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Dental Implants have changed the way we all look at tooth replacement and 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 dental 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 From Dental Implants

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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Thumb sucking is a common habit and natural reflex for children. Sucking on thumbs, fingers, pacifiers or whatever they can get in their mouth may make babies feel secure and happy and help them learn about their world. Thumb sucking can continue as a child grows. They will use the thumb sucking to soothe themselves or help themselves fall asleep.

Is Thumb sucking normal?

Babies have a natural rooting and sucking reflex. This can cause them to put their thumbs or fingers into their mouths. Thumb sucking can sometimes can occur even before birth. Because thumb sucking is soothing to babies, some slowly develop a habit of thumb sucking when they are tired, anxious or simply bored. Some children who are thumb suckers will only suck their thumb, while some will need to hold an object they treasure, like a security blanket or soft stuffed animal.

Does Thumb sucking cause any problems?

Unfortunately thumb sucking can cause problems for children if it continues. Thumb sucking in children younger than 4 is usually not an issue for development. Children who suck their thumbs often or with increased aggressiveness after 4-5 years of age, or those who are still sucking their

effects of thum sucking

Effects of Thumb sucking

thumbs at age 6, are at risk for dental  or speech problems. Once the permanent teeth begin to come in and develop in the mouth, the persistent thumb sucking may cause top teeth to push out and upward, and bottom teeth to push inward. This tooth movement can cause development of a “buck tooth” appearance, an inability to close the front teeth (open bite), damage to the roof of the mouth, and subsequent speech issues. Pacifiers cause similar issues as thumb sucking but the habit of using the pacifier is a far easier habit to break, it can be thrown out, a finger can not. What determines if thumb sucking causes dental problems or not is the intensity and length of time of the thumb sucking. Checking a child’s thumb for damaged skin and calluses can help determine the aggressiveness of the thumb sucking habit. Many children simply rest their thumbs in their mouth. These children are far less likely to develop any long term issues from their version of thumb sucking. On the other hand, an aggressive thumb sucker may develop issues with their primary and permanent teeth (if they are still thumb sucking at that point when they erupt.

Speech problems caused by thumb sucking are related to the misaligned teeth, distorted palate, and tongue thrusting. The tongue does not have the ability to find the correct placement for proper enunciation, and the tongue muscle needs to be retrained. Tongue thrusting is the pushing forward motion of the tongue when swallowing, causing a continued pressure on the teeth even when not thumb sucking.Speech problems can include not being able to properly say S’s, T’s and D’s, lisping, and tongue thrusting when talking.

Children who are thumb suckers may need treatment for the following reason:

-They have not stopped thumb sucking on their own by age 4-5.

-Speech problems are becoming noticeable.

-If they are teased or feel embarrassed by their sucking.

Treatment

At home treatment by children can include:

-Gentle reminders from parents and loved ones. When you notice your child sucking their thumb, gently remind him or her to stop. You should always avoid criticizing or making fun of your child. This will only create stress.

-Positive reinforcement. Positive reinforcement goes a long way in this area. Provide small rewards when they are not sucking their thumbs for extended periods of time. A reward could be as simple as an extra trip to the park or a slightly later bedtime.

-Competing response. Parents should give their child encouragement to do a different activity when they feel the urge to suck their thumbs. Could be something like squeezing a pillow.

Parents should also take away the child’s security blanket or stuffed animal during certain times of day. This will limit the amount of sucking. Another option is putting gloves on the hands or placing band aids over the thumb in question. This can help the child by reminding them they should not suck their thumbs.

If home treatment does not work and you are worried or feel frustrated about your child’s thumb sucking you should talk with your child’s dentist or doctor. There may be other treatment options, such as behavioral therapy, special nail polish for thumbnail, thumb devices, or devices for the mouth (habit appliances). A dental habit appliance is only a good idea for children who have not been able to stop thumb sucking on their own and have asked for help. It is usually something non removable, blocking the roof of the mouth to make thumb sucking impossible. It is worn for a few weeks to months and then removed by the dentist.

thumb sucking nail treatment

Thumb sucking nail treatment

Remember that thumb-sucking usually is not a problem until a child starts kindergarten or later. Most children will cease the activity on their own if you give them enough time. Slowly but surely, most children begin to stop thumb sucking on their own around ages 3-6 years old. If you notice changes in your child’s primary teeth, or are concerned about your child’s thumb sucking consult your dentist.



A phobia is generally defined as an irrational severe fear that leads to avoidance of the feared situation, object or activity. Most people can live with some level of anxiety about going to the dentist. However, for those with dental phobia, the thought of going to the dentist is terrifying. They may be so afraid that they will do anything to avoid a dental appointment. Exposure to the feared stimulus provokes an immediate anxiety response, which may or may not take the form of a panic attack. The dental phobia causes a lot of stress, and not only affects your oral health but other parts of your life as well. People with a dental phobia will spend a large amount of time fretting about their teeth, dentists or dental situations. Some do the exact opposite and spend a lot of their time trying not to think of teeth, dentists or dental situations. People with a true dental phobia often put off routine care for years or even decades. To avoid it, they will deal with periodontal disease, pain, infections, or even unsightly and broken teeth.

The dental phobia may take an emotional toll as well. Damaged or discolored teeth can make people self conscious and insecure. When speaking, they may smile less or keep their mouths partly closed. Some people can become so embarrassed about how their teeth look that their personal and professional lives begin to suffer. There is often a serious loss of self-esteem. People with dental phobia also may suffer from poor general health, and possibly lowered life expectancy.  This is because poor oral health has been found to be related to some life-threatening conditions, such as heart disease and lung infections.

Dental phobia and anxiety are extremely common. Estimates show that 50% of Americans do not visit the dentist regularly. Of those people, an estimated 9-15% are avoiding dental care due to their dental phobia, anxiety of the unknown and phobias that grow with time. This translates into 30-40 million people per year who do not see the dentist because of dental phobias or fear.

Anxiety and Phobia are often interchanged, but they are very different. Phobias are generally much more serious than fears or anxieties. They are deeply rooted within a person. Unlike fears that are learned and can possibly be unlearned, phobias are not as easily dismissed with confronting the situation. It takes time and attention by both patient and doctor to move forward.

Some of the known causes of dental phobia include, previous negative experiences, an uncaring dentist, humiliation, history of abuse, or even the phobia could be learned from a parent or relative when young.

Dental phobia and anxiety come in varying degrees. At the extreme end, a person with dental phobia may never see a dentist. Others may force themselves to go, but they may not sleep the night before. It’s not unusual for people to feel sick (or actually get sick) while they are waiting to be seen.

The dental phobia can be treated. Without treatment, the dental phobia is likely to get progressively worse. That is partly because emotional stress can make dental visits more uncomfortable than the situation warrants.

People who are unusually tense tend to have a lower threshold of pain. This means they may feel pain at lower levels than other people. They may need extra anesthetic. They may even develop stress related problems in other parts of the body. For example, muscle stiffness and headaches are not unusual.

There isn’t a clear boundary that separates “normal” anxiety from dental phobia. Everyone has concerns and fears and deals with them in different ways. However, the prospect of dental work does not need to fill you with terror. If it does, then you may need some help overcoming the fears.

Some of the signs of dental phobia include:

1) You feel tense or have trouble sleeping the night before a dental visit

2) Increased nervousness while you are in the waiting room.

3) Overcome by bouts of crying when you think of going to the dentist. The sight of dental instruments (or even the white lab coats) increases your anxiety.

4) Feeling physically ill with the thought of a dental visit.

5) When objects are placed in your mouth during a dental appointment you panic or have trouble breathing.

Phobias are not easily treated like fears are, however the same techniques can be helpful. Your dentist can prescribe muscle relaxers that help their patients relax before and during an appointment. If the dental phobia is extremely severe, talk with your dentist about the problem. If you can, seek help from a psychiatrist that too may benefit you, allowing you, your dentist and doctor to work together to find the best course of overcoming the dental phobia. Overcoming dental phobia is best done with a team approach. meaning you, your loved ones and the dentist and his/her staff must all work together to move past this. Thankfully it can be overcome. Some of my best patients were former dental phobics with severe anxiety. They are now comfortable having dental work done and actually look forward to coming to their dental visits.