Why some fixed implant teeth come with a pink gum section

When teeth go, bone goes too

The jawbone that holds a tooth gradually becomes thinner and lower after the tooth is lost; the change is fastest in the first months but can continue for years. If teeth were lost to gum disease, the bone loss has usually started earlier. Bone can also keep shrinking under removable dentures worn for a long time. The result is a gap between where the teeth should be and the top of the remaining bone.

If that gap is large, simply making the teeth on the implants longer does not work: very long teeth do not look natural, and dark spaces are left between and beneath them. The pink section fills that gap. The teeth keep their usual length, and the lost volume of gum and bone is made up with artificial gum.

Lip support and speech

The upper front teeth and the bone around them support the upper lip from behind. When the bone shrinks, the lip can fall inwards and the lines between the nose and mouth can deepen. The pink section helps place the teeth in the right position and restore part of that support. However, the underside of a fixed bridge has to be cleanable, so it cannot have the wide flange that fills out the lip on a removable denture. If a lot of lip support is needed, a removable implant-retained denture is also discussed.

Speech can be affected too. Especially in the upper jaw, air can escape through gaps under the bridge and change sounds such as s and sh. The shape of the pink section can reduce these gaps. The position of the teeth and the pink section is tried out first with a temporary bridge, when appearance, chewing, speech and cleaning are assessed together.

Bridges with and without a gum section

On a bridge without a gum section, the teeth appear to come straight out of the gum like natural teeth. This needs enough bone and gum, and implants positioned under the teeth; it is usually possible where little bone has been lost or where bone has been rebuilt with extra procedures. A bridge with a pink section is also called a hybrid bridge or hybrid prosthesis, and it is used when bone loss is greater. In between, there are designs where the teeth are made slightly longer and the pink section is kept small.

What decides between them

• Bone and gum level: the distance between where the teeth should be and the remaining bone.
• Your smile: how much upper gum shows when you smile. The line where the pink section meets your own gum should stay behind the lip even in a broad smile.
• Lip support: how the lips and facial profile look with and without teeth.
• Speech: whether air escapes under the bridge.
• Cleaning: whether a brush and other aids can reach under the bridge.

Facial photographs and a trial arrangement of teeth tried in the mouth are used for this assessment. The position of the teeth is set according to the face and lips, and the implant positions are planned to match.

How to clean under the pink section

The underside of the pink section rests against the gum but is not attached to it, so food and plaque can collect in the narrow space between them. That is why the underside is designed so that a brush and cleaning aids can reach it. At home you need to brush at least twice a day; for under the bridge and around the implants you can use interdental brushes, a water flosser or special floss that threads under the bridge. In studies around implants, interdental brushes and water flossers did slightly better than floss, but the difference was not conclusive and most studies involved single crowns; data on full-arch bridges are scarce.

Check-ups and removing a screw-retained bridge

For fixed implant bridges, check-ups are usually advised at least every six months, and more often if cleaning at home is difficult or there have been problems before. At a check-up the gum around the implants, bleeding and bone levels are assessed; an X-ray taken when the bridge is fitted serves as a baseline for later comparison. A screw-retained bridge can be taken off by the dentist, cleaned, repaired and put back. This is not needed at every visit; it is usually done when cleaning at home is not enough or a problem is found, and the screws may be replaced when it goes back in.

This content is for general information only and does not replace an examination.