Now that you are edentulous without any teeth. You must be wondering what the best dentures are? There are many types of dentures out there. Do you want to know the best denture? You know the removable dentures which can be taken out. The most common problem with them is that they become loose over time. The main drawback of a removable denture is that it facilitates bone loss (resorption). Let me not keep any suspense. The implant dentures are the best.
People with no teeth (Completely edentulous patients) can be treated with implants using either a fully bone-anchored prosthesis or an overdenture.
FULLY BONE ANCHORED PROSTHESIS
The fully bone-anchored prosthesis is connected to supporting fixtures through the transmucosal components, the abutments either in the maxilla or mandible. This prosthesis is independent of soft tissue support, and the load is directly transmitted to the implant fixtures by the abutments. To achieve proper support for the prosthesis, a minimum of 4-6 fixtures are necessary. Ideally, 15mm long or even longer fixtures can be placed if there is adequate bone. The standard for selection of length and number of fixtures is
More than 15mm – 4 fixtures
10-15mm – 5 fixtures
7-10mm – 6 fixtures
If bone density and quality are poor, increase the number of fixtures.
In the maxilla, there is lower success rate then mandible due to different bone densities. The number of fixtures placed in the mandible depends upon the amount of bone available between mental foramina.
OVER DENTURES
When treatment planning for an overdentures, a minimum of 2 fixtures are needed for support, overdentures are attached to supporting fixtures using various connectors or attachments. These attachments usually do not alter esthetic results. They can be used in patients with poor bone quality and quantity and to achieve soft tissue support. The other advantage of overdenture is the ease of oral hygiene maintenance.
Hybrid prosthesis is a prosthesis in which acrylic and denture teeth are added to a metal superstructure.
Porcelain fused to metal prosthesis is a fixed restoration that uses a metal substructure on which a ceramic veneer is fused.
FULLY BONE ANCHORED COMPLETE DENTURE
The fully bone-anchored complete denture prosthesis can be either screw-retained or cement-retained prosthesis.
SCREW RETAINED PROSTHESIS
This fixed prosthesis is fabricated over a cast metal framework with access holes through the acrylic portion. The finished prosthesis is screwed in position using gold screws.
Advantages
- Low profile retention
- Less moments of force
- Absence of cement residues.
Disadvantages
- Passive casting
- Axial loading and esthetics
- Fatigue
- Cost and time
CEMENT RETAINED PROSTHESIS
In this type, the prosthesis is cemented on to abutments with provisional cement. By this technique, a passive-fit of the prosthesis on the abutments can be achieved.
Advantages
- A perfect passive-fit of framework can be achieved.
- The procedure is similar to conventional FPD procedure.
- Correction of the framework can be done by internal grinding. This avoids procedures like soldering and casting to correct the mis-fit.
- The access holes are eliminated resulting in very good esthetics and occlusion.
- Provisional cement luting allows easy retrieved of prosthesis.
Disadvantages
Even though the technique seems to be easy and advantageous, it has certain disadvantages like
- Proper selection and modification of abutments by milling is mandatory.
- Implant angulations beyond 150 will need an angled abutment or a castable abutment to gain an acceptable path of insertion.
- Numbering or other methods for matching the abutment with the correct implant fixture is imperative.
- In patients with limited interarch space – inadequate height of abutments would affect the retention and resistance form or it would cause deficient framework thickness or insufficient space for setting denture teeth.
- Provisional cement failure would result in loose prosthesis.
- Excess cement left in the sulcus would result in increased plaque retention and inflammation of the tissues.
Implant-supported dentures are the best dentures.
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