Lower Jaw Treatment Options
Posted on 7/24/2023 by Greg Kammeyer
|When a patient is going to lose or has lost there lower teeth, there are 3 basic treatment options. A 2 implant “clip on” overdenture, a bar over denture or fixed teeth (All on 4 or All on X). I’ll review the pros and cons of each.
2 implant overdenture: The advantages: This method requires the least surgery, is the cheapest and the simplest. Often a beginner at implant surgery will favor this choice. My favorite things about it is that if it doesn’t satisfy the patient, it can be upgraded and it is easy to clean the implants and it is much better than a lower denture and for many people, an affordable option. The disadvantages: Much like a denture, food gets caught under it causing pain when chewing, it still promotes bone loss in the back of the mouth, the maintenance is usually high (especially with plastic teeth) as there is a lot of pressure at the implant sites, as the attachments wear out and need replacement yearly on an average. Patients report it is only about 30% as good as natural teeth. For many having removable teeth is also not desired. 4 implants can also be used with this method to overcome some of these disadvantages. These teeth are very bulky, since they are a denture.
4 Implant Bar Overdenture: The advantages: Like the 2 implant overdenture, 4 implants can support a denture yet when they are connected by a bar underneath the denture, they put the stress of chewing on the bone much like teeth do. Patients say this is 65-75% as good as natural teeth. They are easy to clean the implants and no bone is lost from the pressure of a denture biting on the tissue. These can be made to feel like fixed teeth and are less bulky than a traditional denture. The disadvantages are: This takes more skill to make than the 2 implant overdenture and as well, takes planning, and a number of dental visits. The attachments wear out and need replacement yearly on an average and as well, if the teeth are plastic they will require maintenance. Very little food gets underneath this overdenture, yet it isn’t bothersome when you chew. These teeth are a significant investment and close to the cost of Fixed All-on-4 teeth.
Fixed Teeth: All-on-4 or All-on-X
The advantages: At the day of surgery, you walk out with trial fixed teeth and a brand new smile! Like implants used anywhere, the bone work hardens around the implants as well as the jaw bone gets thicker and bigger. The temporary and final teeth are fixed in place, removable only by a dentist. The bone support allows you to chew whatever you want, if they are made of a tough material. The first set of temporary teeth, installed at implant placement surgery gives both the dentist and the patient a “trial run” to be sure each implant takes, you can verify the esthetics of your smile and see how well you can chew. In the lower jaw, a patient can start with a 2 implant overdenture and upgrade to these fixed teeth over time. This is often done to spread out the cost. Many times too, if a patient decides to have the teeth be removable before the final teeth are made, the plan can be changed as well. These teeth are bigger than natural teeth yet smaller than the above choices. Overall, these patients have a very high satisfaction rate: 89-94% as they report being able to chew 80-90% as well as natural teeth.
The disadvantages: Food collects under the teeth and this is the most common complaint when people have these full arch fixed teeth. Between the implants the bone is not stimulated over the years and it shrinks, so food collects under the teeth. Sometimes this food collection can be corrected, again depending on what material is used for the teeth. These full arch teeth are bulky: twice the size of the original teeth. Further during the surgery, we have to remove more bone to accommodate the dental materials for the teeth. This type of treatment is best performed by a surgeon and a restorative dentist that do it often enough to get good at it. This treatment method takes skill, planning, and are a significant investment, taking as many visits as a bar overdenture. Most people that are good candidates for this treatment are grateful for the quality of life changes that it provides.
I especially enjoy helping people move away from dentures. If you, a friend or a loved one wants an expert opinion about implant dentistry, feel free to call Danielle and ask for a FREE examination: our gift to you that you can pass on. Yours for better health,
Greg Kammeyer, DDS, MS, DABOI
Board Certified in Implant Dentistry