Dental implants have been designed to artificially replace a natural tooth root and are inserted into the jaw bone to support a restorative or replacement crown, bridge or denture. they can be the best solution for people missing one or more teeth due to injury, periodontal disease or other oral health problem.
• Success rates of treatment are in excess of 95%.
• They are durable and permanent.
• Minimal maintenance is required other than good oral hygiene and professional dental checkups and cleanings.
• Feel natural and comfortable and provide the best aesthetics.
• Only tooth loss solution that prevents jaw bone loss.
• Teeth adjacent to the gap do not need to be modified.
• Can be more cost effective in the longer Term, due to the long life span of treatment.
• Treatment is more invasive – A surgical procedure is required to insert implant.
• Treatment takes longer and requires a greater number of dental visits compared to other options.
• Most expensive tooth replacement solution.
Why to choose Dental Implants
This is the best option if you are suitable for treatment and can afford dental implants.
Treatment is a long-term solution for tooth loss and it provides the best aesthetic results.
Although treatment is more expensive, it can be more cost effective in the longer term as implant restorations will not need to be replace as often as a dental bridge.
Additionally, an implant preserves the jawbone and the gum tissue, and there is no need for your dentist to grind down healthy teeth.
All-on-Four Implant Supported Fix Dentures
It’s possible to support a full-arch lower denture with just Four implants, while an upper denture may require six implants for support. With this treatment, two implants are inserted right at the front of the arch in the positions previously occupied by your front teeth.
The remaining two implants are placed either side and at a 45º angle tilting towards the back of the mouth. The over denture will fix with screw onto its fitting surface.
• Affordable due to the fewer number of implants required to support a complete arch of teeth.
• More stable and strong than dentures.
• Make it possible to enjoy a wider variety of foods compared to dentures.
• Can be constructed without a palate (upper jaw) so it will feel less bulky and eating will be more enjoyable because you will be able to taste food more easily.
• Denture is fix.
• Full-arch rehabilitation with only four implants.
• Graft less procedure
• Immediate function
Need more hygiene than removable type
Implant-Supported Removable Dentures
Implant over dentures are an excellent treatment option for the edentulous patient.
This type of prosthesis is indicated when patient demands cannot be met either through a fixed implant prosthesis or through a complete denture.
Retention is obtained through use of attachments placed directly on implants or on bar superstructures.
Adequate cleaning and hygiene measures and maintenance of the removable denture and intraoral retention elements are crucial for long term clinical success.
Some patients present with soft and hard tissue defects that cannot be addressed by a fix implant prosthesis when Esthetics, phonetics and oral hygiene access are considered, In these patients who have struggled with insufficient complete denture function, implant over dentures offer necessary retention and stability and replacement of lost hard and soft tissues in a manner that fulfills esthetic, phonetic, and functional requirements.
• Significantly higher masticatory, functional and life quality scores than patients wearing conventional complete dentures.
• Oral hygiene access is easier when compare to a fix implant prosthesis due to the removable nature of the restoration.
• The fewer number of implants required to support a complete arch of teeth.
• More stable and strong than dentures.
• Can be constructed without a palate in upper jaw (maxilla)
• It is removable.
• Lower pressure tolerance than fixed type.
Implant number and position
Utilization of two or four implants leads to excellent prosthesis function and patient satisfaction. During the treatment planning phase, it is important to ensure sufficient inter-arch space to avoid fabricating a thin prosthesis that is vulnerable to fracture.
In general, when the inter-arch space is limited, there may not be sufficient space to Use a bar superstructure and attachments should be placed Directly on implants.
Ideally, implants are placed evenly across the edentulous arch.
However, if there is insufficient bone in posterior regions, distributing the implants in the inter-foraminal region of the mandible and the inter-maxillary sinus region of the maxilla is indicated.
In the lower jaw, two implants placed parallel with the hinge axis of the mandible allows to have an overdenture which can rotate to a certain extent. The distal parts of the denture are thus mucosally supported. Excellent long term (> 10 years) survival rates (≥ 95%) have been reported.
Especially in young patients where such treatment will be maintained for decades it may be wise to opt for 4 implants interconnected by a bar, so that the distal parts of the mandible do not resorb due to the denture loading.
Elderly patients, who have been denture wears for years, may express a preference for over dentures to fixed prosthesis.
Even one symphyseal implant seems to suffice to retain an over denture.
In the extremely resorbed mandible 4 short implants could be placed. When the bone height is < 6mm, a bone augmentation procedure is advised.
In the maxilla over dentures should be retained by ≥ 4 implants. With such retention system, medium term survival rates of ≥ 99% are common. There is no difference in outcome between substructures on 4 or 6 implants in maxilla
A variety of retention mechanisms are available including ball/ O-ring, locators, ERA, magnets, etc.
all of these options have advantages and disadvantages. The locator system offers some advantages with regards to the ease of maintenance, the option of different degrees of retention and relatively low abutment profile for use in patients with limited inter-arch space.
Implant-Supported Fixed Bridge
With an implant-supported fixed bridge, it is not necessary to replace every single tooth with a single dental implant. Instead, the implant-supported fixed bridge will restore several missing teeth and it’s possible for this option to replace a complete arch of teeth.
The number of implants required can vary according to the type of dental implant used by your dentist, and the number of teeth being restored.
An implant-supported bridge looks very similar to a tooth-supported fixed bridge and can either be cemented or screwed into place. Sometimes an implant dentist will choose to screw the bridge onto the implants as this makes it easier to retrieve the bridge should it need cleaning or repairing.
The screw holes in the bridge are covered up with tooth- colored composite resin so they are virtually invisible.
• Provides very good aesthetic result.
• Feels and looks very natural, making it easy to speak and to eat virtually anything.
• Easy to look after and can be brushed and flossed just like an ordinary tooth-supported fixed bridge.
• Cost is lower compared to replacing every single tooth with a single dental implant.
• Should last for many years before it needs replacing.
• No need for your dentist to grind down healthy teeth.
• Only suitable if the missing teeth are situated adjacent to each other.
• Relatively expensive, particularly when used to restore a complete arch of teeth.
• Requires a greater number of visits and treatment takes longer to complete compared to a tooth-supported fixed bridge or a denture.
• Implant treatment does require a small surgical procedure.
When to choose and Implant-supported Fixed Bridge?
This option can be ideal for anybody who wishes to enjoy the sensation of having strong and stable teeth that are not removable.
The teeth are strong enough to allow you to eat just about any foods you like, within reason. It also provides excellent aesthetics.
Although more expensive than All-On-Four implant-supported dentures.
Tooth-Supported Fixed Bridge
A Bridge is a fixed dental restoration used to replace one or more missing teeth by joining an artificial tooth definitively to adjacent teeth or dental implants.
A tooth-supported fixed bridge is the most common alternative to having implant-supported restorations, particularly where a single tooth is missing.
A tooth-supported fixed bridge consists of one or more crowns, normally fitted onto the teeth either side of the gap and these are the abutment teeth. The abutment crowns are attached to the replacement teeth which are called pontics.
This type of restoration is permanently cemented in place.
A-Types of Bridges according to structure
1. Conventional bridge
Conventional bridges are bridges that are supported by full coverage crowns, three quarter crowns, post retained crowns, onlays and inlays on the abutment teeth.
In these types of bridges, the abutment teeth require preparation and reduction to support the prosthesis.
Conventional bridges are named depending on the way the pontic (false teeth) is attached to the retainer:
a- fixed-fixed bridge
A pontic is attached to a retainer at the both sides of the space with only one path of insertion.
A pontic is only attached to a retainer only at one side
2. Adhesive bridge
An alternative to the traditional bridge is the adhesive bridge.
There are three types of adhesive bridge:
An adhesive bridge utilizes “wings” on the sides of the pontic which attach it to the abutment teeth. Abutment teeth require minor or no preparation. They are most often used when the abutment teeth are whole and sound
3. Combination Designs
The incorporation of elements of different conventional bridge designs. A popular combination design is the use of a fixed-fixed design with a cantilever.
4. Hybrid designs
Bridges that incorporate elements of both conventional and adhesive bridge designs.
B-Types of Bridges according to materials
1. Metal Based:
Noble based such as nickel gold, or base metal alloys such as nickel chromium.
a- Full metal
Can be provided by precious metal, semi-precious or non-precious metal.
b- Acrylic resin fused to metal
Acrylic resin was the first veneering material used to help restore the aesthetics of crown and bridges, the aim was to maintain a similar colour to natural teeth by attaching it on the labial surface of metal crown/ bridges, however, resin veneered dental prosthetics lacked stability and abrasion resistance.
c- porcelain fused to metal (PFM)
PFM was then introduced; the porcelain is composed of two layers (one opaque to cover the metal substructure and another translucent to provide an enamel illusion).
Still several researchers consider PFM the gold standard as it has been reported to have 95% success over a 10 years period, a reason why newer types of all-ceramic restorations are usually compared to PFM crowns/ bridges to assess its success and durability.
However, PFM restorations may show a grey colour at the cervical margins of The tooth showing the metal substructure.
2. Non-metal based
They can be either resin veneers, fibre-reinforced composite or ceramics which either silica, alumina, or zirconia.
a- IPs Emax
IPs Emax ceramics offer high aesthetic properties, that’s why its use has been increasingly popular, however, there’s insufficient evidence to determine the longevity of Emax in bridges; some reports found fair short-term survival, but unfavorable medium-term survival.
Failure of restorations were most reported in the posterior teeth region. IPs Emax is available as press ingots or as IPs Emax CAD-CAM system. Emax use in crowns or bridges is not recommended for patients who suffer from Bruxism.
Zirconia is used in anterior, and posterior fixed bridges, also on implants.
Zirconia is fabricated using the dental CAD-CAM technology. It has high mechanical strength and it can with stand high occlusal forces compared to all ceramic materials.
In addition it can resist crack propagation in the core material, however, cracks often occur in the veneering material leading to its fracture whether in the tooth-supported or implant-supported bridges.
• Feel and function just like your real teeth.
• Procedure is very straight forward and treatment will normally only take two or three weeks to complete.
• Maintenance is easy, as a fixed bridge can simply be brushed and flossed.
• Cost effective way to replace missing teeth and is less expensive than implant supported teeth.
• Treatment is relatively low risk-if the bridge fail then it can generally be replaced quite quickly and painlessly.
• More expensive than a removable denture.
• Teeth adjacent to the gap must be ground down in order to support the bridge, removing healthy tooth structure that can only ever be artificially replaced.
• Once these teeth are ground down, there is an increased risk that they could become decayed and infected in the future.
• Most thoroughly clean underneath the pontic and there is a possibility that this could become a food trap, especially as bone loss occurs.
• Does not provide any stimulation to the bone underneath the bridge.
• Does not generally last as long as an implant-supported bridge.
When to choose a tooth-Supported Fixed Bridge
This option can be best for anyone looking for a quick solution to tooth loss and/ or who doesn’t want to undergo surgery. Not everyone wishes to or is suitable for implant surgery, especially if they have medical conditions that have compromised their immune system which can slow down healing, increasing the risk of implant failure.
People in these situations can often obtain better and more predictable results through using a fixed dental bridge. Treatment can often be completed within a matter of just a few weeks rather than the several months required for implant treatment.
Removable Partial Dentures
A removable partial denture is designed to replace one or more missing teeth in the same arch and which may or may not be adjacent to each other. The denture consists of an acrylic base which is sometimes strengthened with a cobalt chrome metal frame work.
It will frequently have metal clasps that fit over your existing teeth, holding the denture firmly in place but still allowing it to be easily removed.
Some are made from a flexible nylon material and these have claps made from gum colored nylon so they are less visible in the mouth.
• Less expensive than fixed bridges or implants.
• Very effective at filling in the gap in between teeth and restoring your ability to smile.
• Restoring missing teeth can help improve your speech and your ability to eat comfortably.
• Sometimes possible for additional teeth to be added to the denture.
• Procedure is non-invasive and relatively quick.
• Can be unstable and uncomfortable.
• May not always look very natural and will not function as well as fixed teeth.
• Need to be removed every day and thoroughly cleaned and left out overnight to allow the gums a chance to recover.
• Need to be replaced or relined quite frequently.
• Quite fragile and easily broken, with the exception of nylon dentures which are unbreakable.
• Easy to lose or mislay a partial denture.
When to choose removable partial dentures
Removable partial denture can be a good option for people who cannot afford dental implants, or who do not have natural teeth that are strong enough to support a fixed bridge.
Removable Complete Dentures
Removable complete dentures rest on top of the gums and are a low-cost and non-invasive alternative to dental implant treatment. Dentures consist of an acrylic gum-colored base to which denture teeth are attached.
• Can significantly improve appearance and may help to increase self-confidence by replacing teeth that may have been worn down or decayed.
• Provide the correct support for the muscles in the cheeks and lips, restoring facial dimensions and creating a more youthful appearance.
• Can help improve speech and the ability to eat comfortably.
• Affordable and treatment is relatively fast.
• Look quite natural as they come in many different shapes, colors and sizes, while gum tissue can be closely matched to your natural gums.
• Can be relined or adjusted to accommodate the changing shape of the jawbone.
• Can become ill-fitting within a very short while as the jawbone changes shape.
• Not possible to eat certain foods that are very hard or very sticky without risking damage to the denture.
• Have to be removed for cleaning and must be left out overnight to give the gums a chance to recover.
• Can accelerate bone loss in the jaw due to the pressure of the denture resting on the gums and the jawbone.
• May affect your ability to properly taste food, and they may move around when you eat or speak.
• Can rub on gums, creating painful sore spot.
• Denture adhesive are often messy and do not offer a long-term solution.
• May make a clicking sound when you speak, which can be embarrassing in social situations.
When to choose removable complete dentures
• They can be a good low-cost solution for replacing a complete arch of teeth. They are also good for anybody who doesn’t wish to undergo dental implant surgery, or who is not a suitable candidate for dental implants treatment.
A Resin-bonded bridge is sometimes called a conservative bridge has four types:
1. Maryland bridge
2. Rochette bridge
3. Sockwell bridge
4. Fiber bridge
These types of bridges tends to only be used to replace front teeth. This is because it is relatively fragile and is unable to withstand the chewing forces created by back teeth. It consists two wings that are attached to the abutment teeth on the tooth surfaces and the wings are attached to the replacement tooth or pontic.
The abutment teeth must be healthy and strong, but it’s unlikely that your dentist will need to change their overall shape very much. Sometimes they may choose to remove a small amount of tooth enamel, as a slightly rougher surface will help increase the bond between the tooth and the bridge.
A Maryland bridge has etched surface on the wings to help increase the retention and Rochette type has holes drilled into the wings for more retention, the Sockwell uses more holes and etched surface on the wings for more retention.
In the fiber bridge model, polyethylene tapes are used instead of wings.
• Cheaper and less invasive than a fixed bridge supported by your natural teeth.
• Restores your ability to smile and to eat and speak.
• Provides the correct amount of support for your lips.
• Prevents your remaining teeth from drifting out of place.
• Isn’t very strong, which is why it is only used to restore front teeth.
• Hard food can cause the bridge to pop off your teeth and need to be re-cemented.
• Relatively fragile which doesn’t make it a good long-term option.
When to choose a Resin-bonded bridge
This option is cost-effective and non-invasive, particularly when compared to dental implants, it could be a good short-term solution and this type of bridge may occasionally be supplied as a temporary restoration, while an implant heals underneath the gums.
Flipper- A Temporary Replacement option
A Flipper tooth is a temporary partial denture that is used to restore one or more missing teeth. Its purpose is to fill in any unsightly gaps so that you can smile and talk without feeling self-conscious.
A Flipper tooth is only used until a more permanent replacement can be fitted.
• Treatment is very inexpensive.
• Fabricated prior to tooth extraction and fitted right after a natural tooth is removed.
• Process requires fewer trips to your dentist compared to a more permanent partial denture.
• Light weight-making them easier to wear and to tolerate.
• Not very strong or stable.
• Fragile and easily broken
• Can be bulky, making them uncomfortable to wear, particularly towards the end of a long day.
When to choose a Flipper Tooth
This type of restoration is purely for temporary use, so it can be useful while you decide how to more permanently restore a missing tooth, or while waiting for dental implant treatment to be completed.
• Do Nothing
Those were the most popular ways to replace one or more missing teeth, but there is another option doing nothing. However, this is not an advisable choice if you can help it.
Jawbone density decreases after a natural tooth is removed due to the lack of stimulation that would normally be provided by a natural tooth root. If you later decide to replace the tooth with an implant, you’re more likely to need a bone graft to make up for the lost bone.
Doing nothing will also allow any adjacent teeth to move out of position, potentially destabilizing them and affecting your bite. While it’s not always possible to replace missing teeth immediately after their loss (financially and/ or physically), it is important to figure out a more permanent way of replacing them as soon as possible.