Failing teeth and what can be done? Part 2
The most attractive options for an increasing number of people is an advanced approach that more and more patients are choosing to replace failing teeth. The options available to you are outlined below for comparison.
Conventional dentures, the simplest and cheapest option for failing teeth
Replacement of all the natural failing teeth can still be achieved using conventional acrylic dentures but the use of modern materials and high-quality teeth provide people with a far more natural appearance and better denture experience than was the case some years ago. Modern concepts on the way the upper and lower teeth should meet and the positioning of the teeth allows modern dentures to function far better than they did in the past. However, Dr Priestland understands that many people have no wish to wear conventional dentures and want better alternatives using modern technology.
Implant-retained lower denture
There is an intermediate option that accepts the use of a conventional upper complete denture due to the high degree of success and predictability of upper complete dentures. In the lower jaw, a conventional complete denture is rarely successful due to the moving soft tissues around it. In the lower jaw, it is best to use implants to retain the lower denture to improve its comfort and performance. This lower denture is referred to as a lower complete overdenture. There is a separate practice article/patient leaflet that addresses this option in greater detail for those people who choose this solution.
The principle benefit of this solution is reduced cost but it does accept that the upper denture will remain conventional and will rely on a peripheral seal around the edges of the upper denture to retain the denture in place. Upper dentures are generally acceptable and work well but the lower complete denture with mobile cheek tissues, an active tongue and constantly moving lips during function leads to a tendency for the lower denture to “float” in the mouth and move around.
For this reason, the lower denture is attached to either two or, ideally three, individual implants in the lower jaw with separate precision attachments on each and the opposing part of each attachment is located within the fitting surface of the denture allowing the denture to clip on to the implants. This offers good denture retention and functions well.
Implant-borne Fixed-Removable Bridge/Hybrid Denture
The most advanced treatment option for a patient with no natural teeth is to place a number of dental Titanium implants in the jaws and use these to support a precision made fixed or removable prosthesis. At NQ Surgical Dentistry, Dr Colin Priestland favours the use of either two precision bars, one fitting over the other called a Telescopic Bar or a Two-part Bar or the use of a single bar with clips in the prosthetic arch of teeth to attach to the bar. Both are natural looking with soft tissue replacement material looking like natural gum.
These prostheses are usually referred to as Fixed-Removable Prostheses, rather than Dentures though they may also be referred to as Hybrid Dentures. However, they are so technologically advanced and involve a great deal of precision laboratory work that we refer to them as Fixed-Removable Bridges.
It is common for patients on their first visit to request that their failing teeth be removed and replaced with a fixed teeth on implants. They frequently refer to this treatment as “screwed-in teeth”. However, the biggest problem with a permanently fixed set of teeth is that patients find it very difficult to clean effectively underneath the gum margins around the teeth where they meet the gums. This area gathers plaque and the plaque becomes calcified and forms tartar. This leads to:
- infection of the soft tissues
- inflammation around the implants (peri-implant mucositis)
- ulceration of gum under the fixed bridge
- destruction of the bone supporting the implants (peri-implantitis)
- failure of the implants and the fixed prosthesis
These prostheses may look and feel fantastic on the day they are fitted, but it can take a remarkably short time for inflammation to develop and then for infection to become established leading to loss of the bone supporting the implants.
It is not uncommon to have to remove such devices from the implants due to the development of infection around the implants. Once the bridgework has been removed it is then necessary to clean the bridgework removing plaque and tartar, clean the implants beneath the gum margins, and then arrange for a dental laboratory to reshape the porcelain or metal base to create space between the gum and the porcelain or metal to allow access for cleaning aids including super-floss, X-Floss, Pikster brushes, sonic brushes and dental tape, making cleaning easier.
In the lower jaw this extra space under the bridgework achieves an acceptable situation but in the upper jaw, the creation of a space over the top of the fixed bridge at the front of the mouth can provide an unacceptable appearance especially if the patient has a short upper lip showing teeth and gum when smiling. Such a space can also allow the escape of air when speaking and a lisp can develop. This change in speech is rarely acceptable to the patient and it can be very difficult to reach an acceptable compromise for the patient to clean well and speak well.
In view of the poor access for cleaning beneath fixed implant bridges, Dr Colin Priestland holds the firm opinion that these fixed solutions are likely to provide his patients with more problems than he solves. It is now his practice to fully discuss these problems with his patients and advise that Fixed-Removable Bridgework is provided instead, if the patient demands a fixed option.
Fixed-Removable Bridge – the most popular option for failing teeth
Dr Priestland has noticed that patients find the Fixed-Removable option that enables them to remove the prosthesis from the retaining bar beneath, are able to clean this highly polished metal bar substructure far more easily achieving a high standard of plaque removal. The teeth and prosthetic soft tissues can then be replaced by the patient after cleaning.
Fixed-Removable Bridges do not have to be left out at night like conventional dentures. They can be replaced on the bar and worn at all times other than when cleaning.
The results speak, and smile for themselves!
If any of these options interest you, feel free to call NQ Surgical Dentistry for a consultation with Dr Priestland.