By Dr. H. Kopel
There are numerous treatment options for fully edentulous patients today. These include full upper and lower dentures, implant-assisted prostheses (overdentures), implant-supported removable prostheses (hybrids) and implant-supported fixed bridgework.

Although implant-assisted overdentures “assist” retention and stability, soft tissue and bone are still relied upon to lend support to this type of prosthesis. The overdenture will be much more stable than a regular denture and usually has 2-4 implants supporting it. The overdenture is still removable and easy to clean. It is also the least expensive implant option. Most dentures can be retro fitted with implant attachments and more implants can be added at a later date to improve stability if necessary.

With implant-supported removable prostheses (hybrids), stability, retention and support are completely provided from the implants themselves or from bars attached to the implants. The hybrid, therefore, can be much smaller than a regular denture without flanges or covering the roof of the mouth. A hybrid can be supported by 4 implants. It is screwed into place by the dentist. The patient will have no movement with this prosthesis and the patient cannot remove it. It will need to be serviced and cleaned by the dentist. Hybrids are the most affordable fixed prosthesis.

If finances permit an actual fixed porcelain bridge can be constructed on top of 8-10 implants. There will be no plastic or denture material and this will look and function as natural teeth. This will be permanently cemented in place just as any other crown or bridge. It will be maintained by the patient and dentist as with natural teeth.

The same options are available when the patient has retained some of their teeth by making a partial overdenture or hybrid or fixed bridgework. Although you cannot attach a fixed bridge to a natural tooth and an implant you may use both to support a removable partial denture. There is
controversy regarding this, but if well designed and planned this is a definite option.

Here are some of the benefits achieved by utilizing implants with dentures, partial dentures and bridges:

  • Restores proper chewing, allowing a better diet and improved health
  • Improves speech and confidence
  • Increases comfort with less irritation of gum tissue
  • Ends the cost and inconvenience of denture adhesives
  • Often can utilize your existing denture
  • Minimally invasive procedures

Dental Prosthesis Care

by Dr. O. Karnakova

Among many of the different care approaches for fixed tooth retained bridges and fixed implant bridges, brushing and flossing still remains the most effective and preferred method by dentists. Inadequate oral hygiene will eventually lead to gum disease and the formation of cavities. Ideally, brushing should be performed after every meal, or a minimum of two times daily for at least two minutes.

It is important to brush around the gumline, where plaque is most prone to accumulate. The toothbrush should be held at a forty-five degree angle, using a combination of gentle horizontal strokes and a vertical sweeping stroke towards the occlusal surface of the tooth. Flossing should be performed a minimum of two times daily and is essential at removing plaque where the toothbrush cannot. To floss around the tooth or implant, the floss should be wrapped in a "C" shape to hug the abutment. Gently slide the floss up and down in a vertical motion for a minimum of three to five times. On the downward motion, the floss should slide about two to three millimeters below the gumline. It is also important to floss underneath the bridge by use of a floss threader. Floss threaders feature a stiff plastic end and are effective at inserting the floss under the bridge. Simply use the stiff end to thread the floss under the bridge, and gently slide the floss back and forth parallel to the occlusal plane.

Partial dentures and full dentures can accumulate bacteria and plaque much like natural teeth. Patients should rinse their denture with water after every meal to remove any food particles. Brushing is recommended at least once per day and also prevents staining. It is best to use a brush specifically designed for cleaning dentures or a soft bristled toothbrush. Avoid using hard bristles that can potentially damage the appliance. Special denture cleaning solutions, gels, or pastes are recommended for cleaning the denture because they do not contain abrasive materials. Toothpaste should not be used because they contain abrasive particles that can damage the denture. Polident is a recommended tablet solution by dentist for cleaning or soaking your dentures at night. Please follow the labeled instructions for the length of time the denture should be soaked.

Patients with a removable or fixed prosthesis should visit their dentist for gum treatment every three to four months. The accumulation of plaque over time hardens into a substance called calculus or tartar that can cause many health concerns. Calculus can only be removed by a dental professional. Visiting the dentist regularly ensures that the gums and dental prosthesis are in good health and increases its life span. If a denture breaks or does not fit properly, please take it to your dentist. Do not attempt to adjust or repair the denture yourself as it can cause irreversible damage.