It’s estimated that there are 35 million people who are edentulous in the United States, and although a well-designed denture can be a good option, some patients may struggle to comfortably wear dentures, especially in the longer term. These patients could well benefit from dental implants but concerns over price may deter them from seeking this treatment. Others will be unaware of how implant treatment could help them, or may have previously spoken with clinicians promoting expensive and relatively invasive procedures that might not be suitable.
Not surprisingly, most people prefer the thought of having a fixed prosthesis that closely replicates the feel of natural teeth. This can be an option for patients that have only moderate bone loss and are able to adequately maintain good oral hygiene. However, for patients with significant bone loss, an overdenture will restore vertical dimensions and may be the most suitable choice. One of the reasons why most patients prefer to have a fixed prosthesis is that they assume it will provide far better esthetics, but this isn’t always the case.
Overcoming Patient Concerns About Removable Prostheses
Studies have found implant-supported prostheses, both fixed and removable, are preferable to traditional dentures for improving quality of life. Patient satisfaction can be just as high, regardless of whether a fixed or removable prosthesis is chosen. It could be worth asking about the patient’s concerns for receiving a removable prosthesis during the initial consultation. Discussing any potential fears that patients may have in regard to receiving a removable prosthesis compared to a fixed bridge enables you to address these issues from the beginning. It potentially increases their acceptance of proposed treatment plans and, hopefully, their satisfaction in the outcome of treatment.
Patients Who May Be Particularly Suitable for Implant Overdentures
Implant overdentures can be an excellent treatment option for people who cannot receive a fixed implant prosthesis and who currently struggle with wearing dentures. Some patients may have hard and soft tissue defects. With this treatment, patients can receive a prosthesis that offers reasonable retention and stability, restoring function and esthetics. People who have already received implant overdentures report that they are more able to chew food properly compared to people with complete conventional dentures. Oral hygiene is an important factor, as access is easier with an implant overdenture compared to a fixed implant prosthesis.
Factors to Discuss with the Patient
One thing to consider is that while an implant overdenture may initially be less expensive compared to a fixed implant-supported denture, it’s likely to require more maintenance. You may wish to discuss this in some detail with the patient prior to treatment to ensure they are fully aware of the ongoing maintenance required with an overdenture. Another point to think about is whether a new denture is required or if an existing denture, assuming it is still in reasonable condition, can be utilized. Sometimes it might be possible for the patient’s current denture to be relined or rebased once the implants have been placed. Alternatively, new dentures can be made after implant surgery.
Prior to treatment, you will need to decide whether to immediately load the implants. When implants are placed in good quality bone, then immediate loading may be possible, but this option might not be so desirable if the bone is defective in any way. When immediacies-loading isn’t a viable option, the patient’s existing denture can be adjusted using soft denture reline material, allowing the denture to be seated in the mouth without disturbing the implants. Depending on the bone quality, the implants can be left to integrate for one to three months or even longer. Immediate loading has been shown to give acceptable results, but if you have any concerns about bone quality, then it might not be advisable.
Key Components of Implant Overdentures
Implant overdenture systems have two separate parts. One part is connected to the prosthesis, while the other is connected to the implant or implant bar. Ball and o-rings locators are extremely popular because they are easily built into existing or new dentures. Magnets are another option. However, a bar design can provide increased flexibility and can allow you to optimally position prosthetic teeth. A bar splints implants together, which helps increase the stability of the implants and the prosthesis. Although bar constructions can be more stable and may offer greater retention, the patient may find it tricky to clean around the bar due to reduced access. However, they can require less maintenance compared to individual abutments. Additionally, bar overdentures require increased vertical space compared to fixed prostheses, reducing the available vertical height.
Deciding on the Optimal Number of Implants
Overdentures may be supported by as few as two implants, but some patients may benefit from four dental implants. Even providing just two conventional dental implants can significantly improve denture retention and the patient’s ability to chew. These implants are situated in the canine area for maximum stability. If the patient has sufficient bone in the posterior portion of their jaw, placing additional implants in this area will increase stability and retention. If only two dental implants are placed, it’s important to ensure there is sufficient inter-arch space to create a prosthesis that is thick enough to avoid fracturing.
When a denture is to be supported by four or six dental implants, then it’s possible to use conventional implants or small diameter implants. When small-diameter implants are chosen, they should be the larger variety. The advantage of choosing small-diameter implants is the decrease in cost and greater flexibility when planning treatments. Often an edentulous patient will have insufficient bone to allow the use of conventional-diameter implants in the canine area. Small or narrow-diameter implants can be placed in bone that is only 3 mm to 4 mm facially to lingually.
There is a tremendous variety of implant treatments, but many are expensive, invasive, and time-consuming, factors that are often unappealing to patients. Implant overdentures offer an affordable solution that might be suitable for patients who have already rejected other implant treatment plans or who are constrained by finances.
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