Before a bridge can be created and placed, a patient needs to have an initial consultation and evaluation by a general dentist or a prosthodontist. This will include a comprehensive dental examination and a medical and dental history. X-rays and impressions of the teeth may be taken. In some cases, the dentist may order a computed axial tomography (CAT) scan. This may be important if an implant-supported bridge is planned. The CAT scan is used to determine how much bone is available in the jaw and the exact position of sinuses and nerves. If not enough bone is present to support the bridge, bone grafting or some other bone surgery may be recommended before further dental procedures can occur.

A bridge is a type of indirect restoration. This means that it will require two or more visits to the dental office: one to prepare the abutment teeth and make impressions and another to fit and adjust the bridge and secure it into place. During the time between these visits, the impressions are sent to a dental laboratory, where the bridge is created.

The preparation stage varies depending on what type of bridge will be used. If natural teeth are to serve as abutments, they may need artificial crowns, especially if a fixed bridge is planned. A root canal treatment is usually not necessary if the teeth are healthy and strong. However, part of the natural crowns will have to be removed to accommodate the artificial crowns. Some enamel is typically removed from natural abutment teeth with other types of bridges as well. The amount removed depends on how the bridge is connected. Typically, only enough enamel is removed to accommodate the size of the attachments.

If implants are to be used for the abutment teeth, they must first be surgically placed. This often takes two separate surgical procedures.

• First, the implant is surgically placed within the jaw and covered with the gums. The jaw and gums are allowed time to heal so that the implant can fuse with the bone of the jaw. This may take three to six months.
  
  
• Second, the head of the implant is exposed in a much more minor surgery. The permanent bridge is placed in the area after the gums have healed from this second surgery, which may take four to eight weeks.

Some dentists use a one-step process instead. This involves surgically placing implants into the jaw, while leaving the head of the implant exposed. Therefore, a second surgery is not needed.

After the abutments, either natural or implanted, have been prepared, an impression is made of the area to be restored. The impression is then sent to a dental laboratory, where it is used to make the permanent bridge. Meanwhile, a temporary bridge is placed over the prepared abutments. When the abutments consist of natural teeth with portions of their enamel removed to accommodate the crowns, the temporary bridge protects them and helps maintain their position in the mouth.

For surgically placed implants, a temporary bridge cushions the implant and allows the gum to continue to heal around the implant. Temporary bridges also provide cosmetic appeal while patients wait for their permanent bridge.

After the permanent bridge has been made and sent back to the dental office, the patient returns for another visit. The bridge is set in the mouth and checked for proper fit. It is adjusted as necessary. If the dentist cannot adjust the bridge to the extent needed to ensure a good fit, it may have to be sent back to the laboratory for more adjustment.

After the dentist determines that the bridge fits correctly, it is attached to the abutments. A fixed bridge is bonded into place either by cementing attached crowns to abutment teeth or by bonding directly to the teeth. If a removable bridge is used, the dentist will explain and demonstrate how to put in and remove the bridge.