Dr. Popadic, Rovinj - Croatia, Specialist for Dentistry,Prosthetics

Removable prosthetics

Reconstruction of the dentition extensively damaged through tooth surface loss may require the use of removable prostheses. This can be the most appropriate type of treatment when either the teeth are very severely worn or the patient wishes a simpler and more economical approach than a fixed reconstruction.

The reasons why removable prostheses is sometimes the only way to treat partial or total tooth loss are:

Medical reasons

- severe illness such as: diabetes, heart dysfunction, blood coagulation disorder, etc.

- bone atrophy where implant insertion is not possible without bone augmentation

- severe osteoporosis

- high parodontosis risk

Personal reasons
good esthetical results and the healthy tissues conditions are obtainable only with the perfect oral hygiene, thus some patients feel that the only way to clean the prostheses well is to take it out from the mouth and wash it, so that is the reason why they choose removable prostheses.

- economical reasons � removable prostheses is sometimes much cheaper than any fixed solution

Removable prostheses are generally easy to clean and maintain. Although they are typically less expensive than non-removable restorations,they are not as stable and require a longer adjustment time than complete non-removable prostheses.

Types of removable prostheses

Full denture

Complete or full dentures replace all the teeth in the upper or lower jaw. Complete dentures are either conventional or immediate. A conventional denture is placed in the mouth about 4 to 8 weeks after all of the teeth are removed to allow for proper healing. A conventional denture is also made to replace an existing denture. An immediate denture is placed as soon as the teeth are removed or implants inserted. The drawback with an immediate denture is that it may require more adjustments after the healing has taken place. A denture helps you to properly chew food, a difficult task when you are missing teeth. In addition, a denture may improve speech and prevent a sagging face by providing support for lips and cheeks.

It usually takes a little while to get used to wearing a full denture. There may also be minor adjustments that your dentist will make to fine-tune the fit of your denture. It is very important to wear a new denture every day. If you don't wear your denture for an extended period of time, the denture may no longer fit as well as it should. Over time, your mouth will change. The bone and gum areas may shrink or recede, causing the space between the jaws to change. Because your denture keeps its shape, adjustments will be needed to keep your denture fitting properly.

Caring for your dentures after they have been fitted is very important, not only for oral hygiene but also to make sure that the dentures last for a long time. In order to take good care of dentures a person should have the following in mind:

� Rinse the denture thoroughly after every meal

� Clean the denture thoroughly at least once a day, using a toothbrush and a non-abrasive denture cleanser

� Don't use alcohol, abrasive cleaners, bleaches, whiteners or boiling water to clean or soak your Dentures

� Complete denture should not be worn at night and should be removed and stored in normal ta water or in denture cleaning solution

� Dentures can dry out and distort if they are left outside a moist environment.

Overdenture

An overdenture is a denture that uses precision dental attachments to hold the denture down. The overdenture attachments can be placed in tooth roots that have been saved, or placed into dental implants which have been placed to receive them.

If you lose most or all of your lower teeth, there is nothing to hold a denture down while you chew. An overdenture fastens a denture to the jawbone, much in the way natural teeth are anchored. The adjacent teeth may be altered with locking devices or connecting bars to ensure the denture fits properly. These bar joints support the dentures better than individual implants, though implants are still required to support the bars. Generally, the more implants, the stronger the bar, and bars on the upper arch always require more implants than bars on the lower arch due to the lesser bone density in the upper jaw and static requirements.

Examples from our practice

A telescopic denture, a type of overdenture system is probably the best option. The procedure consists of a double crown system, �the telescopic," and involves fitting inner metal crowns and outer crowns on the remaining natural teeth to create a natural looking removable overdenture. Though this is a reliable denture system that ensures even bite stress distribution, the procedure is extremely complicated and requires root canal therapy for each remaining natural tooth and the insertion of a metal post to ensure the root is strong enough.

Some of the benefits of overdentures include the prevention of bone loss (dental implants) actually strengthen the surrounding bone structure), esthetic appeal, improved speech (when compared with other types of dentures), proper jaw alignment, and improved chewing efficiency

Partial denture

Partial dentures are for single or multiple teeth that are lost. They can be supported by natural teeth and are removable. When the gap in the jaw is still bounded by healthy teeth, a partial denture can act as a spacer to prevent the remaining teeth from shifting.

They usually consist of replacement teeth attached to plastic bases which are connected by metal framework. However, there are different types of partial dentures as well as alternatives to this dental prosthesis.

Most partial dentures use precision attachments or clasps to hook into adjacent teeth. The clasps are visible, therefore from the esthetic stand point, precision attachments are better solution, and they even save the adjacent tooth more. The clasps loosen easily, and the tooth may decay under them. Precision attachments are as close to a natural feeling and look as possible. They are not visible, they are rigid and have a solid feeling, and they provide better support for the denture. They will not cause decay.

Examples from our practice

The teeth to which the precision attachments are connected must be "capped" (crowns) since , that is how the attachment is connected to the tooth. The tooth is permanently protected against decay by the crown.

A partial can restore esthetics and function to your mouth. Since you lost some teeth you may find it more difficult to chew as well as you used to. The partial can give you back much of this function, though not as much as natural teeth. A partial can also help stabilize your remaining teeth. This stabilization can minimize tooth drift, bite changes, and periodontal problems.

Implant supported denture

Dental Implants are artificial tooth roots. They provide a foundation to hold down a denture and hold it firmly in place. It is estimated that implant supported dentures will restore nearly 90% of chewing ability. A full denture is difficult for many patients to wear and get used to. Sore spots and difficulty chewing are caused when a denture moves around in the mouth. Over time the dental ridges required to support a denture will shrink creating a growing problem keeping dentures in place.

Implants can be utilized to hold the denture in place. There will be a major improvement in fit and function.

Examples from our practice

Lower dentures require at least 2 implants to properly hold them in place for normal function, usually at the positions of the canines or lateral incisors. Additional implants will provide additional stability. In the upper jaw, 2 implants are not enough, it is advisable to avoid odd number of implants because of statically bad influence, and therefore 4 implants is optimum choice. It is good to know that with 4 implants it is possible to have a fixed prosthetics, as well. See All-On-4.

An example from our practice: Patient with and without prostheses

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