- What Is It?
- How Does It Work?
- The Implant Process
- Denture Try-In and Insertion
- Caring for Your Implant-Supported Denture
- What Will X-Rays Show?
- Possible Complications
- What Can You Expect From Your Implant-Supported Denture?
What Is It?
An implant-supported denture is a type of overdenture that is
supported by and attached to implants. A regular denture rests on the
gums, and is not supported by implants.
An implant-supported denture is used when a person doesn't have any
teeth in the jaw, but has enough bone in the jaw to support implants.
An implant-supported denture has special attachments that snap onto
attachments on the implants.
Implant-supported dentures usually are made for the lower jaw because
regular dentures tend to be less stable there. Usually, a regular
denture made to fit an upper jaw is quite stable on its own and
doesn't need the extra support offered by implants. However, you can
receive an implant-supported denture in either the upper or lower jaw.
You should remove an implant-supported denture daily to clean the
denture and gum area. Just as with regular dentures, you should not
sleep with the implant-supported dentures at night. Some people prefer
to have fixed (permanent) crown and bridgework in their mouths that
can't be removed. Your dentist will consider your particular needs and
preferences when suggesting fixed or removable options.
How Does It Work?
There are two types of implant-supported dentures: bar-retained and
ball-retained. In both cases, the denture will be made of an acrylic
base that will look like gums. Porcelain or acrylic teeth that look
like natural teeth are attached to the base. Both types of dentures
need at least two implants for support.
Bar-retained dentures - A thin metal bar that follows the curve of
your jaw is attached to two to five implants that have been placed in
your jawbone. Clips or other types of attachments are fitted to the
bar, the denture or both. The denture fits over the bar and is
securely clipped into place by the attachments.
Ball-retained dentures (stud-attachment dentures) - Each implant in
the jawbone holds a metal attachment that fits into another attachment
on the denture. In most cases, the attachments on the implants are
ball-shaped ("male" attachments), and they fit into sockets ("female"
attachments) on the denture. In some cases, the denture holds the male
attachments and the implants hold the female ones.
The Implant Process
The implants usually are placed in the jawbone at the front of your
mouth because there tends to be more bone in the front of the jaw than
in the back. This usually is true even if teeth have been missing for
some time. Once you lose teeth, you begin to lose bone in the area.
Also, the front jaw doesn't have many nerves or other structures that
could interfere with the placement of implants.
The time frame to complete the implant depends on many factors. The
shortest time frame is about five months in the lower jaw and seven
months in the upper jaw. This includes surgeries and the placement of
the denture. However, the process can last a year or more, especially
if you need bone grafting or other preliminary procedures.
Two surgeries usually are needed. The first one places the implants in
the jawbone under your gums. The second surgery exposes the tops of
the implants. The second procedure comes three to six months after the
first.
A one-stage procedure is now used sometimes. In this procedure, your
dentist can place the implants and the supporting bar in one step. The
success rate of this procedure is high.
Initial consultation
Before any work is done, you will visit either a dental specialist
called a prosthodontist or a general dentist who has advanced training
in the placement and restoration of implants.
During the exam, the dentist will review your medical and dental
histories, take X-rays and create impressions of your teeth and gums
so that models can be made. In some cases, the dentist may order a
computed tomography (CT) scan of your mouth. This shows where your
sinuses (located above your upper teeth) and nerves are. It allows the
dentist to make sure they will not be affected by the implant
placement. A CT scan also may be done to see how much bone is
available and to determine the best locations for the implants.
If you are not already wearing a complete denture to replace your
missing teeth, your dentist will make you one. You will use this
temporary denture until the implant-supported denture is placed. It
will take about four visits, spanning several weeks, to complete this
denture. By making this temporary denture, your dentist is able to
determine the best position for the teeth in the final denture. The
temporary denture also can be used as a backup if something happens to
the final implant-supported denture. The temporary denture can also be
used as the final denture to reduce overall costs. Attachments will
need to be added so it can fit securely to the implants.
Once the temporary denture is finished, the surgeon will use a copy of
it as a guide to help place the implants in the proper positions.
Holes will be drilled in the copy of the denture so that the surgeon
can see where the implants should be placed.
First surgery
Month 1 (if no denture needs to be made)
Month 2 (if denture needs to be made)
The first surgery involves placing the implants in the jawbone. During
the first surgery, an incision is made in the gum where the implant
will be placed. A hole is drilled in the bone, the implant is placed
into the hole, and the incision is stitched closed.
After this surgery, you should avoid putting pressure on the implants.
The temporary denture can be made so that direct pressure is placed on
other areas, not on the implants. It may also be given a soft reline
(new lining next to your gums) to help to reduce the pressure on your
gums.
After the first surgery, the dentist will wait three or four months if
implants were placed in the lower jaw, and five or six months if they
were placed in the upper jaw, before scheduling the second surgery.
During this time, the bone and the implants integrate (attach and
fuse).
Second surgery
Month 4 or 5 (no denture needed to be made)
Month 5 or 6 (denture needed to be made)
Standard abutments connected to the tops of the implants
Once the implants have become fused with the bone, the second surgery
can be scheduled. Your dentist will confirm whether the implant is
ready for the second surgery by taking an X-ray. This surgery is
simpler than the first. A small incision is made in your gum to expose
the tops (heads) of the implants.
A healing cap (collar) is placed on the head of each implant after it
is exposed. This guides the gum tissue to heal correctly. The collar
is a round piece of metal that holds the gums away from the head of
the implant. The collar will be in place for 10 to 14 days. The
dentists will adjust your temporary denture again and it may be given
another soft reline. The reline material will secure the denture to
the healing abutments.
About two weeks after the second surgery, the healing caps will be
replaced with regular abutments. Your gums should now be healed enough
for your dentist to make an impression of your gum tissue and
abutments. The impression is used to make a working model of your
abutments and jaw. This model is used to make the denture framework
and teeth.
Denture Try-In and Insertion
Month 5 or 6 (no denture needed to be made)
Month 6 or 7 (denture needed to be made)
At this point, the metal bar is placed on the abutments. You will have
the first try-in of your new denture framework to see if it fits
properly.
Bar secured to abutment with screws Fitting side (inside) of the
denture showing the attachments (clips)
The denture is being seated on the implants and bar
Once the metal bar and the denture framework have been fitted together
properly, the teeth are temporarily placed on the framework in wax.
The whole denture is then tried in your mouth. If everything works
well, the teeth are secured in the denture framework permanently. The
bar or ball attachments also will be secured.
You will have to return to your dentist for another visit to have the
completed denture inserted. When the denture is inserted, the denture
is clipped onto the bar or snapped onto the ball attachments.
At this point, your temporary denture will be given a new reline. This
will allow it to be used as a backup denture in case you lose or break
your new overdenture. If you are using the "temporary" denture as a
permanent denture, the bar or ball attachments are placed in that
denture.
Caring for Your Implant-Supported Denture
Patient wearing final upper and lower denturesYou will need to remove
the denture at at night and for cleaning. You also should carefully
clean around the attachments.
Your dentist will test all the parts of your new denture to see if
they are secure. Even though your denture is stable, it still can move
slightly when you chew. This slight movement can cause the denture to
rub against your gums, which can cause sore spots. Your dentist will
check your gums and also will check the way your top and bottom teeth
come together (your bite) after insertion of the denture.
The clip or other attachments on the bar-retained denture usually will
need to be replaced every 6 to 12 months. They are made of a plastic
material (nylon) and will wear after continued use.
What Will X-Rays Show?
An X-ray will show the implants in the jaw and any attachments to
them. Your dentist will take X-rays a few times during the procedure.
They help the dentist to see that the implants, abutments and
attachments are in the right places.
Possible Complications
In addition to the risks of surgery and of the implants failing, a
bar-retained denture carries certain risks of its own.
A bar-retained denture needs space on the denture framework for the
special attachments that are fitted to the bar. This means that there
is less space available on the denture framework for the teeth to be
fitted. Because of this, the teeth sometimes can come loose from the
base. This problem is easily fixed.
Also, when the bar is attached to the implants it is important that
the bar is evenly balanced on each implant. Dentists call this a
"passive fit." If the fit is not passive, the extra strain on the bar
can cause the screws to loosen. If you grind or clench your teeth,
it's more likely that parts of the denture will break or that your
implants will come loose.
What Can You Expect From Your Implant-Supported Denture?
Your implant-supported denture will be more stable than a regular
denture. You will find it easier to speak and you won't have to worry
about the denture becoming loose or falling out of your mouth. You
generally will be able to eat foods you could not eat before. However,
you will not be able to chew hard or sticky foods because they can
damage the denture.
If you have an implant-supported denture in your upper jaw, it can be
made to cover less of your palate (roof of your mouth) than a regular
denture. That's because the implants are holding it in place instead
of the suction created between the full denture and your palate.
