

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makes a common path of insertion (when dealing with a F-F) prosthesis difficult, because it is near
impossible to get the preparations parallel (without risking pulpal exposure mesial on the molar).

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Side note: It is for this reason, when endodontically accessing a tooth, that it is sometimes advised to
remove the crown to be able to confidently navigate the substructure; decreasing the risk of
perforating. ta
Options:
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Preparation modifications - if a minor tilt is present, some sacrifice may be made in the
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retention of the axial preps.

3/4 crowns used - only if the tooth to be prepared has a distal marginal ridge lower to its
adjacent tooth e.g. prepping the 7 with an 8 behind.
Telescopic crowns
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Orthodontic realignment to upright the molar

Copings made
Two part bridge - (non-rigid design)
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Replacing the Canine:

Canines are usually placed outside of the inter-abutment axis. In addition to this the adjacent teeth
being the lateral incised and the first premolar are both the weakest teeth in the anterior and
posterior sextants. Due to the forces mentioned about creating torque and hinging motions, which
will push the canine out of the arch during guidance, group function is advised to be obtained to
lessen this stress applied.
The lower canine is at less of a disadvantage than the upper if being replaced, as the forces aren't
being pushed outwards from within the arch.

Cantilevers:

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As soon as we use a cantilever design the pontic becomes a lever arm. Following from the points
made in the lesson above; tooth movement can involve mesial drifting, therefore mesial cantilevers
are preferred creating a more stable contact point between the pontic and the adjacent tooth. The
occlusal contact point is ideally placed nearest the abutment tooth, to minimise the lever forces
placed.

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Diagram of a Cantilever Bridge.

If replacing a posterior tooth, an awareness of the occlusal forces is needed. If on the rare occasion
a distal cantilever is placed for the purpose to prevent over eruption of an opposing tooth, a smaller
pontic could be used, with minimal contact obtained between the opposing arches.
Conclusion
I hope the above lesson has helped to frame that there is a lot going on in the mouth that can affect
the type prosthesis we provide and the successful outcome of our treatment.

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Third Party Links
Dental Update: Ibbetson R. A Contemporary Approach to the Provision of Tooth-Supported Fixed
Prostheses Part 1: Indications for Tooth Replacement and the Use of Fixed Bridges Retained by

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Crowns. Dental Update. 2018 Jan 2;45(1):10-20. Dental Update: Ibbetson R. A contemporary
approach to the provision of tooth-supported fixed prostheses part 2: fixed bridges where the
abutment teeth require minimal or no preparation. Dental Update. 2018 Feb 2;45(2):90-100.
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References
These resources were used throughout to help create this lesson: Shillingburg HT, Sather DA,
Wilson Jr EL, Cain JR, Mitchel DL, Blanco LJ. Fundamentals of fixed prosthodontics 4th Ed. Chicago.
Quintessence. 2012;119(130):299-345. Rodrigues AH. Treatment Planning in Restorative Dentistry
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and Implant Prosthodontics. Batavia: Quintessence Publishing Co; 2019. Dyer TA. Churchill's
Pocketbooks: Clinical dentistry. British Dental Journal. 2007 Mar 10;202(5):288.
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