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Removable dentures are a compromise in form and function for many who wear them. Whether it be with reduced cosmetic features, decreased taste sensation, difficulty chewing substantial foods, speech issues, or poor fit. Did you know there are complications that can arise from a poor fitting denture?

Loose Denture Issues

These can be broken down into short term and long term issues. It is important to note that you should openly communicate any issues you have with your dentist to ensure the best possible fit for you.

Short Term Issues

-Discomfort. When dentures do not fit properly, they place pressure against the gum tissues, rub against them, or feel uneven at certain spots. This may be slightly annoying at first, but over time, irritation, pain, and sores will continue to increase.

-Speech problems. If your dentures do not fit properly, you will have difficulty speaking. Usually the first noticeable clue is the inability to pronounce simple sounds like the letter S.

-Difficulty eating. Most people will struggle initally, with even the best fitting dentures, but when wearing a denture that does not fit quite right it will be even worse.

Long-Term Issues

Over time, any denture will loosen as the bone and gum tissues change. A denture that is loose from the beginning will only get worse over time. Below are some of the longer term issues you can experience.

-Swollen Gum Tissues. When dentures are loose they will irritate the gum tissues. This constant irritation will get a response in the form of inflammation and swelling in the areas affected.

-Development Of Sores And Blisters. Once an irritation occurs, mouth sores can develop. These can be quite painful.

-Nutritional Issues. Patients with loose fitting dentures will change the way they eat to accomodate the loose dentures. This can lead to poor dietary habits.

-Fungal infections. Poorly fitting dentures increase the risk of thrush, a fungal infection that results in painful white spots and red areas along the inside of the mouth. Thrush can also lead to difficulty swallowing, and may be spread to other regions of the body if not treated.

-Bacterial infection: If tissue becomes exposed due to sores or cuts, it can become infected. Additionally, stomatitis is a common oral infection from loose dentures, which causes a red and swollen inflammation of the mouth.

-Overuse of denture cream: When denture cream is perpetually used to secure loose dentures, patients may be overexposed to zinc. This has the potential to create symptoms of neuropathy, which temporarily or permanently numb various nerves in the body.

Can Poor Fitting Dentures Be Fixed?

If dentures are only slightly loose, dentures can be relined to give a better fit and more comfort. If the dentures are very loose then a new denture may be recommended. It is important to remember our mouths are constantly changing and this is especially true when the teeth are no longer present. Our teeth serve to maintain the bone levels in the mouth. Once those teeth are gone the bone will undergo remodeling. There are also marked changes in denture fit after severe weight loss.

Dental implants provide a way to permanently secure dentures and ensure a proper fit. By installing as little as 4 dental implants, your dentures can benefit from increased stability, strength, and support. Moreover, dental implants help maintain your bone levels, reducing bone loss over time.

Dentures Conclusion

If you notice problems with your dentures when you first get them, don’t overlook the issues. Communicate with your dentist. Tell them your concerns and see what options are available to you. There will always be compromises with removable dentures but comfort should not be one of them.

Dental implants have evolved over time and become an ideal replacement for a lost tooth or teeth. The long term success rate of dental implants is well over 95%. What once was a product offered to very few has now become a mainstream dental care service available to most.

Options For Dental Implants

Depending on each, unique, individual person, each dental implants case will be personalized. Depending on how many teeth are missing as well as the available quantity and quality of bone present. Below are some of the situations where dental implants can replace lost teeth:

-Loss Of A Single Tooth. At one time, this meant wearing a removable appliance (commonly called a “flipper”) or removing natural tooth structure from surrounding teeth to create a fixed bridge of dental crowns. The flipper tends to be uncomfortable to wear and may affect speech. The 3 unit bridge compromises the support teeth by having them do the work of the lost tooth, and by making them more susceptible to decay. The long term success rate is lowered due to difficulties in cleaning under and around the bridge. A single tooth dental implant, when completed properly, will last a lifetime and function just like a natural tooth.

-Loss Of Multiple Teeth. When missing multiple teeth in a single area, dental implants can be used to form a fixed bridge. The beauty of this arrangement is stability and the ability not to affect the natural teeth in any way.

-Replacing All Teeth. In the past, the only way to restore function was to fabricate a removable denture. With dental implants, dentists have the ability to restore natural function and esthetics.

Complementary Procedures To Dental Implants

There are times when other dental procedures are necessary to successfully complete the placement of dental implants. These include:

-Sinus Lift. When you have a large sinus area that impinges on available bone depth, the sinus lift is a common surgical procedure. Sinus lifts are needed to elevate the sinus membrane and thicken a part of the upper jaw with a bone graft. This helps give  a dental implant enough bone depth to place it properly in the area you need it. Dental implants need a good quantity of bone along with good, dense quality of bone to succeed. The upper jaw is known to have poorer quantity and quality bone structure as opposed to the lower jaw. The maxillary sinus also plays a role in increasing difficulty in this area. Sinus augmentation can remedy these issues by raising the sinus floor and placing bone grafts in the area to aid in dental implant placement.

-Bone Grafting. When the bone is not 100% adequate for dental implant placement, dentists are able to add to it by performing a dental bone graft. A bone graft is the placement of bone or bone-like materials in the jaw to to build it up. This gives an excellent platform for dental implants. Modification of the bone in this fashion has been shown to improve both appearance and long term success of dental implants. Typically, dentists try to place implants at least as deeply into bone as the crown or tooth will be above the bone. This is called a 1:1 crown to root ratio. This ratio serves as a guide for bone grafting in most situations.

Can A Dental Implant Fail?

It is quite rare for a dental implant to fail but when it does the dental implant must be removed. Then re evaluated as to why the failure occurred and to see if a new dental implant may be placed. Some of the common reasons for dental implant failure include:

-Failed Integration of Dental Implants - This occurs when the bone does not grow and fuse between the threads of the implant. This fusion of bone to dental implant is called osseointegration. If this does not occur, the dental implants will not function properly,will become uncomfortable, become loose, or come out completely. To reduce this risk, your dental surgeon will evaluate the quality and density of the jaw bone prior to surgery. This will help to only place dental implants in areas where there is a highly predictable success rate. If osseointegration does not take place, the dental implants can be removed, and surgery can be attempted again once the area has fully healed.

-Infection –  This is the most common complication of dental implant surgery. The surrounding bone and gums can get infected during the surgical procedure. This can happen due to non-sterile technique, a contaminated implant, poor healing ability(diabetic, smoker, osteoporosis medications), or pre-existing infection. The most likely time for this to occur would be during the surgical placement of the dental implant into the bone. Implant infection can occur after placement as well. Poor hygiene, too much force placed on the implant, or excess cement can cause the support tissue to breakdown. Implant infection is a condition referred to as peri-implantitis. Peri-implantitis is characterized by inflammation or swelling of the tissues surrounding the implant area. Peri-implantitis can also present as a secondary infection later on is a form of periodontal disease that can lead to inflammation, bone loss and implant failure if not treated quickly and properly. Although implant infections are usually caused by the presence of bacteria during or immediately after the oral surgery for the placement of the dental implants, an implant infection can occur months or years after surgery.

-Post Surgical Bleeding - Some bleeding following surgery is normal and should be expected for about 1-2 days. Biting gently on a gauze pad placed over the surgery area for 30 minutes should normally stop the bleeding. Excessive bleeding is not normal and you should notify your dentist immediately if you have concerns about your dental implants.

-Damage To Surrounding Tissues - Dental implant complications related with surgical errors affecting adjacent teeth, nerves or sinus are directly correlated with the experience and skills of the dentist or surgeon. An experienced and skilled implant dentist is able to identify potential problems by examining x-rays or CT scan (computer tomography), design the proper surgical plan for ideal location and angle, and execute it successfully without complications. Even with the most skilled implant dentist there is always a possibility of dental implant complications. The complications can be limited by choosing an implant dentist with the skills and experience necessary to handle any complications if they arise.

-Rejection – An extremely rare complication for dental implants but it has been noted in the research literature. The dental implants can sometimes be viewed as a foreign body.

-Unusable Dental Implants – An implant that has successfully integrated with bone, but the area or extreme angle of placement deem it unrestorable.

Dental Implants Conclusion

Dental implants have been the solution for many. They come with risks but with proper treatment planning from a well qualified dentist they can be a successful tooth replacement for a lifetime of smiles.

 

 

Dental implants have changed the face of dentistry over the last 20 years. They have been nothing less than a miracle in the replacement of teeth whether it be a single tooth, multiple teeth, or as an anchor for a denture. As the technology matures, new advancements and techniques come into play. One of those newer techniques is called All On 4 Dental Implants. This technique allows for the placement of four dental implants (hence the name all on 4 dental implants), and the restoration to be placed on the same day. Patients leave the office with teeth. For this reason all on 4 dental implants are also called “new teeth in a day“.

Who Wants All On 4 Dental Implants?

The patients who choose all on four, do so for many reasons including, poor fitting existing dentures, terrible trauma causing tooth loss, decay or periodontal disease causing progressive tooth loss. The most common patients to choose all on four, are not denture wearers. They are patients who have been fighting an uphill battle for a while and know that they are losing their teeth. These individuals have been trying to hold on as long as possible because they do not want to have any time in their life without teeth, and the thought of a removable denture is not an option.

What are All On 4 Dental Implants

The All on 4 Dental Implants procedure was developed in the mid 1990′s. The all on 4 dental implants system has allowed for a variety of patients who, for various reasons, were not considered good candidates for traditional dental implants to now become candidates.

The All on 4 Dental Implants procedure uses four dental implants per arch (upper or lower).  The dental implants in the back are placed on an angle to take maximum advantage of the existing bone structure. Special dental implants were developed that could support the immediate fitting of replacement teeth. This treatment is attractive to those with loose dentures or those in need of full upper and/or lower restorations. With the All-on-4 dental implants procedure, qualified patients receive just four dental implants and a full set of new upper or lower replacement teeth in just one appointment. This usually able to be done without dental bone grafts.  The real attraction to the all on 4 dental implants procedure is how quickly permanent dental implants can be placed. This allows patients the ability to leave the same day with a denture that is fixed in place and stabilized by the dental implants.

Traditionally, the  approach to restoring a full arch of teeth (either upper or lower) usually involved dental bone grafts, six or more dental implants, and as much as 18 months of treatment. In that time, the patient would be wearing an interim denture while the dental bone grafts and dental implants heal and integrate into the bone. This can be very expensive, time consuming, and uncomfortable for a patient to continuously go back for treatment.

What Appointments are Needed for All On 4 Dental Implants?

The All on 4 Dental Implants procedure consists of the following visits:

Initial Visit(s) – The initial visit(s) for the all on 4 dental implants procedure is necessary for the dentist to do a proper treatment plan for you. These visits will include gathering pertinent medical history, needed X-rays, dental impressions, photos, and a CAT Scan. The dentist will then be able to review all the information with the patient and develop the proper course of treatment.

Actual All On 4 Dental Implants Procedure Visit – At this visit the patient will undergo the procedure for placement of the 4 dental implants. Following placement of the dental implants, the dentist will place the denture in and the patient will leave in the afternoon with a beautiful set of fixed, functional teeth.

Follow-up Appointments - The patient will need to return to the dentist for occasional dental examinations over the next several days, weeks, and months to ensure comfort and fit. In about 6 months, the patient will return for a final set of dentures. The reason for the 6 month wait is to give the tissues in the mouth time to heal properly, correct anything the patient wishes to change, and to allow the implants to properly integrate into the bone.

Conclusion on All on 4 Dental Implants

More than 100 million people in the United States alone are missing between 11 and 15 of their permanent adult teeth. By the age of 60, almost 70% of these people are completely without teeth and in desperate need of complete oral rehabilitation. This is where the all on 4 dental implants procedure comes in and is able to restore people’s teeth and change their outlook on life.

 

Dental Implants have changed the way we look at dentistry. Dental implants are not just for single tooth or multiple teeth replacement. They can also be used in support and stabilization

of removable dentures. Long time denture wearers will tell you that over time the bone remodels and resorbs resulting in loose and ill fitting dentures. When this happens patients used to be forced to grin and bear it using various denture adhesives. Now with the development of dental implant supported dentures those days can be a relic left in the past for many patients.

Dental Implant Overdenture – What is it?

A dental implant supported denture is also called an overdenture. A traditional removable denture rests directly on the gums, and is not supported by dental implants. This is because the denture sits over the dental implants. The dental implants give support and stability to the denture.

A dental implant supported denture is recommended when a person is missing all the teeth in the jaw. The patient needs to have enough bone in the jaw to support the dental implants. The denture is able to stay in place using special attachments that allow the denture to “snap” into place over the dental implants.

Implant supported removable dentures usually are fabricated for the lower jaw. This is because regular dentures tend to be less stable on the lower arch due to tongue and musculature present. Usually, a regular denture made to fit an upper jaw is much more stable and tolerable on its own and doesn’t need the extra support offered by implants. If the patient chooses they can receive a dental implant supported denture in either the upper or lower jaw.

Dental implant supported denture should be removed daily to clean the denture and gum area just like traditional dentures. Also, you should not sleep with the dental implant supported dentures at night. Some people prefer to have fixed (permanent) crown and bridgework in their mouths that can’t be removed but this is not always possible in every patient’s case. Your dentist will consider your particular needs and preferences when suggesting fixed or removable options.

Dental Implants with bar supporting denture

Dental Implants with Bar Supporting Denture

Types of Dental Implant Supported Dentures

 

There are two types of dental implant supported dentures:

1) Bar-retained dentures. Your dentist will have a thin metal bar custom fabricated for your mouth. This bar will follow the curve of your jaw and is attached to 2-5 dental implants that have been placed directly into your jawbone. Clips or other types of attachments are fitted to the bar, the denture or both. The denture is then designed to fit directly over the bar stabilized by the attachments. The dental implants along with the bar and attachments gives the denture support and stability.

2) Ball-retained dentures. The dental implants in the jawbone hold a metal attachment(ball) that fits into another attachment(socket) on the

Dental implant supported denture - Ball retained

Dental Implants – Ball Retained Denture

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 situation is reversed and the male attachment is in the denture and female attachment is on the dental implant. This also gives the denture wearer increased stability and retention over the traditional removable denture without dental implants.

In both scenarios, the removable denture will be made of a custom fabricated acrylic base that will look like gingival tissue. The teeth can be made of porcelain or acrylic. These teeth will look very natural. Either type of denture needs a minimum of 2 dental implants to work properly over the long term.

Placement of Dental Implants

The prime location for placement of the dental implants is in the front of the mouth. The reason for this is due to the fact that there is

supporting denture with dental implants

Visualization of dental implants supporting dentures

generally more bone present in this area for the dental implants. This is the case even if the teeth have been missing for a long period of time. When teeth are lost, bone is lost in that surrounding area.  Anatomy plays a role as well. In the front of the mouth there are less nerves orother important structures that could interfere with he placement of the dental implants.

The time schedule to complete the dental implants can be complicated. The general time frame is approximately 5 months for the lower jaw and approximately 7 months in the upper jaw. The process can take much longer if the case is more complicated. Complications can include the need for bone grafting or even sinus lifts.

The procedure generally requires two surgeries. The first surgery is for placement of the dental implants in the jawbone under your gingival tissue. The second surgery is to remove the gingival tissue that has now covered the dental implants. The second procedure comes 3-6 after the first.

There has been increased use of a one stage procedure.

A one-stage procedure is now used sometimes. In this procedure, your dentist places the implants and the supporting bar all at same visit.  The success rate of this procedure is high. if properly treatment planned.

Dental Implant Supported Denture Care

The dentures need to be removed at at night and to clean them. The attachments and/or bar need to be cleaned as well. Your dentist will give you instructions on how to clean these as they can be delicate.

Your dentist will periodically check the parts of your new denture to ensure they are secure and in proper place. Your denture may seem stable but over time these attachments can loosen. If they loosen even slightly it will cause the denture to move when chewing. This movement of the denture can cause sore spots as the denture rubs against your gums. Your dentist will also check to make sure your bite is correct and make any adjustments as needed.

The clip or other attachments on the bar retained denture usually will need to be replaced every 6-12 months. They are made of a plastic material (nylon) and will wear after continued use.

Complications that may Arise

The actual dental implant surgery carries its own risks but so does a bar retained denture. The fabrication of a bar retained denture needs extra space inside the denture to allow for the bar to fit inside. This means there is less support for the teeth in the denture. Due to this, the teeth sometimes come loose. This is an easy fix but an inconvenience for the patient.

Another important item is that the denture fits on the bar passively. This means that the bar is evenly balanced across all implants. If the fit is not passive, the extra strain can cause the screws holding the bar down to loosen. A special note for teeth grinders or clenchers is that their parts are more likely to break due to the excessive force they are placing on the components and dental implants.

Dental Implant Overdenture Expectations

A denture supported by dental implants will be far more stable than a traditional removable denture. Patients will find everyday tasks easier. They will find speaking easier. They will also not be concerned that their denture may fall out or become loose. Patients report being able to eat foods they have not been able to eat in years. A word of caution is to avoid sticky or very hard foods as you can damage the denture with these types of food.

A big advantage to having dental implants support the upper denture is the dentist can make your denture much less bulky. A traditional denture covers your entire palate whereas a dental implant supported denture does not need that extra material for support.

A whole new world has opened up with dental implants for both patient and dentist. The old compromise and limitations are slowly being worn away. We are entering a new world of dentistry and dental implants are leading the way!

 

Benefits of Dental Implants with Removable Dentures
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