One of the most common forms to treat patients who have lost all their teeth is to make dentures that fit around implants. Many times patients will request implants for their dentures but not realize that there are many different ways to accomplish this. If someone comes in wanting implants to help out their dentures, it might mean just a couple implants on the bottom jaw to snap in a lower denture or it may mean up to sixteen implants to hold in crowns and bridges on both the top and bottom jaw. Before deciding upon what type of denture to make it is necessary to do the initial exam with x-rays and models of the jaw. After this is done I talk about fixed implant dentures and removable implant dentures.
As I mentioned above, most of my patients do not quite know what an implant denture is. The way that I think about it is that an implant a man-made titanium root that the bone heals into that helps hold in a dental prosthetic. This dental prosthetic can be a single tooth or it can be a denture. When a patient asks for implants, I do an exam and take a 3D x-ray. In the exam, I am evaluating the smile and the usefulness of the remaining teeth, and I am looking for signs of infection. The 3D x-ray is necessary because it also helps show infection but it mostly shows where the bone is in the jaws. Before placing implants, I like to treat all infection such as cavities and gum disease because even though implants do not get cavities or gum disease, it is possible for those infections to travel into the bone and cause problems for the implants. An implant that gets infected is not easy to treat down the road and is best avoided at all costs. If there is not enough bone present to support an implant, bone grafting may be needed so that the implant can be placed.
I find that the vast majority of my patients who request implant dentures want teeth that are fixed in the mouth. While there are a variety of ways to get to this end result, I break it down into the question if we are replacing just the teeth or replacing both the teeth and the gums. Replacing the teeth alone is usually more difficult as we need to have even gum heights around each tooth; however the benefit is that it looks more natural, is easier to clean, is easier to repair when something breaks as usually only one to three teeth need to be replaced. Usually this process with take between 12 to 18 months. If we are replacing both teeth and gums, then the jaw bone is shaved back so that the gums do not show in the smile line as it is impossible to get prosthetic gums to match natural gums. At the same time, implants are placed and a full denture is placed in the mouth and fixed to the implants. After six months of healing, we place a final fixed full denture. This process is easier to do as I do not need to worry as much about individual teeth and gums because they will all be replaced by a denture, but these are harder to keep clean and when something breaks, the entire denture usually must be redone. I will usually recommend these types of dentures for patients who have lost teeth due to trauma or have had major dental work done in the past and are used to having routine maintenance visits. The reason for this is that these restorations are much more difficult to keep clean and with implants, cleanliness is paramount.
My personal preference for most of my denture patients is to fabricate a removable implant supported denture. Usually I will place the implants in the best locations and allow them to heal for between three to six months. At this time, a regular denture is worn. After the implants have healed, I fabricate a denture to fit around them. If it is a bottom denture, I will typically use what is called denture locator attachments. These are liked because they are easy to make and easy to clean. Also when they wear out, they can be replaced in as little as 15 minutes for minimal cost. If it is a top denture, an extra step must be added in that we need to splint the implants together with a milled titanium bar. This helps ensure that the implants stay healthy because the bone on the top jaw is much weaker than the bone on the bottom jaw. The milled bar is harder to clean than the denture locator attachments themselves, but not significantly harder. I best part of removable implant dentures in my opinion is that the maintenance is significantly easier with these and when something breaks, it is much easier and cheaper to fix. Fixing a fixed implant prosthetic usually takes about one month and the cost is at least three thousand dollars whereas I can fix a removable implant prosthetic in one day and it usually is for the cost of a few hundred dollars.
Implants are wonderful for all dentures. They can really help improve not only the function of the dentures but also allow you to feel more confident in your own smile and your life. While my preference is for implant placement that allows the prosthetics to still come in and out of the mouth, fixed dentures do have their place and are a common type of prosthetic. If you feel like implants are needed to help your dentures feel more comfortable, call us at 504-392-5104 and we will help you out.