Fixed, Removable and Implant Prosthodontics

These before and after photos, taken in our practice, are for educational purposes. Implant dentistry should only be undertaken following accurate diagnosis of conditions in the mouth and following a thorough discussion of alternative treatments.

Fixed Prosthodontics

Fixed bridges replace missing teeth by using adjacent teeth to support one or more artificial teeth.  Although dental implants are becoming the preferred option to replace missing teeth, fixed bridges persist in being the best solution for certain situations.  Contemporary fixed bridges look very natural, as you can see from the photographs immediately below.

Removable Prosthodontics

Removable prosthodontics refers to tooth replacements that can be removed by the patient.  These are (1) removable partial dentures for people with some of their own natural teeth remaining, and (2) removable complete dentures for people with no natural teeth remaining.

Below, note the improved appearance of the new complete denture (right) as compared to the old denture (left).

Implant Prosthodontics

A dental implant is a threaded titanium cylinder that is placed into the jawbone to serve as a substitute for the root of a tooth.  Below is an x-ray of three dental implants.  The screw-type threads help to anchor the implant in the bone.  The body grows new bone next to a newly-placed implant in a process called osseointegration.

Implants do not replace the visible part of a tooth-- only the root.  The teeth must be made in a separate procedure, and are either screwed, or cemented onto the implants.

Situation 1: No natural lower teeth remaining

There are three types of dental implant prostheses that are used to replace all the lower teeth.  These are (1) acrylic-to-metal fixed implant-supported prostheses, (2) porcelain-to-metal fixed implant-supported prostheses, and (3) removable prostheses (overdentures).  The type of prosthesis selected depends upon three factors: (1) patient preference, (2) the relation of the upper teeth to the lower teeth, and (3) the degree of residual ridge resorption.

Residual ridge resorption

The gum always shrinks after natural teeth are removed.  The gum left over after teeth are lost is called the residual ridge.  This residual ridge continues to shrink gradually over time (although the placement of dental implants can prevent this).  This shrinkage over time is called residual ridge resorption.

Acrylic-to-metal fixed implant-supported prostheses

The lower tooth replacement pictured below is entirely supported by dental implants, and does not contact the patient's gum tissue.  The upper teeth have been replaced by a regular denture without implants. This type of prosthesis is used when residual ridge resorption has resulted in loss of gum tissue, and therefore the prosthesis has to replace gum tissue as well as the teeth themselves.   Notice the pink acrylic (type of plastic) material surrounding the artificial teeth.  The metal posts are not visible during speech or smiling, and are not uncomfortable or noticeable to the patient.                   

Porcelain-to-metal fixed implant-supported prosthesis

This type of prosthesis uses porcelain instead of acrylic, and is used when there is very little or no gum tissue in need of replacement.  In other words, when there has been less residual ridge resorption. The particular case pictured below also illustrates the practice of immediate (or early) loading. 

Immediate (early) loading

In the past, a prosthodontist was required to wait 3 months after implant surgery before starting to construct a lower prosthesis, and 6 months before construction of an upper prosthesis.  Currently, when making a lower prosthesis, it is possible for teeth to be constructed on the implants the day of implant surgery, or within a few days.

Below (left) are pictured four implants that will support a future fixed tooth replacement.  We say it is fixed  because the patient will not be able or be required to take it in and out.  A temporary bridge (right) has been made to screw onto these four implants 24 hours later.

The completed porcelain-to-metal implant-supported tooth replacement is pictured below, and was placed in position 12 weeks after implant surgery.

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Removable dental implant prostheses (implant overdentures)

Dental implant prostheses that can be removed by the patient are called  implant overdentures.

This type of tooth replacement is used when a patient is comfortable with removable devices, and has experienced a greater degree of residual ridge resorption.  An implant overdenture retained by two dental implants in the front of the lower jaw is now considered to be the best treatment for those who lave lost all their lower teeth.

As an alternative to the individual snap-type attachments pictured above, several types of gold bars may be used to join the implants together, and to provide a place for the denture to clip into place.

Situation Two: No natural upper teeth remaining

For upper teeth, dental implants can be used to construct the same three types of tooth replacements noted above for lower teeth.  Restoring all the upper teeth using dental implants has the additional challenges of achieving optimum appearance and natural speech.  As for lower teeth, the type of prosthesis selected depends upon (1) patient preference, (2) the relation of the upper teeth to the lower teeth, and (3) the degree of residual ridge resorption as explained above.             

Acrylic-to-metal fixed implant-supported "hybrid" prosthesis

The term "hybrid" is sometimes applied to tooth replacements that replace gums as well as teeth.

Porcelain-metal fixed implant-supported prosthesis

Porcelain-metal implant prostheses are being used with increasing frequency.  They are the best treatment under a variety of conditions, such as when a patient has their own teeth opposite the prosthesis.  Eight implants (below, left) support this "hybrid" prosthesis (below, right), which uses pink porcelain to simulate gum tissue.

In the frame directly above (center), note the natural appearance of both the teeth and gums.

Porcelain-metal prostheses are also best when there has been very little residual rdge resorption.  Note below that in both of these cases, the teeth are being replaced, but (unlike the case above) there is no need to simulate the surrounding gums.

Above (left), five of the six front teeth are supported by dental implants.  Notice that the artificial metal-ceramic teeth appear to emerge from the gum just as a natural tooth would.  Accurate implant placement is critical to achieve this kind of a result.  Above (right) both upper and lower bridges are supported by dental implants.  The metal top of two implants are visible only when the lip is pulled up for purposes of photography, and do not show during normal facial expressions.

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