A bridge (also known as a fixed partial denture) is one way to replace a missing tooth by connecting the replacement tooth to the adjacent teeth.
Making a bridge first involves preparing the teeth adjacent to the missing space (essentially each adjacent tooth is prepared for a crown). This involves removing some tooth structure all around the tooth and over the top to make room for the bridge. A mold of the prepared teeth is taken and sent to the laboratory where the bridge will be made. There is an enormous difference in the quality between laboratories. We use the best laboratories we can find. The day the teeth are prepared, a temporary bridge is made and placed. Once the bridge returns from the lab (around 2 weeks) we remove the temporary bridge and cement the final bridge in place.
Porcelain fused to metal (PFM) is a tooth-colored bridge with high strength. The metal core makes a PFM many times stronger than an all-ceramic bridge. The metal core can be made of many different materials. In our office the metal core is only "high noble", which means mostly gold and/or platinum; our bridge material is 54% gold and over 26% platinum. We use only high noble metal due to the better-fit and extremely rare allergies and sensitivities. Tooth colored porcelain is baked on the outside of the gold. We only use the highest quality porcelains (a combination of beauty, biocompatibility, and strength). Because there is metal under the porcelain, it blocks natural tooth translucency and is not as pretty (aesthetic) as an all-ceramic bridge. However, all ceramic bridges do not enjoy the longevity of PFMs.
There are many different marginal configurations (the area where the bridge meets the tooth) with a PFM. How well the margin of the bridge fits affects the health of the gums and ultimately the longevity of the bridge. We choose to do a porcelain butt margin, which is the most aesthetic (also the most challenging for the dentist and the laboratory technicians to perform well). A porcelain butt joint, when done well, is aesthetic, healthy for the gums, and durable.
An all-ceramic bridge (or porcelain with ceramic substrate) is the most beautiful of all bridges but is not as durable as the other types. There is no metal so translucency is usually excellent (depending on the type of materials used for the all-ceramic bridge). These bridges are usually indicated on front teeth or teeth that are highly visible. We use only the best materials (a combination of beauty, biocompatibility, and strength) for our all-ceramic bridges. Note: All ceramic bridges do not have the same longevity as PFM bridges.
A full gold bridge is composed of gold and looks gold. We only use high noble metal for our gold bridges (about 72% gold or 18 carat gold, 3.5% platinum). High noble metal fits better and is much less likely to result in allergies or sensitivities. Full gold bridges are indicated on back teeth with low visibility and are performed rather than a PFM at patient's request. The primary benefit of a full gold bridge is durability.