implant supported bridge vs. full upper denture
Fixed Bridge Dental Implants
Fixed dental bridge supported by dental implants over the entire arch is an option that is only considered when there is adequate tissue and gum presence and support. This option is considered when the patient wants the implant restorations to match as closely to the natural missing teeth as possible. The fixed bridge restoration options when doing full mouth implants reconstruction can be of two types:
- A single long span full arch fixed bridge across the entire arch where all of the implants crowns are connected together as a single unit.
- Multiple segment fixed bridges: only 2-3 implants are connected together as single segments.
Adequate amount of bone and soft tissue “gums” support is essential in considering the above treatment options. The number of dental implants required for the above restorative options is 8-14 for the upper arch and 6-14 for the lower arch. There are some minor variations in the number of dental implants required between dentists depending on philosophy of practice, training and experience.
Hybrid Bridge and Dentures
Hybrid dental implant fixed bridge or hybrid dental implant fixed dentures are a full mouth reconstruction with dental implants where adequate tissue support is not possible. The fixed bridge in this case will be connected along the entire arch in one segment and customized pink porcelain or acrylic will be added to reconstruct missing tissue. This is why they are called hybrid implant supported fixed bridges, “it includes teeth and tissue replacement”. The number of dental implants required for the above restorative option is 8-12 for the upper arch and 6-10 for the lower arch. Keep in mind that there are some minor variations in the number of dental implants required between dentists depending on philosophy of practice, training and experience.
All-On-Four Dental Implants
All-on-four dental implants is where the entire edentulous upper or lower arch is restored with a fixed restoration anchored by four implants. In all-on-four, a fixed temporary restoration is placed on the same day of surgery similar to teeth in a day concept.
In all-on-four, the dental implants are placed in the front part of the jaw avoiding the need for bone grafting, sinus lifts, nerves, second surgery and other vital structures.
Two of the implants are placed near the front midsection of the jaw while, the back implants are angled to avoid vital structures and to provide for a favorable restorative mechanics.
Advantages of all-on-four dental implants:
There are several advantages of all-on-four over other fixed full arch restorative options
- Less costly than other full arch fixed restorative options
- There is no need for second surgery such as bone grafting and sinus lifts
- Greater measure of safety by avoiding vital structures
- The simplicity of this concept produces higher level of predictability with less complications
All–on–Four is a good option for patients who have battled with gum disease for a long time and have reached the point where the remaining teeth must be removed. These patients can have the teeth removed and implants placed along with a fixed temporary restoration on the same day. The result is very well received by these patients and at times it’s emotional and dramatic as their lifetime struggles with bad teeth are resolved in a day.
Limitations of all-on-four dental implants
All-in–Four dental implants require the presence of a considerable vertical space “arch height” for adequate restoration. If the space is not adequate, bone removal to reduce the height of the arches is required thus creating more space. In some patients bone removal may not be possible as they may exhibit a minimal amount of existing bone which is just enough to retain the implant. In these cases other alternatives must be explored.
Implant Supported Dentures
The addition of at least two dental implants per arch to support dentures can increase the degree of retention significantly. Retaining dentures with dental implants allows for much more chewing and biting ability of tougher foods like meat, lettuce and apples. There are several ways by which dental implants can support and help retain a removable denture:
Removable dentures with two dental implants
Two dental implants are the minimal number of implants that can be used for retain full upper or lower dentures. These two implants are usually placed around the eye teeth position.
Dentures supported by two dental implants
Removable dentures with three or more dental implants
Using three or four dental implants to retain full dentures allows for even higher degree of retention and stability. More importantly it eliminates the unfavorable fulcrum forces on the bone. These forces are associated with using two dental implants to retain full dentures. More importantly, using more than two implants on the upper arch allows us to eliminate the denture coverage of the roof of the mouth. This allows for the tactile feel of food against the roof of the mouth which translates to a much more enjoyable eating experience.
Bar retained dentures supported by dental implants
In certain cases we may utilize a metal bar that connects the implants to retain full dentures. Clips or other attachments can be fixed into the dentures and bar to retain and secure the denture on top of the bar.
Locator retained dentures by dental implants
Denture locator attachments are a another type of male /female connection where a protruding triangle-like attachment is placed on the implant “male part” and skirt –like attachment is placed on the under surface of dentures “female part”. The advantage of locator retained dentures over ball retained dentures is that locator retained dentures provide more stability, tighter fit, and less wear of the attachment components.
Ball retained dentures by dental implants
Ball retained implant dentures is where a ball-like attachment is placed on top of the dental implant “also called the male part”. The socket–like structure on the under surface of the dentures, “also called female part,” is the retention mechanism is based on tight and accurate fitting of the ball to the socket.
Partial Implant Bridge
Partial mouth dental implant options
This is when the patient is only missing few teeth. Two restorative options are usually considered when few teeth are missing:
Replacing teeth with implant bridge
Dental Bridges by Implant Dentist Dr. Mo Saleh
Replacing each individual missing tooth with an individual implant
Individual Dental Implants by Implant Dentist Dr. Mo Saleh