These are carefully crafted to look as much like your own natural teeth as possible, and are able to function properly in your mouth for a long time.
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Implant-Supported Overdentures: To increase the stability of a lower or upper denture, it's possible for it to be securely anchored using two or more dental implants. The upper jaw requires more implants generally three or more than the lower jaw due to a lesser bone density.
How It Works
Many people find this option offers a great balance of comfort, functionality and value. Transitional Partial Dentures: These relatively inexpensive removable plastic dentures serve as a temporary tooth replacement and space maintainer as you wait for your mouth to heal from tooth extraction, for example. Once the healing process is complete, dental implants can be placed. Removable Partial Dentures RPDs : Usually made of cast vitallium, these well-constructed, metal-based removable partial dentures are much lighter and less obtrusive than those made of plastic.
They are a little more expensive than plastic dentures but will fit better. They are, however, much less expensive than implants or fixed bridgework. Making quality dentures is a blend of science and art.
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First, an accurate impression mold is made of the alveolar ridges on the top and bottom of your mouth. The base of the denture is made from this mold in a dental laboratory. Working together, the dentist and lab technician choose from among many different sizes and shapes of prosthetic teeth to re-create a natural-looking smile. When everyone is satisfied with the result, the temporary dentures are made in permanent form. To enable normal speech and eating, it's crucial to balance your bite. This means that the upper and lower dentures come together and properly stabilize each other.
The form and function of the dentures are carefully checked to ensure that they are working and fitting properly. If you've recently lost your teeth and received an immediate denture, it's normal to find some tissue shrinkage and bone loss occurring. Therefore, in several months you may find that your immediate dentures no longer fit well. You will have two choices at this point: You can have your immediate temporary dentures re-lined. This means that material is added under the denture's base to better conform to the new contours of your alveolar ridge. A better option is to move to a set of conventional full dentures, which will last longer and fit better.
American Dental Association - Removable Partial Dentures
If the restoring dentist does not take lip movement into account, it can result in an esthetic failure in which the transition line between the prosthesis and gingiva is clearly visible. Another possible failure is when the lip becomes trapped on the flange in an elevated position. In these cases, the only solution acceptable to the patient may be the use of botulinum toxin-A to reduce lip movement; on average, movement can be reduced by 5 mm with botulinum toxin-A.
A common error in treatment planning is failing to ensure adequate space for the prostheses.
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Phillips and Wong 11,12 outlined space requirements for fixed removable, as well as bar-and-clip, prosthetics. In , the fixed removable hybrid prosthesis FRHP had a cast framework, and their recommendation for 18 mm in the anterior is based on a screw-access hole in the cingulum of these anterior teeth Figure 1.
Although 18 mm is a good guideline, it can be reduced with the advent of more streamlined, milled titanium frameworks.
Dental Health and Dentures
The restoring clinician should have a conversation with the laboratory technician in order to understand exactly how much space the technician needs to provide an esthetic and functional prosthesis with adequate strength. What are the indications for use of an implant-supported fixed prosthesis in the maxilla?
While the connector size will need to be at least 7 mm depending on the material selected , even that may prove inadequate. Traditionally, the biggest drawback of a fixed prosthesis is cost — but even though an FRHP may be a less costly alternative, it comes with a potential biologic compromise namely, bone. Depending on the implant manufacturer, FRHPs are marketed under a variety of names. All basically use a concept of four implants placed and loaded immediately, with abutments to connect a modified denture based on the success of Branemark et al 13 and, more recently, Malo et al 14 and Lopes et al.
The FRHP procedure is a denture-driven treatment and requires experience and skill in fitting, fabrication and repair of complete dentures. Why choose a fixed removable hybrid rather than a zirconia prosthesis? Although many clinicians prefer a prosthesis made entirely from zirconia Figures 2A and 2B , use of this material raises its own set of considerations.
Briefly, concerns regarding a full zirconia prosthesis include: 1 chipping of layered porcelain if present due to differing coefficients of thermal expansion; 2 uncertainty of the actual flexural strength and fatigue toughness of the zirconia framework based on possible failure to follow recommended firing cycles; 3 concern regarding multilayered zirconia frameworks chipping due to the percentage of cubic versus tetragonal zirconia in the layers; 4 difficulty creating realistic colors of gingiva and translucency; and 5 cost of fabrication and repair.
Today, the classic FRHP is a milled titanium bar wrapped with denture acrylic with denture teeth. Advantages include fabrication expense, the ability to repair broken teeth or acrylic, abundant choices in denture teeth from a cosmetic, wear and cost standpoint, and esthetic options to mimic the color of the gingiva with acrylic Figure 3.
It could be argued that in an FRHP fabricated with acrylic and denture teeth, the latter are the sacrificial components. The question becomes: When fabricating a prosthesis, is it not better to control where the failure occurs with time? After all, a failing or broken implant or abutment is more difficult to repair than a piece of plastic. By the same token, if a zirconia prosthesis chips or fractures, the only option is the costly replacement of the entire prosthesis.
What are the indications for use of an implant-supported removable prosthesis in the maxilla? There are two primary indications for removable prostheses: inadequate lip support due to horizontal loss of maxillary bone requiring a buccal flange , and lip dynamics that would produce an unfavorable esthetic result due to the position of the junction of the prosthesis and soft tissues.
In the first situation, a removable implant-supported prosthesis is warranted because the bone and soft tissues are deficient. In this case, a buccal flange is created to replace the missing structures; in addition, the appliance must be removable for hygiene. Considering the recommendations of Phillips and Wong, 11,12 if 11 to 12 mm of vertical space exists, clinicians can utilize a telescopic-type attachment. However, if the ridge defect also includes a significant vertical component, the practitioner should consider a bar-and-clip overdenture — in which case 15 mm of space is required.
An additional consideration are patients who have not experienced horizontal loss of maxillary bone, but are simply unhappy with their lip support. If an evaluation of incisal edge position and tooth angulation indicates the deficiency is in the soft tissues of the lip, the clinician must be cautious about fabricating a prosthesis that creates an unnatural projection of the maxillary arch.
Instead, soft tissue augmentation with dermal fillers may be warranted.
The timing of any dermal filler placement should be discussed with the surgeon in order to determine whether it should occur before or after delivery of the final prosthesis. In the second scenario — in which lip dynamics pose a risk of creating an unesthetic result — a removable prosthesis with a buccal flange should be considered. Another option would be a reduction of bone to change the position of the junction.
However, this comes at the biological cost of bone — which the patient may not be receptive to, or that is not possible based on the need for adequate bone to support the implants. Cone beam computed tomography CBCT , for example, allows the restoring dentist and surgeon to evaluate possible sites for implant placement. In some cases, guides for fully guided surgeries can be created utilizing the CBCT information and merging with scans of models or scans created intraorally.
Intraoral scans work well in terminal dentition cases in which adequate hard tissue i.
Dental prosthesis types
Although the clinical ability to create accurate intraoral scans of soft tissues — and recording the displaceability of such tissue — may not be ideal at this point, scanning technology is improving. Some may argue that because the ICD is being converted, complete accuracy of the intaglio surface is unnecessary and an intraoral scan is adequate. But if the case cannot be loaded immediately, it is likely the ICD will have to be relined due to bone reduction that may have occurred.
The surgeon and restoring dentist need to communicate how much bone reduction is needed to obtain sufficient space for the final prosthesis. The restoring dentist should fabricate the surgical guide. If possible, the restorative dentist should be present the day of surgery to verify bone reduction, the anterior-posterior spread of implants, attachment of angled abutments in the correct position, and convert the ICD to an interim FRHP. Implant design software can be used to plan implant placement, which will also allow fabrication of surgical guides.
These can be milled using CAM technology or printed with a three-dimensional printer. Many clinicians believe that fully guided surgery is unnecessary, impractical and unduly expensive.
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