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Dentures and Dental Implants

What Are Implant Supported Dentures And Why Are They Used?

Implant supported dentures are restorations that replace missing teeth similarly to a complete denture but are stabilized and held in place by dental implants. Dental implants can reduce or eliminate denture pinching of the gums and denture sores. Dental implants will also slow down the rate at which the bone normally resorbs (shrinks) under dentures. Dental implants allow you to bite harder and chew more normally for more enjoyment of eating. Dental implants will also give you greater confidence in preventing unexpected denture dislodgment or movement during eating, talking or laughing that can otherwise be embarrassing. Depending on the number of implants that are placed, different restorative options are possible. Dental implants can usually be placed in either jaw but are most frequently placed in the lower jaw as the lower denture is frequently the most troublesome.

Implant dentistry is best completed by a dentist who has extensive training and the appropriate knowledge and skills in implant dentistry. The bone of the jaws can give predictable long term support called osseointegration when specific types of titanium dental implants are used in combination with researched and proven techniques. The dental implants will then provide support for the replacement teeth.

The following is an outline of the general implant supported denture options

    Lower Jaw:
  1. Non-removable/fixed Implant ‘Hybrid’ Prosthesis: This restoration is best suited for the lower jaw. Normally 5 implants are placed in the front area of the lower jaw on which a framework and replacement teeth are attached. The implants will completely support the teeth and because of this, the teeth will not move and the teeth will not ever pinch the gums or cause sore spots. The hybrid prosthesis is not removable from your mouth and is made so that the framework and teeth are cleaned similarly to natural teeth. Some parts of the supporting framework may be visible if the lips or cheek are artificially pulled back but the hybrid restoration appears very natural during eating, speaking and laughing. There is virtually no annual maintenance associated with this restoration. Only the teeth are replaced when they eventually wear down but the implants and framework will continue to function, so this restoration requires very little annual maintenance.


  2. Implant Overdenture: Two implants are placed in the front of the lower jaw on which a small framework is attached. The denture will be made so that two clips are placed inside the denture and these clips will snap onto the framework whenever the denture is placed in the mouth. The framework is completely hidden by the denture. The denture is removed with a 'snap' whenever desired by the wearer. The implant overdenture is partly supported by the implants and partly supported by the gums so that it functions similarly to a regular denture but has greater stability and comfort. An implant overdenture will need annual maintenance including clip replacement. Less frequently, a reline and eventually replacement of the overdenture when the teeth wear down will also be required although the implants and framework should continue to function without change.



  3. Upper Jaw:
  4. Implant Overdenture: Four or more implants are placed in the front and possibly back of the upper jaw on which a framework is attached. The denture will be made so that clips are placed inside the denture and these clips will snap onto the framework whenever the denture is placed in the mouth. The framework is completely hidden by the denture. The denture is removed with a 'snap' whenever desired by the wearer. The implant overdenture is partly supported by the implants and partly supported by the gums so that it functions similarly to a regular denture but has greater stability and comfort. Depending on the number and location of implants in the upper jaw, it may be possible to have an upper denture that does not cover the roof of the mouth. An implant overdenture will need annual maintenance including clip replacement. Less frequently, a reline and eventually replacement of the overdenture when the teeth wear down will also be required although the implants and framework should continue to function without change.


  5. Precision Locking Implant Overdenture: This restoration is especially well suited for the upper jaw. Usually 6 to 8 implants are placed on which a precision milled framework is attached. The denture also has a precision milled framework which precisely fits onto the implant framework and can be locked solidly into place or removed whenever desired by the wearer. The precise locking implant overdenture is supported entirely by the implants and because of this, the teeth will not move and the teeth will not ever pinch the gums or cause sore spots. The frameworks are completely hidden by the denture. The roof of the mouth is not covered. A precision locking implant overdenture will need virtually no annual maintenance but the overdenture may require periodic reline and the teeth will require replacement when they eventually wear down but the implants and framework should continue to function without change.

How Are Implant Supported Dentures Placed?

A number of steps are involved in placing an implant supported denture. For patients that already wear a complete denture, a new denture will often need to be fabricated prior to placing implants in order to determine the optimal tooth size, position and arrangement. If you still have natural teeth which require removal, this and a denture are usually completed well before the time of implant placement. These new dentures will be used to plan the proper implant location, worn as a temporary denture following implant placement during healing and then possibly altered for use with the implants depending on the nature of the final restoration. An implant guide stent is then fabricated from your denture which is used to guide the correct surgical placement of the implants and can also be used if additional x-ray imaging of your jaws is required prior to surgical placement of the implants.

These days, following the removal of any teeth, it is often possible to complete all the remaining surgical treatment in a single surgery. However, there are still situations when treatment is best completed in multiple surgical stages. During your surgery, the area will be anaesthetized and an implant will be placed at the selected locations in the jaw along with any other required procedures. This surgery requires meticulous care in an appropriately prepared office. Your denture will be modified for ongoing use usually at or soon after each surgical appointment. Usually three to five months is required for the bone to solidly stabilize the implants; a process called osseointegration.

Once the implants are solidly attached to the bone, fabrication of the implant supported restoration can begin. The making of your implant supported restoration is exacting to achieve the optimum results for you and therefore can require multiple appointments.

Success Rates

Research has shown that high success rates of over 95% are routinely possible with appropriate implant materials and good surgical technique. The implant system and techniques we use are supported by extensive world wide research. In our office we have achieved an even higher success rate, but success can never be guaranteed.

The most likely causes for the loss of an implant are excessive force on the implant during healing and infection. Our techniques minimize both of these risks. Before starting to fabricate or connect the teeth to the implants, the stability of each implant and bone healing will be assessed. In the unlikely event that the bone fails to stabilize the implant, then after implant removal and subsequent healing in the area, a replacement implant can usually be placed.

Because smoking compromises the body's ability to heal, there is a somewhat reduced success rate for implants and especially bone rebuilding or grafting in smokers. You are encouraged to reduce or preferably quit smoking as soon as possible, prior to implant placement.

How Long Will Implant Supported Dentures Last?

Implants and their supported restorations will not get dental decay like teeth. However, if not carefully made, cleaned and annually checked, a process similar to periodontal (gum and bone) disease can develop. In the event that one or more implants are lost, this type of implant is versatile and well suited for future modification or change. The existing implants would be maintained as is and additional implants placed if needed. The original implant supported denture would then be either modified or a new one made.

Replacement of missing teeth using these particular dental implants and techniques is supported by volumes of research and experience. Osseointegration has been researched and demonstrated to be clinically successful for more than thirty years in Sweden and was introduced into North America at the Toronto Conference in 1982. We only use implants that are manufactured with safe bio-compatible materials that have been adequately tested and are of a standardized size and shape from a large reputable manufacturer so that our patients can anticipate long term use of their implants and future maintenance and modification of the crowns will be facilitated.

By using specialized knowledge, skill and experience in combination with careful planning and attention to detail, an implant restoration will likely give you many years of service. Success is also dependent on your daily cleaning and periodic maintenance. Quality will give you the best value for your time and financial investment.

How Do I Clean My Implant Supported Denture?

If you have an implant supported overdenture or precision locking implant overdenture then it is removed for cleaning on a regular basis by the wearer. The framework that remains in your mouth (fixed to the implants) or the hybrid restoration is cleaned similarly to natural teeth with a tooth brush and other cleaning aids designed to make cleaning easier. You will be shown and coached on the techniques necessary to care for your implant restoration.

What Will An Implant Supported Denture Feel Like?

At rest, an implant supported denture will feel similar to a well made denture except you will feel more confidence. During eating, speaking or laughing the implant supported denture will feel much more comfortable and stable with less worry of embarrassment. There is no sensation associated with the implants themselves. They will support your implant restoration in total comfort. Implant dentistry has improved the quality of life for many patients, restoring lost confidence, comfort, chewing ability and a natural attractive smile.

Case Studies - Lower Fixed Implant Hybrid

Mrs. F.H. was referred to us by her general dentist in 1995 when she was 51 years old with a complaint that she had loose dentures, needed to wear adhesive and had difficulty eating. Her dentures were getting old and worn but because the jaw bones were very shrunken, only modest improvement could be anticipated from new dentures without implant support. New dentures were completed first to restore the proper appearance, good fit and an even bite. Five implants were placed in the front of the lower jaw onto which specially designed lower teeth were attached. This lower implant hybrid restoration was only supported by the implants and the teeth did not rest on the gum as dentures do. No matter what food was chewed, little seeds or pieces of food couldn’t get pinched against the lower gum. The teeth are attached to the implants, are not removable and are cleaned in a similar manner to real teeth. Despite what might be imagined, the support offered by the implants feels completely natural and comfortable.

Before
Before After
Before After

Mr. J.T. was fairly recently retired in 2001 when he was sent to us by his general dentist. Mr. J.T. complained of sores that came and went under his lower denture and although he could eat fairly well, he thought he was just slow at eating. His first and only set of dentures were 25 years old and had never been relined. Examination revealed very deteriorated dentures with a poor fit and bite. The supporting bone in the lower jaw was extremely poor, possibly in part, a result of the very poor denture fit. We have noticed that most patients have no idea how deteriorated their dentures and mouth are because it happens slowly day by day and human nature is to adapt. If deterioration happens slowly enough, most of us don’t even realize that it is happening. Once new dentures were completed, the extent of the deterioration was obvious by comparison with the old dentures. Mr. J.T. agreed with our recommendation that five dental implants in the front of the lower jaw was the best way to give him the best in comfort and security once we finished outlining the several options available. In the span of two weeks Mr. J.T. went from having no implants to having the finished lower teeth attached to the implants in a very efficient and organized approach. As with virtually all patients who go from dentures to implant supported dentures, one of his first comments was “I should have done this years ago.”

After

Mr. J.S. was referred to us by a dentist he consulted in 2002 when he was 55 years old. He had worn an upper denture for over 40 years and a lower denture for 32 years. He desired comfort, chewing ability and good looking teeth. When he presented to our office, his existing dentures were quite deteriorated with a poor fit and very swollen and inflammed upper gums and a flabby lower gum. His lower denture had fractured into two pieces the night before so the first thing we did following our examination and discussion was to repair the lower denture and place temporary soft liners in both dentures to make some immediate improvements in the existing denture fit and bite. A number of recommendations were also made such as removing the dentures during sleep, massaging his gums with his thumb and forefinger during the initial period of soft liners and through cleaning of the dentures on a daily basis. Once the gums had a chance to recover to a more normal and healthy condition, new dentures were fabricated to obtain the best tooth position for facial profile, lip support, appearance, speech and even bite for eating. Many improvements were evident to Mr. J.S. with his new dentures but he was convinced that dental implants would not only give him further improvement in comfort and function but also help ensure his future comfort and function. Dental implants actually help to slow the process of bone shrinkage that occurs when natural teeth are removed. It is well known that the more the gum and bone shrinks, that the more difficult it is to use dentures which is a terrible thing to consider as you get older. Mr. J.S. scheduled his implants to be placed about three months after his new dentures were completed. It took only about two weeks to completely finish the new teeth (lower fixed implant hybrid restoration) so Mr. J.S. could finally eat without any movement of these teeth and no pinching of his gums. Mr. J.S. is extremely happy with his implants and again, one of his first comments was “I wish I’d done this sooner!”

Before After
Before After
Case Studies - Lower Removable Implant Overdenture

Mr. E.F. was 74 in 1995 when a dentist that he consulted referred him to our office. He had his teeth removed only two years prior and had already had two different sets of dentures made by two different denturists. He said he couldn’t eat meat, only mashed vegetables and that the lower denture teeth were about a ¼ of an inch shorter than his natural teeth. We suggested that new dentures would likely make a number of improvements but dental implants would make an even greater difference. We proceeded to make a new set of dentures, which Mr. E.P. was very happy with and could chew much better. The next year, however, Mr. E.P. told us he wanted a further improvement in chewing and so he decided to proceed with two implants in the front of the lower jaw to support an implant overdenture. This type of denture is held in place with clips that snap onto the implant framework. The denture can be removed at any time by the wearer by simply snapping the denture off the implants and out of the mouth. Mr. E.P. now feels good and has no complaints.

Before After
Before After
Before After

Mrs. B.H. was referred to us by her dentist in 1995 when she was 58 years old. She wanted an examination of her mouth because her gums had a whitish appearance which she thought might be a yeast infection. She also wanted a better lower denture than the one another previous dentist had made for her. She had also consulted a third dentist for three months in order to try and adjust her denture. One of her prior dentists had tried unsuccessfully to treat the white lesions in her mouth. A discussion revealed that her mother had died of mouth cancer and she was of course worried about herself. She was under a great deal of stress because her husband had significant medical problems and she had a harmful habit of clenching her teeth. We determined that the white in her mouth was indeed a yeast infection and prescribed the appropriate form of medication as well as described the critically important need to disinfect the dentures on a daily basis and remove the dentures at night. The yeast infection quickly cleared up. We helped her to learn to reduce her clenching but this is difficult to do and not always achievable. Once everything was stabilized with temporary soft liners in her old dentures, Mrs. B.H. realized the potential benefit of implants and decided to proceed with two implants in the front of the lower jaw that would support a lower overdenture and this was made in combination with a new upper denture. Mrs. B.H. has been very happy with her dentures and implants.

After
Case Studies - Upper Removable Implant Overdenture

Mrs. M.Q. was referred to us in 1996 when she was 53 years old because her upper denture made her gag. This denture was also a little loose and she had heard about dental implants and wondered if they might help her overcome her denture problems. First a new denture was completed with an improved alignment of teeth for better appearance and bite. Mrs. M.Q. still had her lower natural teeth, but they were not aligned evenly so some of the natural teeth were reshaped on the biting surface to enable the new denture to be made with a more even bite which helped to stabilize the denture. Mrs. M.Q. felt that the new denture was an improvement over what she had previously put up with, but still felt she wanted to have a much more secure feeling upper denture without gagging. She then appropriately decided to pursue the next stage of treatment involving the use of dental implants to stabilize the upper denture. Six implants were placed fairly evenly spaced under the upper denture teeth. All of the implants were connected with a framework. Snaps were placed into the modified upper denture which allowed the denture to be snapped onto and off the supporting implant framework whenever desired by Mrs. M.Q. This allowed the denture to become very stable as it was strongly supported by the implants. When the denture is in the mouth, none of the implants or framework is visible. Because the denture no longer required suction to stay in place, the roof of her mouth no longer had to be covered by the denture. Once the denture was solidly supported and modified to not cover the roof of the mouth, the gagging problem disappeared.

After
After

Mr. A.K. came to our office in 1993 when he was 55 years old. He had known for a long time that he was going to loose his teeth and wasn’t looking forward to this. After examination, we determined that he did not yet need to have his lower teeth taken out, but because he had already lost a few upper teeth and others were already quite loose, that it would be best to have an immediate upper denture made and all the remaining upper teeth removed. Mr. A.K. was quite keen on pursuing the use of dental implants to better stabilize the upper denture once healing had adequately progressed following removal of his upper teeth. Seven implants were placed in the upper jaw and following healing, were connected with a framework. Snaps were fitted inside the modified upper denture allowing the denture to be snapped into and out of the mouth whenever desired by Mr. A.K. The part of the denture that covered the roof of his mouth was no longer required and was removed making the teeth seem even less like a denture. As usual, none of the implants, framework or snaps are visible when the teeth are in the mouth. Mr. A.K. can eat whatever he likes, never feels like his teeth might come loose and feels he doesn’t miss out on anything. As anticipated, Mr. A.K. lost his lower teeth in 1999 and there was no doubt in his mind that he was going to also get dental implants in the lower jaw, which indeed he completed soon afterwards.

Before After
Before After

Mrs. J.R. had a complete upper denture but she had heard about dental implants and really wanted to eliminate the roof of her mouth being covered by her denture. Following consultation in 1995 when she was 47 years old, she proceeded with having 8 implants placed into the upper jaw. This provided a very strong foundation onto which a specially designed framework and teeth were attached. The framework design was special in that two locks were incorporated which did not permit the removal of the teeth unless they were unlocked. The teeth, however could be unlocked and removed whenever desired by Mrs. J.R. for cleaning. This provided every possible assurance that the teeth would absolutely stay in place and feel as solid as natural teeth. Mrs. J.R. lives her life like she has natural teeth and loves the way she can feel her food against the roof of her mouth.

Before After
After

Mr. K.R. was 42 years old in 1996 and sadly, had worn a complete upper denture since he was age 15 or 16. Fortunately, he had most of his lower teeth but the gum and bone under the upper denture was quite deteriorated due to the years of wearing a poor upper denture. Mr. K.R. was at the point in his life where he could finally afford to fix his teeth and begin to enjoy a higher quality of life. Mr. K.R. was sent to us by his general dentist who wasn’t sure he could provide an adequate new upper denture and fix the lower teeth as there were many difficulties in coordinating the type of care that would be required. We reviewed the nature of the required treatment with this very concerned dentist who was relieved that we were confident of some promising solutions. Following a discussion on the possible use and benefits of dental implants Mr. K.R. wanted to immediately proceed. A new upper denture was completed in conjunction with fixing and replacing the teeth in the lower jaw. Once the upper denture was finished with its improved appearance and better bite, bone grafting was required to rebuild the deteriorated bone followed by 8 implants. These implants provided enough support to completely support the upper teeth which were attached to the implants by a precisely fabricated interlocking framework. The teeth were made removable for cleaning but were held in place by two locks against the implants so they would feel and work as close to natural teeth as possible. The roof of the mouth was not covered any more by the denture. Mr. K.R. is very happy with his new teeth and we are happy to report success to his concerned dentist.

Before
After