Implants: Denture Stabilisation

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What are they?

An implant-supported denture is a stable solution to loose dentures. It is a type of denture that is supported by and attached to implants. It has special attachments that fit over the implants like a snap fastener or a press-stud. These help to keep the denture in place, preventing movement, and dramatically improving the fit and chewing ability. Implant-supported dentures can be made for either jaw, but are particularly beneficial in the lower jaw because regular dentures tend to be less stable there.

Why have a denture instead of fixed porcelain teeth?

Many people don’t like the idea of a denture because it is removable, but it offers some advantages over fixed implant teeth:

• Better cosmetics – particularly when a lot of the gum and bone has shrunk away;
• Easier to clean and maintain;
• Cheaper than porcelain crowns and bridges

Is it suitable for me?

If you are in good health and don’t smoke then it is likely that you are suitable for dental implants. Age is not an impediment to treatment – senior patients may actually benefit from the improved fit of implant supported dentures.

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 matches the shade of your gums. Porcelain or acrylic teeth that look like natural teeth are attached to this base. We need at least two implants for support, so we often use ball-retained dentures for their simplicity and reduced cost.

• 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. It works like a press-stud mechanism, keeping the denture steady in the mouth but also allowing its removal for cleaning.

The Process for implant dentures

The implants are usually placed in the jawbone near the front of your mouth because there tends to be more bone in the front of the jaw than in the back. This is usually true even when teeth have been missing for some time. Once you lose teeth you begin to lose bone in the area. In addition, 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 usually five months in the lower jaw and seven months in the upper jaw, and this includes surgeries and the placement of the denture. The process however can last a year or more, especially if you need bone grafting or other preliminary procedures. More often than now, two surgeries are needed in this process. The first one places the implants in the jawbone under your gums, and during the second surgery which comes three to six months after the first, the abutment is placed on top of the implant so that it protrudes through the gums.

A one-stage procedure is now sometimes used as a preference to the two-stage. In this procedure, we can place the implants and the supporting bar in one step, and the success rate of this procedure is quite high. Before any work is done you will have a comprehensive consultation where we 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 we 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 us to make sure they will not be affected by the implant placement. A CT will show us how much bone is available and will help us determine the best locations for the implants.
If you are not already wearing a complete denture to replace your missing teeth, we will make one for you. 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 we can determine the best position for the teeth in the final denture. The temporary denture can also be used as a backup if something happens to the final implant-supported denture. The temporary denture can also sometimes be used as the final denture to reduce overall costs.

First surgery, Month 1
The first surgery involves placing the implants in the jawbone. During this procedure, the implants are positioned in the bone under the gum and are allowed to heal.
After the 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 we 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
Once the implants have become fused with the bone, the second surgery can be scheduled. We will confirm whether the implant is ready for the second surgery by taking an X-ray.
A healing cap (collar) is placed on the head of each implant after it is exposed, which 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, and will be in place for 10 to 14 days. About two weeks after the second surgery, the healing caps will be replaced with regular abutments. Your gums should now be healed enough for us to make an impression of your gum tissue and abutments. The impression is used to make a working model of your abutments and jaw, and this model is used to make the denture framework and teeth.

Completion, Month 5 or 6
At this point, press stud attachments are placed on the implants and the new denture is made. When the denture is inserted, it is clipped onto these attachments. We will then test all the parts of your new denture to see if they are secure, and will check your gums and the way your top and bottom teeth come together (your bite).

Caring for Your Implant-Supported Denture

You will need to remove the denture every night and for cleaning. You should carefully clean around the attachments, which, along with the clip, should be replaced every 6 to 12 months. These are made of a plastic material (nylon) and will wear with use. The abutments (the half of the press stud system that is attached to the implants) can also wear out, and will need replacing every 3-5 years.

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 will generally be able to eat foods you could not eat before, but you will not be able to chew very hard or eat sticky foods because they can damage your 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. This is because the implants are holding it in place instead of the suction created between the full denture and your palate.

Maintenance & Cleaning

You should remove an implant-supported denture daily to clean the denture and gum area. Just as with regular dentures, you should not sleep at night with the implant-supported dentures left in.

The right solution for you

Your dentist will explain the attachment options avalable to you and help identify which solution is best suited to your needs. Please see diagram below for further information.