By Hilarie Galloway, DMD
Dental implant overdentures provide edentulous patients with an excellent option for replacing missing teeth. While conventional dentures rely on the patient’s bony ridge and gingiva for support and stability, implant overdentures are attached to the jaw through strategically placed dental implants.
This additional support is beneficial in a number of ways, including improved functionality, improved aesthetics and patient satisfaction, and decreased bone loss when compared to conventional complete dentures. The process for fabricating implant-supported overdentures is more complex than that of traditional dentures and requires multiple steps, outlined below.
Overview of the Dental Implant Overdenture Process
Conventional dentures offer a traditional replacement for the edentulous patient. This long-standing option has a few drawbacks, particularly fit/stability and function. Dental implant overdentures are a more involved option that offers improvement in these particular areas of concern — improved fit, stability, functionality, aesthetics, and decreased bone loss.
Implant overdentures are attached to implants fixed in the patient’s jaw which prevents the issue of a denture moving around – this improvement leads to higher levels of patient satisfaction. There are multiple options when it comes to fixed implant-supported dentures — from the number of implants to the type of attachment between implant and denture. The appropriate clinical process is key to ensuring success and longevity in dental implant overdentures.
Step 1: Initial Consultation and Diagnosis
The first step in dental implant overdentures (as with any dental treatment) is patient evaluation and case selection. The initial consult should include a thorough clinical exam, evaluation of the patient’s medical history, and imaging (ideally radiographs and CBCT scan).
Used together, these elements allow the dentist to assess the overall health of the patient and the health of the patient’s bone. It is important to combine this clinical data with a personal discussion with the patient to assess goals, needs, and expectations. When considered together this information can be used to determine the suitability of a patient for an implant-supported overdenture.
Step 2: Treatment Planning
The next step in dental implant overdenture fabrication is creating a customized treatment plan for the patient. This is the stage where the dentist will develop a detailed plan for implant placement, including the number, length, and width of implants to be used.
The implant placement portion of the treatment plan will take into consideration factors such as bone density and anatomical limitations of the specific patient. Studies suggest that 2-4 intraforaminal implants in the mandible and 4+ well-spaced implants in the maxilla have the best outcomes. It is also recommended that implants are at least 10 mm in length as shorter implants have shown an increased rate of failure.
Developing a prosthetic treatment plan is also critical at this stage of planning. This is where the dentist will determine the design of the overdenture and attachment type. The three main types of attachment are bar, ball, and magnet. Magnetic attachments are generally not recommended as they have been found to provide the least retention of all systems. However, they are sometimes appropriate in the case of severe bruxism or for patients with dexterity challenges.
Bar-retained implant overdentures splint implants together to share forces, which is ideal but also requires more clearance than ball attachments. Bar attachments require at least 13-14mm from implant to incisal edge, whereas individual ball anchors only require 10-11mm of space in this vertical dimension. The development of the all-encompassing treatment plan requires careful coordination between the dentist, the oral surgeon, and the dental lab.
Step 3: Implant Placement Surgery
Following the development of a thorough treatment plan, the dental implants will be surgically placed. While this procedure can vary slightly from one provider to the next, the general process is consistent. First, the doctor will anesthetize the patient — in many cases, this will simply be a local anesthetic to numb the gums, but some patients or practitioners will opt for sedation medications to further relax the patient or put them to sleep entirely.
Once the patient is numb, the dentist will make an incision in the gum to access the bone. A hole will then be made in the bone using a series of instruments until the ideal size for the implant is achieved. Once the hole is the correct size, an implant will be carefully inserted into the hole and the gingiva closed over the implant for healing. For implant overdentures, this process is repeated for each implant (typically 2-4 per arch).
Step 4: Healing and Integration
Once the implants are placed, they are left alone for a period of time to allow the implants to fuse to the bone — a process called osseointegration. This typically takes anywhere from 3-6 months, depending on how quickly healing occurs in the patient. During this time, bone cells fuse to the titanium implant and grow into the nooks and crannies in the implant, effectively making the implant part of the jaw bone. This step is crucial to the longevity of a dental implant because if proper osseointegration doesn’t occur an implant can get loose and fall out.
During this healing phase of treatment, it is important for the patient to maintain excellent oral health and home care as recommended by their dentist/surgeon — this often includes an antimicrobial mouth rinse to reduce the risk of infection in the surgical site. The patient also needs to continue with regularly scheduled dental exams to monitor the implant healing and overall dental health. Once the surgeon is happy with the level of osseointegration, they will schedule a minor surgery to uncover the implants and place healing caps to help guide gingival healing.
Step 5: Overdenture Fabrication
After months of waiting, the custom overdenture can be fabricated. The dentist will take an impression or digital impression using a scanner to show the lab the patient’s individual anatomy as well as the precise location of the dental implants. The dentist will send this to the lab along with a prescription for the exact implant overdenture specifications for fabrication — this includes tooth shade, shape, size, and placement for aesthetics and comfort. An accurate scan or impression is critical in creating a well-fitting overdenture. Implant overdentures offer patients comfort and satisfaction.
Step 6: Attachment and Final Fitting
Once the overdenture has been fabricated by the lab, it can be secured onto the dental implants using the previously selected attachment system (bar, ball or magnetic). If the bar system was used, the bar will be attached to the implants and then the overdenture will be placed on the bar. In the case of ball attachments, each attachment will be placed on individual implants. Once fully seated, the dentist will ensure the overdenture is comfortable and fits properly and will check and adjust the bite as needed.
Conclusion and Maintenance Guidelines
Following the final delivery of the implant overdenture, the dentist will provide the patient with instructions for homecare as well as for removal and reinsertion of the overdenture. The patient should remove and clean the removable denture and around the implants/connectors daily and always keep the denture out at night to maintain healthy bone and soft tissues.
Follow-up visits will be scheduled to ensure a comfortable fit and make any adjustments necessary as the patient gets used to their new overdenture. It is also important that patients maintain regular care appointments to monitor the health of the dental implants and surrounding bone and tissues as well as the overdenture itself.
Stomadent Dental Lab can help with any dental implant overdenture needs. We can aid in the treatment plan and design phase and fabricate quality custom implant overdentures. To learn more, visit our website.
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