The Hybrid Denture on Long Island

Suppose you had lost all of your upper or lower teeth. What are the options?

1. The simplest, least costly but most prone to problems, is the conventional denture.

2. An improvement is the overdenture in which the denture snaps into two or more implant attachments. See my blog entry and video of  April 14, 2015.

3. Even better is the hybrid denture. For the hybrid denture, several implants, (typically six) are placed in the arch.  A prosthesis that is screwed into the implants is constructed. It is a fixed prosthesis as far as the patient is concerned, but the dentist can remove it for maintenance.  Thus we call it a hybrid, or fixed/removable.

     The hybrid is a wonderful service. The teeth function like natural teeth. However the hybrid and surrounding tissues need to be kept clean.  Calculus and plaque can lead to gingival inflammation and peri-implantitis with eventual loss of the implants. I instruct the patient to use a water pic from outside and inside, as well as running floss under the hybrid denture and use of an end tufted toothbrush.  The patient also needs to return to the office at six month intervals so we can professionally clean the hybrid and remove it as necessary.  The acrylic teeth can also chip or fracture. We supply a temporary hybrid so the patient can wear this if the denture needs to be repaired. Acrylic teeth may have to be repaired in five to seven years. If the hybrid opposes natural teeth, we may also make a night guard to protect the hybrid from breakage.

     Alan had upper and lower hybrids that were made seven years ago in another office. The teeth had chipped and they were heavily stained as well as being a vehicle for heavy calculus and plaque.  I removed the hybrids and constructed new ones.  This took several visits but look how wonderful he looks now!  He is more comfortable and can function better too. He promises to return regularly.  He went back to Florida for the winter, his spare hybrids in hand.

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New hybrids

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It is a truth universally acknowledged (thank you Jane Austin) that a lower denture is difficult to stabilize and difficult for the individual to wear comfortably.  In my office I work hard to provide a lower denture that fits well, functions well and is comfortable. But if a person has excessive bone loss or strong musculature, the lower denture may be a problem.  Today the standard of care for a person without lower teeth is really the implant overdenture.  Minimally we place two implants in the lower jaw, let them integrate with the bone for several months, then attach what are called Locators. A housing is then added to the denture base that snaps into the Locators. Since the denture snaps into the Locators, the denture is very stable. It takes some strength to remove! No more wobbly lower denture, no more denture adhesive!

I always discuss the advantages of the overdenture and let the patient make the decision. The implants do add to the cost of the denture service. Sometimes people elect to try to wear the denture and add the implants later, if needed. Often cost is a factor. But when we do add the implants, the “wow” factor is amazing. People love the overdenture and it is a life-changer.

Betty had been wearing dentures for many years and had significant bone loss. She was ready for an overdenture. She had bone grafts, then healing, then placement of the implants, then more healing until we placed the Locators and housing. She is thrilled. For the first time, she has a comfortable, secure lower denture.  Listen to what Betty has to say about her overdenture on our youtube channel.

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A model of four implants on the lower jaw showing how a denture fits over the implants.

It always strikes me that people never seem to be as concerned about losing a back tooth as they are about losing a front tooth. But back teeth also count!!  You need your back teeth so you can chew properly. Back teeth also protect the front teeth, and they help to maintain your facial structure. If even one back tooth is missing, the adjacent teeth will drift to close the space; they may loosen and a pocket of infection may form. The opposing teeth may erupt into the open space. Your bite will start to collapse. The front teeth will begin to splay forward.

The following patient was missing all of her back teeth. She was putting a lot of stress on her front teeth because she didn’t have back teeth for chewing. The front teeth were beginning to splay forward. She elected to have implants placed. We placed four implants on the top and two on the bottom and gave her new front crowns – a great result and a very happy patient:

Posterior Implants Picture

 

The following patient lost her lower back teeth, and consequently the top teeth have super-erupted into the space. This weakens the top teeth and they become susceptible to loss. We did some periodontal crown lengthening and placed five crowns on the top teeth in order to restore them to their proper position. Four implants were also placed on the bottom and will soon be uncovered so implant crowns can be placed:

Posterior Implants before and after picture

Ray spent several years in the military. He was sent overseas, but before he left, the army surgeons removed all of his remaining teeth. His teeth were in poor condition but the military did not make dentures for him.  So for two years Ray had to function without any teeth at all. This means that he chewed on his gums.  This destroys the gums and resorbs the bone and makes it very difficult to make dentures that will stay in place.  But using my custom denture technique I made him dentures that are as good as they can be. We will add two implants on the top and two on the bottom for the dentures to snap into – giving him a more secure fit.  He is happy to be able to smile again.

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Teeth!

I first met Nancy almost a year ago.  Her front teeth badly needed help.  One front tooth had discolored composite fillings and a fracture.  The other front tooth was short and tipped inward. We extracted the fractured tooth and placed an implant.  After the healing period we placed an abutment (implant post) and porcelain crown.  We restored the other tooth with a porcelain veneer.  Both teeth are now whiter and more evenly situated.  Nancy looks years younger and she just keeps smiling.  She brought us early vegetables from her Selden garden as a thank you.

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What is the greatest concern of the prospective denture wearer?  “I don’t want to have to take my teeth out at night.”  People still have childhood memories of grandma’s teeth floating in a glass by the bedside.  But rest assured – you don’t have to remove your dentures at night.  Well-made dentures today are quite unlike those bulky, loose dentures that your grandmother wore.  The processing is more high-tech.  Custom dentures fit much, much better and look very natural.

Dentures can remain in the mouth overnight.  Just take them out to clean and a short soak in a denture cleanser.  We have many patients whose spouses don’t know that they have lost their teeth and that they wear dentures.  Sure, implants are great and they don’t come out at all – but they are not for everyone.  We still see lots of dentures – their death is greatly exaggerated.

Check out our dentures.  Check out our implants.

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Always looking to keep up with new developments in dentistry, I took two continuing education courses this week.

Wednesday night was a lecture on how periodontal therapy can enhance orthodontic results.  That gummy smile in which too much gum tissue is exposed when the patient smiles can be eliminated with periodontal treatment.  An impacted tooth can be coaxed into position with proper periodontal access.

On Friday I took an all-day course on “All on Four,” in which implants are placed and teeth affixed the same day, thus eliminating a removable denture when all of a patient’s teeth need to be extracted.  This is an amazing service for people who qualify for this treatment.

Recently a woman came into my office with an upper bridge that was failing.  Her teeth could not be salvaged.  But she did not want her husband to know that she was going to lose her teeth.  So we scheduled her for teeth-in-a-day: her teeth were removed, implants placed and a provisional fixed bridge placed.  She looks great and her husband never found out that instead of her own, failing teeth, she now has implants!

No one likes an unsightly gap.  But what are your options?

The gold standard to replace a missing tooth is the osseointegrated implant on which is attached an implant crown.  The implant crown looks and feels like a natural tooth.  But because implants require surgery, the implant patient must be in good health and have adequate bone to support the implant. This service is also the most costly.

The second option is the fixed bridge.  Here, teeth on either side of the missing tooth are covered with crowns to which an artificial tooth is connected.  The bridge is then cemented in place.  Disadvantages are that the teeth on either side of the missing tooth have to be reduced to accommodate the crowns and three or more teeth are now connected, making it difficult to clean underneath and a potential food trap.

The third choice is the removable partial denture. As it is removable, the partial denture is less natural than the implant or fixed bridge.   The partial denture takes getting used to, it may feel bulky and you may not be able to chew as you would with natural teeth.  The advantage is the relative simplicity of the procedure and lower cost.

You may not be a candidate for the implant, the fixed bridge or the removable partial denture.  A dentist can best evaluate which options are suitable for a given clinical situation.  It is important to replace missing teeth because other teeth will drift into the gap and the entire dentition may be compromised.  For more information on replacing missing teeth, call our Long Island dental office for a free consult.

Jim came to my dental office one day in September embarrassed to admit that he had just four remaining upper teeth.  The teeth were black with decay and loose from gum disease.  He knew he needed dentures (implants were not an option due to financial considerations), but he did not want his teeth extracted and to have to go home without teeth.  But have no fear – we do not let patients leave the office without teeth!  The solution is the immediate denture.

The immediate denture is a denture that a patient goes home with on the day of extractions so he/she is never without teeth.  The procedure is as follows:  Before we do any extractions, we take impressions and measurements for the immediate dentures.  The models are sent to our laboratory, Lord Dental Laboratory in De Pere, Wisconsin (a denture specialty lab and one of the best in the country).  The laboratory constructs the immediate dentures according to our specifications.  Once the dentures are fabricated and back in our office, we schedule an appointment for the extractions (either with myself or with an oral surgeon).  If necessary, we coordinate the appointment with the oral surgeon so we are ready to insert the denture as soon as the extractions are accomplished.

Before inserting the denture, we apply a soft tissue liner called PermaSoft to the inside of the denture.  This is a wonderful material that molds to the gums and helps in the healing process. Over the next few months, while the gums and bone heal, there will be some shrinkage of the tissues.  The denture may loosen over this time, but we reapply the soft tissue liner so the denture will fit better and be comfortable.  This may take several visits.  We are happy to see you as many times as necessary.

After several months, the bone is more stable, and at that time we make a new denture that looks great, feels great, and functions well! One of the most gratifying services that I provide for my dental patients is the immediate denture.  The results are so dramatic.  The patient comes in with a few straggly teeth and walks out with a full set of natural looking teeth. What could be better than that!

 

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Today’s knowledgeable dental patients often know that excellent cosmetic dentistry is a partnership between the dentist and the dental ceramist.  The ceramist who fabricates my porcelain tooth veneers and crowns is Peter Kouvaris.  Peter has been a ceramic artist for more than 20 years.  He was the Cosmetic Designer at the JK Dental Laboratory and recently opened his own dental studio in New York City: Peter Kouvaris Dental Studio.

Peter is a member of the prestigious Oral Design International, a group of dental ceramists who have studied under Master Willi Geller.  Willi Geller resides in Switzerland and is considered to be the world’s leading dental ceramist.  He was one of the first ceramists who realized that teeth reflect and refract light like prisms because of layers of tooth dentin and enamel.  He invented a buildup technique which involves layering different density of porcelain in different colors and degrees of translucence. His method is used by a highly trained and talented group of 80 ceramists and is used to create beautiful, life-like veneers, crowns and implant crowns.  Peter Kouvaris is one of Willi Geller’s proteges.

Not every dentist can or will work with an oral design ceramist.  The dentist needs to have advanced training and needs to work at a higher level and with increased attention to detail.  Excellent cosmetic dentistry is a collaboration between the cosmetic dentist and the dental ceramist.