Implant Retained Complete Dentures

Replacing missing teeth with implant retained complete dentures

Few patients will ever say they are happy wearing complete dentures. Dental implants help those that are not happy. When utilizing implants for an edentulous arch (jaw, top or bottom), there are a few different methods. Implants can help hold a conventional denture in place with attachments or “snaps” (removable by patient, they can be used to support a bar that a conventional denture “snaps to” (removable by patient), and they can be used to support a completely fixed bridge that is not removable by patient (fixed hybrid denture) but can be removed by the dentist.

Terminology is always confusing for patients considering these treatments. Different terms are sometimes used when describing these treatments and sometimes terms are used incorrectly. Our office often refers to two terms: removable or fixed. This seems simple but can still get confusing.

Removable means that the patient can and must remove the prosthesis to clean it and allow the gums to rest. Removable prosthetics almost always utilize the gums for support. What this means, is that when the patient is chewing, biting down, or clenching, the gums will support that pressure, so that any implants or remaining teeth do not take all of the load. The retention (how well it stays in place) and stability of removable prosthetics can vary greatly depending the number of implants and or teeth utilized.

Fixed is used to describe a complete or partial “bridge” that can not be removed by the patient. It is designed to allow the patient to perform proper hygiene.

What if I’m missing all of my lower teeth?

Ball Attachment Over-denture

One option is to have two implants placed in your lower jaw and a denture made that snaps onto these implants. This option allows your lower denture to be more stable while chewing than without implants. However, there will still be movement of your lower denture, and sore spots will occur if any food particles, especially seeds, are caught under it. As with all removable replacement teeth, you still will need periodic appointments for denture adjustment and possibly relines. Because this type of prosthesis is supported by only two implants, the gums MUST be utilized to support vertical pressure when chewing and clenching. The implants main job is to help hold the denture in place. The areas that do not have implants are still subject to resorption (shrinkage) over time. As this happens, the implants and the attachment system are further burdened for support. This is why relines may become critical and why initial fitting is paramount in the overall comfort and performance. A common problem seen in these case is inadequate soft tissue (gum) support resulting in sore spots, rocking of denture, and/or loosening of attachments.

1. Before

2. Implants Placed

3. Denture Attached

Bar Attachment Over-denture

Another option involves placing two or more implants, depending on your jaw size or shape, into your lower jaw. After healing is complete, the implants are connected with a custom-made support bar. Your denture will be made with special internal retention clips that attach onto the support bar, enabling the denture to snap firmly into place. This is called an “over-denture.” The advantage of this option is that it is much more stable than the first option and allows very little denture movement. Your denture is still removable for easy cleaning and maintenance. Often times the cost difference between a bar over-denture and fixed hybrid (screw retained) denture is relatively small. Bar over-dentures require a great deal of clinical and laboratory time for fabrication and proper fitting. Many components and attachments are needed as well. So why do a bar over-denture? Good question.

Every case is different, so there can be times that it may be a good option or even the best available option. In our experience, a bar over-denture is rarely advantages for the lower jaw. In most cases there is enough bone in the lower jaw to allow placement of enough implants for a fixed (screw retained) denture, removable prosthetics are less tolerable for the lower jaw, and the cost difference is minimal. Because hygiene is more of a challenge for screw retained dentures, bar over-dentures may be encouraged by some practitioners more than others. It is our opinion that the quality of life a fixed prosthesis provides outweighs any additional efforts required in hygiene.

1. Before

2. Implants Placed

3. Denture Attached

Screw Retained Denture

A third option involves placing four or more implants in your jaw and attaching a permanent denture. Your denture is held in place by screws or is cemented over abutments that are screwed into the implant much like a conventional fixed bridge on natural teeth. It doesn’t touch the gum tissue, which allows you to clean under the denture without removing it. This denture will replace all your missing lower teeth and will not be removed except at maintenance visits. Although cleaning under your denture without removing it is more time consuming and requires more dexterity, many patients who want a permanent denture prefer this option.

1. Before

2. Implants Placed

3. Denture Attached

What If I’m Missing All Of My Upper Teeth?

A similar range of treatment options is also available for your upper jaw. However, because the bone is not as hard as that in the lower jaw, people often need more implants to support their new replacement teeth. Depending upon the number of implants to be placed, it may be possible to eliminate the need for covering the roof of your mouth with a complete denture. This option allows you to fully taste your food and gives you a better sense of its temperature. Your denture will feel more natural. You will still have a removable denture, which makes cleaning the support bar and denture much easier.

The upper jaw often times does not have as good bone density or quality as the lower jaw does, therefor, more implants are typically required to support a fixed hybrid than in the lower. The upper jaw often times has less bone available for implants as well. This can greatly limit the ability to provide a fixed case which leaves a bar over-denture as the next best available. The most common complaint of an upper complete denture is the palate being covered. In order to provide a palateles or “horseshoe shaped” upper denture, most dentists would agree that at least four implants are needed. Our practice shares this philosophy, but also feels that in almost all cases a bar over-denture has the best long term prognosis as opposed to four implants with individual attachments. Again, this is mostly due to bone quality as well as the lateral forces placed on an upper denture. Because the bar is mechanically attached (screwed down) to the implants, all loads are distributed to all implants as opposed to just one or two.

Removable dentures typically extend over the gums and into the vestibule (space between lips and gums or cheeks and gums). This is referred to as the flange. A very small percentage of patients may choose a bar over-denture in order to have the flange giving them lip and facial support they may not have with a screw retained denture. The face is mostly supported by the teeth, but the gum and underlying bone tissue does as well. In most fixed cases (screw retained), there is adequate support and sometimes facial esthetics is better.

Implant Retained Upper Denture

Depending upon the number of implants to be placed, it may be possible to eliminate the need for covering the roof of your mouth with a complete denture. This option allows you to fully taste your food and gives you a better sense of its temperature. Your denture will feel more natural. You will still have a removable denture, which makes cleaning the support bar and denture much easier.

Dental Implant Benefits

• Improved confidence
• Stability during eating
• Bone and gum preservation
• Improved dental hygiene
• Superior esthetics
• Nutritional benefits

Call South Texas Dental Implants & Prosthodontics Phone Number 210-692-0136 for more information or to make an appointment.