ARE YOU CONSIDERING DENTAL IMPLANT BRIDGE OR OVER DENTURE ON IMPLANTS?
If you are considering dental implant treatment to replace all of the upper or lower teeth you have the option of choosing fixed teeth on implants or a denture on implants ( known as an overdenture on implants)
Lets start by discussing the advantages and disadvantages of each option
This option is usually the more popular among patients. Having fixed teeth means that one is able to function, ie eat and speak with ease as the teeth are fixed and don’t move. Usually for fixed teeth a bridge is attached to the dental implants and 8-12 teeth are fixed usually by means of small screws to the implants that were placed into the jaw. Usually this treatment is carried out in just one day. The treatment of all on 4 or same day teeth means that one is able to remove problem teeth, place a minimum of 4 implants and fixed teeth attached to the implants on the same day. As the fixed bridge is secured to the implants by small screws its possible to remove the bridge without too much trouble. Naturally only your implant dentist will be able to do this as this will not be something you will be able to do yourself. Fixed teeth therefore are more easy to accommodate, better with biting and functioning and generally are more stable than a denture on implants. Patients also generally feel more comfortable with fixed teeth and psychologically patients prefer having something which is not removable frequently each day ( for example its recommended that an overdenture be removed and cleaned after meals.)
However the disadvantages of a fixed bridge are that the cleaning of the bridge is more complex and requires more time to maintain properly. Small brushes and floss need to be used each day in order to prevent the build up of plaque and food debris around the implants which hold the fixed bridge in place.
A fixed bridge treatment is usually more expensive than an overdenture.
One of the most important disadvantages of the fixed bridge is that there may be a lack of lip support with the final result. What does this mean. After losing teeth our jaw bone usually shrinks, and when this happens the lips which are supported by the jaw bone changes form. In the upper and lower jaws it may cause patients to look older with the onset of loss of teeth. If a patient has been wearing full dentures for a long period time and the bone loss has been extensive or severe then a fixed bridge may not provide the same amount of support as there was before with the full removable denture. This is unfortunate as the patient may be presented with a dilemma of fixed teeth but poor aesthetic result at the end of treatment. The lip support is very important when choosing which option to consider as a lack of lip support can drastically age the appearance of the individual.
Denture on locators
In this option a denture is made which fits very accurately onto implants. The denture either upper or lower usually clicks into position and is maintained stable by the implants and some small unique attachments usually called ‘locators’.
The overdenture provides good function as the teeth are secured and stable with the help of the implants. A very small amount of movement will exist between the denture and the implants as the teeth are removable and not fixed. I am referring to a movement of less then 1 mm in all directions. In order to remove the overdenture the patient will need to exert some force in order to remove the denture. Usually a small click is heard when the overdenture is seated correctly and when it is removed.
As discussed above the overdenture will provide good function and allow patients to eat comfortably and speak without the overdenture moving. It is recommended that the overdenture is removed after meals for cleaning and overnight. This is one of the advantages of the overdenture over a fixed bridge as some patients may have difficulty in keeping a fixed bridge properly clean. This can be due to arthiritis or lack of manual dexterity in order to keep the fixed bridge clean. In these cases an overdenture may be better in order to allow patients to clean their teeth and be able to visually see that the overdenture has been thoroughly cleaned. Cleaning the implants in the mouth is considered easier than a fixed bridge as this will only require a normal brush. Its very important that when cleaning implants which support and overdenture that the patient is able to see that the implants are properly cleaned. The implants and their locator attachments are easy to clean and don’t usually attract plaque as they are highly polished surfaces and plaque does not usually adhere to them however if plaque is left for long enough then this will eventually accumulate around the implant and the locator attachment. Studies have shown that this plaque around implants can cause gum disease around implants known as peri implantitis.
An overdenture on implants will also provide very good final aesthetic results.Because bone shrinks when natural teeth are removed the jaw will change shape. By using an overdenture one would be able to replace this missing bone and tissue. In doing so the natural proportion of the mouth will be better and hence the final result can be aesthetically better than if a fixed bridge were used.
An overdenture on implants is usually cheaper than fixed teeth.
An overdenture on the upper jaw can sometimes be easier to speak with. Because the roof of the mouth is covered with the overdenture air does not leak through small air spaces which can sometimes be found with fixed teeth.
Lastly a denture on locators will require more frequent maintenance as the small clips which the denture uses to attach to the implants do wear out with time. This means that more visits will be required to change these small attachments every 4-6 months or so. The attachments are generally inexpensive and wear out due to the in and out movements several times per day.
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