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Implant-supported Removable Denture
The treatment of edentulous patients has been one of the most difficult challenges for the oral rehabilitation specialist. Bone loss in these patients makes it difficult to adapt total prostheses. Complete (conventional) prostheses are considered acceptable when the patient has enough bone flange to retain them. The chief benefit of non-implant retained dentures is their lower cost when compared to implant-retained prostheses such as the overdenture or hybrid prosthesis.
Dental prostheses are evaluated based on aesthetics, function, retention and stability. These last three are the main difficulties that a conventional prosthesis (not implant-retained) presents due to the lack of bone flange, mostly in the lower jaw. With the rise of dental implants, these difficulties were overcome by creating both an aesthetic and functional result.
Removable Implant-supported Denture retained by ball attachments
The chief benefit of non-implant retained dentures is their lower cost when compared to implant-retained
prostheses such as the overdenture or hybrid prosthesis.
Dental implants that are surgically placed in the bone act as anchors for the overlying denture. This provides support in chewing, speech and overall function. The more implants placed, the less the denture needs to rest on the soft tissues, and the more comfortable the patient. The more dental implants placed – 6 to 8 on the upper and 2-6 on the lower – the more likely the hybrid prosthesis can be screwed into place, rest minimally on soft tissues, be reliably stable in function, and provide soft tissue / facial support. Two dental implants can retain a denture; however, it will still sit on the gum tissue. Four dental implants allows the denture to sit above the gums, creating more comfort and stability while functioning.
What is an Implant-retained Removable Denture (or Prosthesis)?
An implant-supported removable denture is a dental prosthesis retained by two or more dental implants. Whereas a hybrid prosthesis is screwed into placed and removable only by a dentist, the removable prosthesis uses ball attachments to allow the patient to remove the prosthesis.
Compared to the hybrid prosthesis, the removable overdenture requires fewer implants,
making surgical treatment less invasive and expensive.
What are the advantages of the Implant-supported Removable Denture compared to a conventional denture?
– Better retention
– Improved Stability for chewing
– Improved self-esteem
The removable denture is often used in cases where bone quality and quantity
is diminished and does not allow a greater number of dental implants.
What are the advantages of the Implant-supported Removable Denture compared with a screw-retained hybrid prosthesis?
The two primary advantages are cost and ease of cleaning. Compared to the hybrid prosthesis, the removable overdenture requires fewer implants, making surgical treatment less invasive and expensive. The removable denture is often used in cases where bone quality and quantity is diminished and does not allow a greater number of dental implants. Cleaning the overdenture is easier because the patient can remove the prosthesis for cleaning.
How Is an Implant-Supported Removable Denture (Overdenture) Made?
The treatment for an implant-supported removable denture is usually completed in several phases:
- Evaluation and Planning A full clinical examination is performed along with panoramic X-rays and 3D CBCT scans to assess bone quality and quantity and to plan the ideal position of the implants.
- Implant Placement Between 2 and 4 dental implants are surgically placed in the lower jaw (or more in the upper jaw). The number of implants depends on the patient’s specific case. The procedure is done under local anesthesia and typically takes 1 to 2 hours.
- Healing and Osseointegration The implants need 3 to 6 months to integrate firmly with the bone. During this time, the patient can wear a temporary denture.
- Attachment Placement and Impressions Once the implants are integrated, the retention attachments (ball, locator, or bar) are placed and impressions are taken to fabricate the custom overdenture.
- Delivery of the Overdenture The final prosthesis is delivered and adjusted. The patient is taught how to properly insert and remove it, as well as the specific cleaning techniques required.
Types of Retention Systems
There are different retention systems used for overdentures:
- Ball Attachments: A simple and economical system.
- Locator System: Very commonly used due to its good retention and ease of maintenance.
- Metal Bar: Offers greater stability, especially in cases with more implants.
Implant-Supported Removable Denture vs Hybrid Prosthesis vs Conventional Denture
| Aspect | Implant-Supported Removable Denture | Hybrid Prosthesis (Fixed) | Conventional Denture |
|---|---|---|---|
| Type of Prosthesis | Removable (taken out) | Fixed (cannot be removed) | Removable (taken out) |
| Number of Implants | 2 to 4 implants | 4 to 6+ implants | No implants required |
| Stability & Retention | Very good | Excellent (best) | Low (moves around) |
| Comfort When Eating & Speaking | Good | Excellent | Limited |
| Ease of Cleaning | Very easy (removable) | More difficult (fixed) | Easy (removable) |
| Prevents Bone Loss | Good | Excellent | None |
| Cost | Medium | Higher | Most affordable |
| Durability | Very good (implants last a lifetime) | Excellent (implants last a lifetime) | 5–7 years average |
| Best For | Patients who want good stability but prefer a removable option | Patients seeking the most fixed and natural-feeling solution | Patients with limited budget or insufficient bone |
Frequently Asked Questions
How many implants are needed for an overdenture? Usually between 2 and 4 implants are placed in the lower jaw. In the upper jaw, more implants are often required (minimum 4) because the bone is generally less dense.
Does an implant-supported removable denture feel like natural teeth? It offers much better stability and retention than a conventional denture, which significantly improves chewing ability, speech, and confidence. However, because it is still a removable prosthesis, it does not feel as fixed or natural as a hybrid prosthesis that is screwed in permanently.
Is it difficult to clean an overdenture? One of the main advantages of an overdenture is that it is much easier to clean than a fixed hybrid prosthesis. The patient can remove it to brush it thoroughly and can also clean around the implants and attachments in the mouth.
How long does an overdenture last? With proper care and regular maintenance visits, an overdenture can last many years. The dental implants themselves have a very high success rate (over 95%) and can last a lifetime with good oral hygiene.
Can I sleep with my overdenture in? It is generally recommended to remove the overdenture at night. This allows the gum tissues to rest and makes it easier to clean the implants and attachments properly. Your dentist will give you specific instructions based on your case.
Does an overdenture prevent bone loss? Yes. Because the implants are anchored in the bone, they provide stimulation that helps reduce the bone resorption that normally occurs with conventional dentures.
What is the difference between an overdenture and a hybrid prosthesis? An overdenture is removable and is held in place by 2 to 4 implants using attachments (such as locators or a bar). A hybrid prosthesis is fixed (screwed in) and usually requires more implants (4 to 6 or more). The hybrid feels more like natural teeth but is harder to clean because it cannot be removed by the patient.