Replacement of Natural Teeth with Dental Implants. Dr Paul Moore BDS. Galway Ireland

Replacement of Natural Teeth with Dental Implants

Dr Paul Moore BDS

Replacing all the natural teeth of the upper or lower jaw presents many options to consider.

An X-ray or 3D Scan may be required to determine what bone is present to place the titanium implants into and the best positions for maximising success.

Is your preference for a removable option or a fixed option?

Either my provide an improvement in the quality of your life.

Removable options allow for easier cleaning of the supporting implants and therefore are simpler to maintain and adjust .

Fixed options appeal to many, but generally do demand a higher commitment to standards of hygiene and care, and a higher commitments to your investment.

In this document we will explore some of the options and materials that you may be able to consider.

IMPLANT SUPPORTED ALTERNATIVES AND OPTIONS

Below are some of the options for improving or replacing dentures with Implants.

The aim of treatment is to 1. Increase retention ( the ability of the teeth NOT to move up and down) and 2. Increase stability ( the ability of teeth NOT to move in function.).

We aim to improve to appearance giving increased support to the lip and creating the correct “face height”.

This will give increase visible lip support and reduce the depth of the creases at the corners of the mouth.We would like you to be proud of your teeth – ideally no reduce the need to take them out . eg if you have a hospital stay.

Plan A…..New dentures and two implants in the front of the lower jaw with “locator” ( snap fastener) attachments. The denture also has two receiving attachments.

Plan B ….New dentures and four implants with “ankylos” ( thimble ) attachments. The denture also has four receiving thimbles. The lower denture has to made with a chrome cobalt framework. ( the metal will not be seen but gives strength to the denture.)

The denture is still removable but would be more secure with greater stability (less movement).

Plan C ….New dentures and four implants and a “bar” attachments. The denture has a precision custom made slot for the titanium bar to fit into. Again the lower denture has to made with a chrome cobalt framework. ( the metal will not be seen but gives strength to the denture.) The denture is still removable but would be yet again more secure with increased stability (less movement).

Plan D……Fixed bridge that cannot be removed by yourself ( The dentist however can do so if required to adjust or inspect the implants ).

Certainly one advantage of the removable solution is that you can remove it to clean the teeth. The main advantage of the fixed solution is that it is fixed! You will have to clean the inside, the outside and we will show you have to do this simply with electric toothbrush and special “under-bar” cleaning brush.

I would emphasis that with all of the implant techniques we would encourage you to attend for an annual check, and if required a hygienist visit to maintain around the implants every 4 or 6 months to remove any accumulating bacteria and keep the gums and bone around the implants healthy.

Design

Descriptions Removable 2 - 4 Dental implant retained .

“Snap Fastener” locators Acrylic

Removable 2 - 4 Dental implant retained .

“Snap Fastener” denture Acrylic with Chrome Cobalt frame

Removable 2 - 4 Dental implant or tooth `retained .

“Snap Fastener” denture Acrylic with Chrome Cobalt frame

Fixed All Acrylic Bridge on 4 implants.

“All on Four”

Fixed Titanium Bar. Removable Porcelain Bridge. or Fixed Titanium Bar Removable Chrome Cobalt /Acrylic denture

Fixed Titanium Bar. with Integrated xed Porcelain Bridge. or Fixed Titanium Bar with Integrated xed Chrome Cobalt /Acrylic denture

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Fixed All Porcelain Prettau Bridge On “Ti-base” connectors

Locator Retained Dentures on 2 Implants in the Lower Jaw Probably the simplest way to use dental implants to help improve a denture is to place two, three or four dental implants into the jaw and these allow a “Snap Fastner” or Locator to be locked onto the implant and a matching silicon rings inside the denture.

This solution will give you both grip and stability.

It is huge improvement in the function and the con dence that

First we will assess the best areas to place the dental implants with a suitable x ray or cat scan, to ensure you get the best result.

The implants are placed into the bone and a small metal button will be visible.

It takes 3 - 4 months for the implants to integrate before they can be “activated”.

The metal Locators or “snap Fasteners” are placed onto the implants.

These will provide the grip for the denture to link to.

This can be done with only two implants in the lower denture.

It is better to place three or even four implants to give greater stability and grip.

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The silicon grips seen inside the denture will need replacement every 6 - 12 months.

This replacement is very simple to keep the grip ideal.

Locator Retained Dentures on 4 Implants in the Lower Jaw

The images here show the planning of four implants placed in the bottom jaw (mandible) with a CBCT ( cat scan ) (A minimum of two implants will provide a significant improvement of grip or “retention” for a patient with little or no lower ridge for a bottom denture to fit adequately.)

Four dental implants as seen here will allow the option of 4 x locators, or a fixed bar solution, or a fixed bridge in acrylic or porcelain.

“Two implants good - four implants better” as the load and the grip is better distributed.

Locator Retained Dentures For the upper jaw, this concept requires a minimum of four implants to support the denture The roof of the mouth will still be covered This can optionally be done with a Chrome Cobalt metal plate.

This gives a thinner and lighter solution that is easier to wear.

Upper Denture with “Conus” Attachments

The Conus Attachment can best be described as a cone that fits on the tooth or implant and a thimble that matches perfectly that fits inside the denture By combining multiple thimbles that have a 6 degree “Morse” taper, the fit of the denture can be enhanced to give a greater grip, greater function and increased patient comfort.

One of the signi cant advantages of this solution is the ability to remove the denture and look after the implants with improved home care

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The contouring and colour of the gums is “sculpted and tinted” to mimic the contour and shades of natural gums.

Titanium Bar Retained Removable Porcelain Bridge or Denture For the upper jaw, this concept requires a minimum of four (preferably six) implants to support the bridge or denture

One of the significant advantages of this solution is the ability to remove the denture to be able to clean and look after the implants.

A bridge can be fitted made of acrylic or made of porcelain. either will fit and be bonded to the bar with a sleeve under the teeth that provides the grip and stability.

This is especially valid in patients with reduced finger strength or control, or those who may need help from a “carer”

A removable denture that fits the bar can be made with a Chrome Cobalt metal plate inside the denture for strength, which houses the sleeve, or a “porcelain” removable denture that will have greater longevity.

With the denture, the roof of the mouth will still be partially covered. but the teeth are removable

Lower All Porcelain Bridge with “Ti-base” Connectors If you are looking for an all-porcelain fixed bridge, this is an excellent option for function and aesthetics.

The acrylic option will wear with time and need replacement depending on how hard you chew ( load and function).

Porcelain gives a much higher resistance to wear and will last longer.

If you have a high load or grind you teeth we may recommend you have the Titanium frame option

All-Porcelain Bridge with “Tibase” Connectors Upper Jaw

Often a fixed bridge is placed on four or more dental implants.

This is sometimes called an “All on Four” In practice we would recommend that six implants will provide a better platform than four implants. With six implants: Each implant will bear less load as the balance of weight distribution is improved.

If at a later date as time goes by you were to have a problem with a six implant supported bridge ( which would be less likely than with a four implant bridge ), you will still have 5 implants which is adequate support to continue.

If you have a four unit bridge and lost one implant, the remaining three would be insufficient to carry the load and the bridge would fail.

It is worth noting the the fixed upper bridge does demand attention to detail for homecare with a high standard of dental hygiene to keep the implant supporting gums healthy.

With this in mind the upper bar supported bridge can be an easier alternative as is can be removed daily for cleaning and to access the Titanium bar which is easier to clean.