UPDATED JUNE 2024
A gap or space can develop under a dental implant bridge or even a bridge with natural teeth. The focus of this post will be on implant bridges, especially immediate “all on X”/”all on 4″/”all on 6” dental implant procedures for the full arch replacement.
This most commonly occurs on an ALL ON 4/full mouth zirconia or acrylic bridge within the first month after the immediate temporary is placed.
Why is there a gap underneath my dental bridge?
I am going under the assumption that you had your teeth extracted, implants placed and a bridge made on the same day or by the next day. With this procedure, which I do very commonly in my practice, when the bridges inserted there is some swelling of the gums making that space really tight. Typically what happens over the course of 2-8 weeks after the procedure is the swelling comes down around the gums and it shrinks back to normal size…leaving a gap. This is a common occurrence and usually not a cause for concern. However, if the gap affects your speech or comfort significantly, it’s important to consult with your dentist.
A common complaint is that it is difficult to speak. With this space under the dental implant full arch bridge, it is hard to pronounce certain sounds that start with “S” and “H” because too much airflow goes through. This can be frustrating, especially if it affects your confidence in social or professional settings. Additionally, some patients report feeling like there is something stuck between their gums and the bridge, which can be uncomfortable.
A small gap would be considered normal and its best to just let it heal because it will likely increase.
Space Under Dental Bridge Affects Speech
It is more of a problem on the upper jaw because the space affects your speech. On the lower jaw I sometimes encourage to design to have somewhat of a “high water” design so that it is easy to clean. A gap or space under the lower jaw does not usually create any speech issues at all as long as the tissue surface of the bridge is convex rather than concave.
A very short-term remedy would be to place orthodontic wax into that space with your dentist’s permission during the time that it is healing. In my practice once I convert the patient over to a prototype PMMA provisional temporary that is closed up so that we can work out all of the details before we go to the final zirconia bridge on the implants. Keep the area clean to prevent food particles from getting trapped, which can cause discomfort.
Cleaning under the bridge for an all on 4 dental implant procedure with or without zygomatics/pterygoids is pretty much the same. A water pick and a toothbrush as long as the bridges designed well to be very easily cleansed. This is probably one of the biggest issues with these type of bridges over time and honestly has got a lot to do with how the surgery was done and whether or not multiunit abutments are used with proper margin height.
I know this sounds a bit technical, but bottom line is the space can be closed quite easily in temporary settings but if you have your final bridge it can be very difficult if it is made out of zirconia to close that space (although it is possible). It is more simple to do with the acrylic type of bridges because plastic can be bonded with additional acrylic. An improperly fitted or misaligned dental bridge can cause permanent gaps. Using a high-quality dental lab is paramount for longevity.
I have corrected many of these situations over my last 25 years in practice.
Comments? Questions?
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Burbank, California
what is different zygomatic implants & porcelain ceramic implant?
Ceramic implants are non-metal. I do not suggest them. Stick with titanium dental implants. Zygomatic implants are for special cases on the upper jaw with little to no bone.
what is different zygomatic implants & porcelain ceramic implant?
Ceramic implants are non-metal. I do not suggest them. Stick with titanium dental implants. Zygomatic implants are for special cases on the upper jaw with little to no bone.
Hello, I am planning on having a single dental implant for #30. Dental recommendations for crowns for #2 and #3. Would it be wise to have the dental implant before the crowns for alignment purposes and avoiding possible contact/conflict with healing post for #30?
I would actually do them all at the same time so that the bite, contour, color, materials are all perfect and level with one another.
Hi Dr Amin, I did full implants in my upper side 20 years ago, but by the time my gum shrinks and now there is a big gap b/w my implant bridge and implants which causes lots of issues for cleaning and my speech , is there any way to fix this gap in easy way?
This is not easily fixed. Likely you would need to upgrade to a new bridge and probably drop the margin level down on the abutments so that it could be made correctly. Be cautious who you see on this as these can be very tricky to get right
I have AO6 top and bottom, got finals 18 months ago. Still having ongoing issues since the start but persevered as thought it all needed time to heal. The issues are only on right side top and bottom, three areas are always inflamed and it seems to be where part of the implants are exposed, it gets so sore I can’t brush or use waterpik. The right side of the top arch has always felt unfortable and what I can best describe as ‘really tight’ one of the implants on this area at the front is also really exposed. One of the incisors chipped after 8 months and the bottom arch split right down the middle. I don’t eat meat and eat mostly a soft food diet, mainly due to my gums always being sore. I went to a dentist for scans last October he said the implants look okay apart from one where I feel the discomfort and where it’s exposed, he thinks the implant is too close to the sinus. He also thinks the arches have been poorly made, due to amount of gaps/pockets around the implants the bottom implant would only break down the middle due to poor craftsmanship as the back must have put pressure on the front and caused the breakage. The inflammation is coming from the exposed areas ariund the implants and gums becoming irritated from eating/food getting stuck and also the cement can cause ongoing gum irritation and infection. He said cement retained implants are old practice and should only ever be screwed, this allowed for annual cleaning (which i have never been offered) and if any problems (like i have) can be dealt with easier, ie. access to implants. He would only ever use cement on a single implant, never a AO6 full arch. I also had to go to an emergency dentist this week due to the irrational again and it started bleeding, this dentists thoughts were exactly the same as the others. They both recommend get new arches made to close the gaps and not to wait for the split bottom arch to completely break, change from cement retained to screw in, close the gaps. I shouldn’t still be having these issues 18 months after finals. They said these gaps are also causing me to sound like I have a lisp and not being able to pronounce some words properly. They said this should be rectified by the original dentist at no cost. I’m at a loss what to do, hate being in pain, continuously taking pain killers and anti inflammatory’s and it’s making me irritable and unhappy. I feel no better off getting this done than I did before.
Sorry for issues and thank you for all the detail. It sounds like you need to get this all done again. Some dentist practice to a much higher standard than others. Everybody has a different skill set, experience and judgment. I would suggest you see somebody who has a good local reputation for this. If the implants are exposed he may have bigger issues necessitating removal of the implants and not just making new bridges. I am hoping that you do not have miniature implants but rather full size. Typically this is a beautiful procedure that provides a life-changing results but it sounds like your experience has been less than stellar. Here is a link to common problems with all on 4 type of bridges that might help you.
I had a three piece bridge made four months ago and there are two implants. The bridge is causing me pain and does not feel right and I have a bad taste in my mouth and my whole mouth hurts.
It sounds like you need to go go back to your dentist and have this checked out
I had all on 4, zirconia upper implants. After 3 months it feels like I have something very foreign and thick at the underside of my implants, I can run my finger along the back between gum and implant, it’s like a thick shelf, us this normal?
This may be part of the shape of your bridge, depending on your level of bone loss in that area. it could possibly be an intentional design of the bridge or it could be an area that can be narrowed out or tapered in a bit as you get closer to the final.
As long as the shape of the bridge is self cleansing and convex underneath a slight shelf can be OK especially if it supports your lip or face
Ok, I’ll try and explain better, I have my finals, almost 3 months later the shelf I refer to is underneath, at the back of the implants. I’m aware of it all the time. It feels big and like I’ve got a foreign thing there.
I asked the dentist at the time if it was normal to feel like I’ve got a thick bit all along and doesn’t align with the back of my top gum, underneath, at the back of the implants, I’ve tried to find out more online but I’ve never heard anyone with this issue?
It often will not align with your existing gum, especially if you had a lot of bone missing on your teeth or the trajectory of your jaw is different than the trajectory of your teeth.
This is an area that I spend an immense amount of time on with my patients to try to make it feel as natural as possible. It is not always possible to make it perfect it is very dependent on your anatomy. This is very much a case by case basis issue.
Very hard to determine without seeing you
I’m 9 months on my hearing all on four upper arch and experiencing nawing pain through out the day. The space between the arch and my gums seems to be good size at different points in the day but the front seems to be squeezing my gums and irritating them causing me to live on ibuprofen… will this get better after I get into my next set of teeth or is this pain and gum irritation a forever thing ?
The pain should be gone in the healing teeth before moving to the final. Something is up.
I have been experiencing the same thing for 15 months and 2 temp sets …. Did you ever find out what the problem was and how did they fix it?
Just got my final lower arch of Zirconia. It’s been 14 months.
It feels deep with the Zirconia gum on the left & really short on the right. I can also feel the 2 front abutments making me think the went too short.
They do not have to be level in the gums. As long as the gum is not irritated this is probably fine 😉
I have my final full upper arch prosthetic. I asked for BruxZir Zirconia Esthetic. Unfortunately after being in the temporary PMMA for 2 months, somewhere along the process the changes the Dentist made did not get incorporated into the final . He claims he did not know how it happened and now says that the changes are minor and can be fixed with additional material. It is my understanding that Zirconia cannot be ” fixed” in this manner and leads me to believe that I do not have a solid monolithic piece of Zirconia in my mouth. How can I tell ?
It should look solid white on an x-ray. But porcelain glass can be overlaid which you would not be able to tell.
I feel a tiny piece, kind of a little point made of metal pushing through the pink fake gingivae part of my temporary hybrid., attached to my upper all on 5 implants placed in January. I might be grinding teeth in my sleep! Does this ever happen yet it’s not a failed implant but just something which happens at the end of the temp cycle after initial surgery? I see my dentist to be released for final crowns/ bridge attached to the implants in 3 weeks. Please reassure me, or just tell me if this is my middle implant failing. I’m SO WORRIED!! I have no pain which is how my oral surgeon says that it would feel if it failed. I’m even scared to call him bc I fear he will blame me and say I have been grinding but I’m not aware of it if this if the case though I have a very strong bite. Thank you for your response.
This is likely a very minor issue if this just on the biting surface. This is likely just the titanium cylinder showing through.
The provisional bridge may not fully cover the titanium cylinder, leaving a portion of it exposed. This can happen if the bridge is not properly contoured or is too thin in certain areas.
It is generally very easily corrected in the final and not something you should worry about 😉 😊
Hi,
I have had my permanent implant bridge fitted for three weeks and have gaps and some of the implants are visible. I constantly feel like there is something stuck between my gums and the bridges and have a constant pressure. The top bridge was cemented onto the implants and the bottom is screwed on. I feel like I want to rip them out of my mouth there is so much discomfort. Is any of this usual. I would add photos to show what I mean but I don’t know how. Any advice you can give would be appreciated.
Thankyou
You can provide a Google Drive link that is public to anyone. That is the only way to post a picture.
I have gaps around my permanent implant bridge which food is getting stuck in. Also I feel constant pressure, is this normal. Its 3 weeks since I got my permanent arches anndI feel like I want to rip both arches out of my mouth it’s so bad. It seems like it’s getting worse instead of better. I would send photos but I don’t know how to attach them. Any advice would be greatly appreciated.
Thankyou
Give yourself at least 3 months to get used to it. At that point you should reassess. These are typically worked out in the prototype phase. Although most people can adapt there is a tiny portion of the population that has a really hard time. This is something that I work very hard at with facial scanning and digital prototyping.
Hi Dr.
had a lot of problems with zirconia implants. First made wrong now have a small hole which brings air through and a slight pulling sensation in font teeth. Is this normal. Dentist does not want to be bothered any longer. I feel lost.
Do you have an all on four style bridge like what is being discussed here? Is it zirconia? You could take it out and bond the underside to fill in the space. It can usually be fixed!
Thank you. My Dentist told me there is nothing I can do final is final. Yes it is Zirconia and I have 5 implants. Very upset. It does look like it might be closing , I am having some on and off after three weeks, so I am assuming they are moving. I am allergic to PMMA badly so I don’t know if I would be allergic to the bonding and need to find a dentist with a lab close by. Otherwise they leave me without teeth for five weeks. Sounds crazy. Thank you for answering. But again according to my dentist This is it.
Allergy to PMMA is really rare but this makes more sense now. So sorry
Hello Dr.Amim I am from Sacramento and just got back from having 14 extractions 2 sinus lifts and bone graphs with 10 implants 4 on top and 6 on the bottom 2 more will follow the sinus lift and bone graph healing my temporary archs are being held in with re line it ..and it is painful to say the least the final teeth will be Prettau Zirconia. I paid 15k for both archs..all on 6 zirconia…but I feel I need this work checked out ….6/15/21 was my surgery I am back in Sacramento but can’t talk with the temporary arcs…need some advice from another professional on this work I paid 7500 for this part and I want to make sure I get the best for the next 7500 zirconia finish and the best procedure …I have a 3D scan on DVD…please help me
I gave 6mm of bone above a missing tooth where I plan to have an implant. Is it necessary to get a sinus lift and build additional bone before doing the implant?
6mm is not enough length for a free standing implant crown in the upper. It can work on the bottom since the bone is better. I would suggest a Morse taper design if you ‘have’ to go that small.
Better to lift the sinus for sure 😇
Thank you so much!
Today, when I look at how perfect my teeth look, I can’t thank you enough, Dr. Amin. for your unwavering support, for your guidance and for doing such a wonderful job with my zygomatic implants. I will be forever grateful.
HELLO!!!!!!!! Wow! So glad to see you on the forum! Thank you for allowing me to treat you and trusting my team and I!
Merry Christmas!
Today, when I look at how perfect my teeth look, I can’t thank you enough, Dr. Amin. for your unwavering support, for your guidance and for doing such a wonderful job with my zygomatic implants. I will be forever grateful.
HELLO!!!!!!!! Wow! So glad to see you on the forum! Thank you for allowing me to treat you and trusting my team and I!
Merry Christmas!