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Fixed complete prosthesis on implants

A dental implant is a screw that is inserted into the alveolar bone, the bone that supports the teeth. It acts as an “artificial dental root” that can accommodate a prosthesis, therefore referred to as an “implant-supported prosthesis”. When the implant is stable in the jaw bone, the prosthesis is installed on it. This type of prosthesis can be permanently attached to the implant.

The following list deals only with fixed prostheses on one or more dental implants:

  • Single implant: the prosthesis is a simple artificial crown that is screwed onto a pillar, itself screwed into the implant. It is used to replace a single tooth, or sometimes a few teeth that can be properly supported with a single implant;
  • All-on-4® technology: this recent technique supports a complete dental prosthesis on four implants, both in the maxilla and mandible. The patient must be completely edentulous on one or two jaws to benefit from this technique. The technique can be used even with low bone volume in the jaws, so it is therefore rare to have to resort to a bone graft beforehand. The secret of this technique is the insertion of the two posterior implants at a 45 degree angle into the jaw bone, which gives them greater stability. The installation of implants and prosthesis is done in a single visit to the dental office. As a result, the All-on-4® technique is less invasive and recovery is shorter than other treatment plans. The cost of this treatment plan may be lower depending on the number of implants required;
  • The bridge: it is used to replace both a single tooth and a complete dentition. It is an alternative to the traditional butterfly bridge (a bridge permanently attached to adjacent natural teeth) when the teeth on either side of the edentulous space are not healthy enough or if too many teeth are missing to attach a traditional bridge. If there are natural teeth adjacent to the bridge, they are not modified (ground) as in the case of a traditional butterfly bridge, which preserves them a little longer;
  • 5-6-7-8-10 implants: this technique is used to permanently install a complete dental prosthesis (dentures). Although four dental implants may be sufficient to support a complete prosthesis, especially with the All-on-4® technique, it is sometimes recommended to insert five, six, eight or even ten implants into the alveolar bone to support such a prosthesis. The factors that most influence the number of implants needed are the quality and quantity of the bone substance, the desired stability and the recommended alveolar bone stimulation (and therefore the cessation or slowing of jaw bone resorption) by your oral health professional. Usually, more implants will be needed if:
    • the quantity of bone is insufficient or if the quality of the bone is poor;
    • The stability of the prosthesis is an important feature for you;
    • the stimulation of the alveolar bone should be as great as possible according to your condition to avoid serious bone resorption problems.

It is more common to use eight or more implants to support a complete prosthesis in the upper jaw than in the lower jaw. Prostheses attached to the lower jaw more rarely require the use of more than six implants.

There are also removable prostheses on implants, i.e. dentures that attach to implants to make them more stable in the mouth; they can be easily removed for cleaning.

Advantages

  • The fixed implant prosthesis allows you to regain a natural chewing function while improving the aesthetics of your smile and the harmony of your face. A fixed prosthesis is comfortable and discreet in the mouth, because no unpleasant friction is caused by the prosthesis as in the case of removable prostheses not fixed by implants. Usually, a prosthesis attached to the upper jaw with implants does not cover the palate, making it less cumbersome, does not interfere with speech and does not alter the taste of food;
  • There is a very low risk of rejection of implants by the human body, because titanium, the most commonly used material for their manufacture, is biocompatible. This results in a very high success rate for the treatment plan;
  • A fixed implant-borne prosthesis is the most permanent, reliable and durable long-term solution for the replacement of one or more teeth. Once osseointegration is complete, implants can remain in the bone for a lifetime;
  • The prosthesis that attaches to the implants can be replaced when it is very damaged, which happens after several years of normal use. The best person to check the condition of your prosthesis is your oral health professional. Replacement requires additional costs, but these are less than those required for implants in the jawbone;
  • The installation of dental implants in the alveolar bone plays a protective role for the bone by slowing down its resorption. In contrast, removable prostheses not attached to implants do not strain the alveolar bone, which gradually resorbs;
  • The use of dental implants distributes chewing forces evenly between the implants and adjacent healthy structures, which helps to reduce stress on these structures and maximize their preservation;
  • The installation of a fixed prosthesis on an implant does not require modifications to the structure of adjacent healthy teeth (e. g. grinding a part of the enamel), as is the case for a traditional bridge not fixed on an implant;
  • The teeth of the prosthesis are completely in harmony with the remaining teeth (partial prosthesis) or the old teeth (complete prosthesis) by the colour and shape given to them;
  • The fixed implant-supported prosthesis is very stable, which means you do not need to use an adhesive (glue) that must sometimes be used with a removable prosthesis;
  • Following your treatment, you are not forced to change your diet permanently, as is often the case with removable prostheses not fixed by implants;
  • Implants and the prosthesis attached to them cannot be affected by tooth decay.

Disadvantages

  • A fixed prosthesis on implants requires a significant investment of money compared to other alternative treatments, such as removable prostheses not fixed to dental implants. However, it is important to keep in mind that it is a good investment in relation to its long lifespan;
  • The time required to complete the treatment plan for a fixed implant-supported prosthesis is much longer than the time required to manufacture a denture or a partial prosthesis not fixed to dental implants;
  • Since a surgical procedure is required for the installation of a fixed prosthesis on an implant, the treatment plan is more invasive than other treatments;
  • Dental implants may be contraindicated for certain patients with particular medical or anatomical conditions;
  • Implant rejection as well as implantitis (an infection of the soft and hard tissues surrounding osteointegrated implants) may occur following implant placement.

Risks and consequences of not treating

  • Unwanted changes in the characteristics of your face, features and chewing function;
  • Irreversible resorption of the jaw bone where one or more teeth are extracted or already missing;
  • Displacement of the remaining teeth if the space left free by missing teeth is not quickly filled by a prosthesis.
  • Bone grafting may be required before implant placement;
  • Dental implants are placed in the jawbone using a technique adapted to the number of teeth to be replaced and the condition of your jaw (see section on dental implants);
  • In the case of an existing prosthesis, it is modified so that it can be worn without impairing the healing of the implants, or a temporary prosthesis is prepared using models taken from your teeth and jaws (if necessary);
  • A six-month period must be respected in order to ensure a complete recovery;
  • Abutments are added to the implants. The new prosthesis is installed or the current prosthesis is modified to suit the implants.

Maintenance

Like natural teeth, dental implants require regular brushing and flossing to remove plaque that causes inflammatory reactions that can affect the integration and longevity of the implants. A regular visit to a dentist’s office (once or twice a year, as recommended by your dentist) for implant cleaning (prophylaxis) and a complete examination is also required to ensure the durability of implants and prostheses.

Cost

Costs vary greatly depending on the technique used, the number of implants required, the type of final prosthesis, etc.

Some of the costs for the manufacture of a fixed prosthesis on an implant may be reimbursed in part or in full by some dental insurance companies.

Restrictions

The most frequent contraindications are:

  • Major allergies;
  • An early age;
  • An organ transplant;
  • An immunosuppressive or autoimmune disease;
  • Osteoporosis;
  • Cancers (those that are in progress or have been treated with certain types of drugs or treatments);
  • Cardiovascular diseases;
  • Smoking, drug and alcohol abuse;
  • Pregnancy;
  • Poorly controlled diabetes;
  • Taking anticoagulants;
  • Some untreated psychiatric problems;
  • Bruxism (teeth grinding);
  • An anatomy unfavourable to implantology;
  • Poor oral hygiene or infection;
  • Some dental malocclusions.

It is therefore important to know your oral and physical health condition and all the diseases that were diagnosed in the past before your initial consultation.

Depending on your medical condition, other treatments may be possible, such as:

  • Removable dentures without implants (complete or partial);
  • Implant-supported removable dentures;
  • Any other solution recommended by your oral health care professional.
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