Full Arch Implant Restoration Options

Raymond E La Vigne, DDS Palatine, IL

This article will describe the range of possible treatment options when all teeth within an arch (upper or lower) are missing already or need to be extracted.

• Full Denture
• Full Denture retained by 2 or more remaining teeth - over denture
• Full Denture retained by 2 or more Mini Implants
• Full Denture retained by 2 or more Standard Implants with Bars attached
• Full Denture screwed down to multiple Implants
• Long Span Fixed Bridge cemented or screwed onto multiple Implants

Full Denture

Supported entirely by resting upon the ridge bone and palate in the case of uppers
Retained by fitting into undercut areas
Least costly investment initially - do require relines recommended about every year at the start then about every three years on the average
Teeth wear, bone resorbs so that a new denture is typically needed after every 5 years
May require adhesive paste to provide additional retention initially for major chewing and later for all eating and speaking
Ridge bone continues to be lost due to two reasons:
Atrophy - lack of use since no more tooth roots embedded in bone
Resorption - forces upon bone as denture shifts during chewing causes stress
This is magnified and accelerated the longer the denture is worn without relining and the more unbalanced the bite is from the start (over bite, irregularities) or has become due to uneven wear of the teeth (especially a problem when various teeth oppose the denture - some natural enamel, some porcelain, various types of filling materials)
Dentures must be made and maintained in harmony with the surrounding muscles.
The tongue is an especially important factor in having success with lower dentures
Denture can be made to be attractive and natural looking
When initially fitted dentures allow about 25% of the chewing force possible with strong full set of natural teeth
Undercuts give dentures retention but also can be a source of sore spots

Over- denture

Two or more teeth with reasonably healthy bone and gum tissue can be saved so that a denture can be retained over them - The denture is still completely supported by resting on the gums and underlying bone The remaining teeth provide retention only.
Saving teeth also saves bone thus avoiding even more atrophy - the bone stays around the roots as long as forces are normal
The denture can be retained by a variety of options: silicone rubber, O- Rings or "snap "attachments, Clips on a bar.
Teeth saved must be in good condition and must be maintained by good home care and professional cleanings in order to make this feasible.

Attachments work well when there are poor existing undercut areas and / or very strong muscles wanting to dislodge the denture.
The forces used when chewing should still be within the 25 - 35% range. Care should be used in type of food and force used so that the attachments and remaining tooth roots are not overloaded. A night time retainer or second denture is often made to prevent clenching upon the attachments while sleeping.

Full Denture with Mini Implants

Denture is supported by the gums and bone Implants provide retention typically by silicone rubber or attachments like a snap.
The Mini Implants help prevent further atrophy of the ridge bone sine the implant acts similar to a tooth root
Mini Implants are great when teeth are not available, are in poor condition, or are poorly spaced for proper balance and stability.

Mini Implants are usually one piece - that is implant and abutment all in one Mini Implants are indicated in the lower front area due to their size and the type of bone density found in this area - which is typically the densest bone in the mouth In some cases the denture can be fit to be retained by the implants in the same appointment due to the dense bone allowing for immediate stability

Full Denture Supported and Retained by Standard Implants and Bars
Four or more standard size implants are strategically placed and joined by bars that are screwed down to the implants forming a frame. The denture has retention clips that fit over the bar usually in 2 - 4 places. In this case the denture rests upon the bar and is passive to the gum and bone tissues.

Dentures supported by bars can typically allow 50 - 60 % of maximum chewing force (based on natural teeth) Dentures are removed for cleaning. Implants and bars require cleaning with brush and floss with moderate effort needed. As with any Implant, professional exam and cleaning are recommended every 6 months and in some cases every 3-4.

Fixed Denture - Denture screwed down onto multiple Implants
Four or more standard size implants are placed and joined by bars similar to the above clip on but removable denture over bars. In this case, however, the denture is screwed onto the bar and not removable by the patient. These appliances allow 60 - 80% of maximum chewing ability. Since they can not be removed for cleaning after each meal, the denture borders are raised off the gum tissue enough to allow floss to pass under the base. Also frequent brisk rinsing and use of an irrigator such as a "Water-Pik" are highly recommended for cleaning several times each day.

The bar under-structure is similar to the previous over denture however the denture is not removable by the patient since it is screwed down to the bars.

Fixed Bridge / Crowns Cemented or screwed onto 6 - 10 Implants
Multiple single crowns allow best appearance and easiest flossing.
Implants can also be abutments for several bridge sections or one long span bridge for the entire arch.
These restorations allow maximum cosmetic appearance since the crowns are made from porcelain which has natural translucency, many shades are available and shades can be custom blended.

These restorations are the strongest and can deliver 80 - 90% chewing force. Excellent daily home care is needed just like when a patient has many remaining natural teeth heavily restored by crowns or bridges. That means flossing between the implants.

Implants help maintain jaw bone since they give the bone a purpose - the bone in use with normal amount of force stays healthy - similar to exercising for muscles and joints.

In many cases a patient wears a partial or full denture as a temporary when they ultimately plan to have implants as their long term tooth replacement. Having good fitting and nice appearing partial or full dentures prevents further damage to remaining teeth and also protects implants as they heal within the bone. Having a good partial or full denture and also a dentist who knows how to customize and modify them, can be a great advantage when a patient desires implants but will need a year or even much longer before completion.