Traditional, cantilever and Maryland bridges — what each asks of the teeth beside the gap

Every fixed bridge does the same job — it hangs a false tooth, the pontic, in a gap — and they differ in what they borrow from the teeth either side to do it. That borrowing is the real currency of this decision, and it is not on the invoice. The three arrangements below ask for progressively less tooth, and, as the fee schedules show, the ones that ask for less are the ones payers have thought about least.

Which of them suits a particular gap is a clinical question about bite, bone, gum health and how much of each neighbouring tooth is still sound. Nobody at this desk can answer it and nothing here tries to. What follows is what each type is, and what the published documents say about paying for it.

The traditional bridge: two teeth crowned, one tooth carried

This is the arrangement almost everyone means by "a bridge". The teeth on both sides of the gap are cut down and capped with retainer crowns, and the pontic is joined permanently between them. The ADA describes fixed bridges as ones that "are attached to surrounding teeth for support" and that only a dentist can remove, and lists the materials as gold, alloys, porcelain or a combination of those.

In billing terms it is three units, which is why it arrives at three figures. Washington State's 2026–27 schedule allows $800.00 for a porcelain-fused-to-base-metal retainer crown and $800.00 for a pontic in the same material — the full arithmetic is on what a dental bridge costs. Montana allows $632.32 and $711.36 for the equivalent lines, and Pennsylvania has no line for either.

The cost that never appears as money is the preparation. Two teeth that may have been intact are reduced to stumps to carry the third. That is not an argument against a traditional bridge — sometimes those neighbours were already heavily filled and were heading for crowns anyway — but it is the part to have explained, in writing, before anything is cut.

The cantilever bridge: supported from one side only

A cantilever bridge anchors to a tooth on one side of the gap instead of both, and the pontic projects out from it unsupported at the far end — exactly the arrangement the word describes in a real bridge. It is used where there is only one usable tooth next to the gap, or where the dentist would rather not touch the tooth on the other side.

The obvious engineering consequence is that every force on the false tooth is carried by one abutment rather than shared between two, as a lever rather than a beam. Whether a given tooth can take that is a judgement for the dentist examining it, and it is the single most useful question to ask if a cantilever is proposed: what is holding it, and what happens to that tooth over time?

None of the three schedules read for this site prices "cantilever" as a distinct thing. It is built from the same retainer-crown and pontic lines as any other bridge — fewer of them, because there is only one retainer — so a cantilever is generally two units rather than three. Nothing in the documents confirms a discount beyond that unit count, so do not assume one.

The Maryland bridge: wings bonded to the backs of the neighbours

A Maryland bridge, also called a resin-bonded bridge, replaces the retainer crowns with thin wings that are bonded onto the back surfaces of the teeth either side. The neighbours keep almost all of their structure — the appeal of the design — and the whole thing is held by adhesive rather than by encircling the tooth.

Here the schedules produce their most striking silence. Resin-bonded retainers have their own procedure codes, and not one of the three documents carries any of them. Pennsylvania has no line, Montana has no line, Washington has no line. The most conservative of the three designs — the one that destroys least — is the one none of these payers has priced.

Be careful what you conclude from that. It does not mean a Maryland bridge is unavailable, unsuitable or a bad idea; payer schedules describe funding decisions, not clinical merit, and a private practice can offer one whatever a state programme prices. What it does mean is that if you are relying on public funding for restorative work, this option is unlikely to be part of the conversation, and you may only hear about it if you ask.

What the schedules do split by, which is material

Where the documents are detailed is in what the units are made of, and the detail is inconsistent between them in a way worth seeing.

Read the two columns against each other. In Washington the all-ceramic pontic is the most expensive of the three at $900.00 and the resin-with-metal one the cheapest at $780.00 — the order you would expect. In Montana the order reverses at the top: all-ceramic is allowed $596.75, less than the $711.36 for porcelain fused to base metal. Two public payers, reading the same procedure codes, disagree about which material costs more. Any sentence that tells you a particular bridge material is categorically pricier is describing one fee list, not a fact about dentistry.

Montana also prices full cast metal retainer crowns, at $553.28 for base metal. Washington's schedule has none of those lines — its retainer crowns are porcelain or porcelain-on-metal only. Pennsylvania, again, has none of it: its entire fixed section is a re-cementing line at $30.00 and a repair line at $35.00.

The question that outranks the type

Before choosing between these three, there is a prior question: what condition are the teeth either side of the gap actually in? A neighbour already carrying a large filling is a different proposition from an untouched one, and it changes which designs are sensible. That is a question for an examination and X-rays, not a website — but it is the question, and a plan that arrives with a bridge type already chosen and no explanation of why is a plan worth asking about.

The other thing worth asking is what the crowns themselves will be. Every retainer in a traditional or cantilever bridge is a crown, and crown material and construction are priced exactly as they are for a single tooth — the whole picture is in types of dental crown and what each one costs. If the two teeth are being crowned anyway, the pontic is the only genuinely new item, and the plan should show it as its own line.