Whole Jaw Replacement
Whole jaw replacements are for you if you either do not have any teeth on the top or bottom or both, or if you soon will have all the teeth on top, bottom, or both removed. You are lucky if you fall into this category because you have multiple options for replacing your teeth with dental implants, more than anyone else.
Your restoration options include having a complete denture that snaps on and off of dental implants, replace every missing tooth with an individual implant and individual crown, and several options in between. Each of the options available to you will be reviewed with you in a moment. The best option for you will be discussed with your dentist or surgeon at your consultation.
Before turning to dental implant replacements, I will briefly review the non-implant options, traditional dentures or gumming it.
Gumming it is just that, using your gums and not replacing your teeth.
This is an option, but not a good one. It is difficult to chew and speak. It is also unaesthetic and makes you look older. Over time, your jaw muscles will atrophy and your jaw bone will reduce in size. The one benefit of this option is that the deterioration of your jaw bone is slower than it is when wearing traditional dentures.
Traditional dentures are the standard dentures that have not really changed in a hundred years. They are made of acrylic or other plastics.
The top denture stays in place by suction, which depends highly on your jaw shape. The bottom denture stays in place by gravity and muscle control. Most people will use goopy adhesives to help hold the denture in.
There is a wide range of quality of materials that affect the durability and longevity of your denture, however all dentures will eventually wear out over time and all of them accelerate the deterioration of your jaw bone so that eventually they will no longer fit and need to be replaced.
In both cases, bone deterioration happens. The bone of your jaw is there
• to support your teeth. The presence of teeth stimulates the jaw bone and helps to maintain it. When your teeth are no longer present, your body will decide it has better use of the bone materials and takes the bone away for other uses. Dental implants stimulate your bone like teeth, so your bone stays where it is.
Implant consultation and examination
Before having dental implants placed, you will need to have a consultation and examination with your dentist and/or surgeon. If you are already missing teeth, great, some of your healing has already begun.
If you have teeth that need to be removed, then this is done first.
Sometimes your dental implants can be put in on the same day as your teeth come out, sometimes your bone will have to heal first, either because of infection or needing to reshape or add to the bone for ideal implant placement. Whether you have teeth present or not, you may also need some work done to re-shape or improve the health of your gums and bone in the area. These will be discussed with you at your consultation.
At your consultation, expect a visual examination of the area as well as some form of X-ray, often a CBCT scan. The visual exam is to determine the health of your gums and to assess aesthetic and sizing factors for your restoration. The x-rays and/or CBCT scan are used to determine the health of your bone as well as size and angle of placement of your dental implants. Your dentist or surgeon will discuss with you their findings and if you will need to have any other work done in the area, such as adding bone with a bone graft or re-shaping your gums for better aesthetics and cleanliness.
Your consultation will also cover some of the variations about dental implants. Implants in the maxilla, your top jaw, often take longer to heal than implants in the mandible, your lower jaw. Your exact time frames will be reviewed with you. If you still have teeth that need to be removed, sometimes your implants can be placed on the same day as your teeth come out. Sometimes your bone will need to heal first. Sometimes you can have a temporary replacement restoration attached to your implants on the same day as your implants are put in; however, this depends upon your bone health. Sometimes your gums will need to be closed over the implant and restorations done later. Again, these variables will be discussed with you at your consultation where what is best for you will be determined.
Though there are many variables, as every mouth and every patient is different, there are many things that are the same with dental implants being placed. What I have written here is the usual process and I will mention some of the more common variations as they come up.
Dental implant options
Implant retained removable dentures
This option is a denture that snaps on and off of dental implants. The implant retained removable denture gives you much more security than traditional dentures and may allow you to have reduced flanges and less coverage of the roof of your mouth. Flanges are the parts that cover over your gums along the sides of your jaw.
First, a bit of information about dentures. Traditional dentures replace all of the teeth within a jaw, either the maxilla, your top jaw, or the mandible, your bottom jaw. Of course, you can have dentures on both the top and bottom as well.
The similarities between the dental implant retained dentures and traditional dentures is that both are removable, meaning that you take them out to clean the dentures and to clean your mouth. They are both usually made of acrylic or other plastic materials, which do wear out over time in both cases.
The difference between traditional dentures and implant retained dentures is that the implant retained dentures have implants in your jaw and attachments in the denture that help hold them in place, instead of just suction to your gums for the top or gravity for the bottom as it is for traditional dentures. Because of the additional hold, an implant retained denture is much more secure than traditional dentures.
Another difference is that you will need to clean your dental implants.
Some people use these as transitional restoration before moving into a non-removable restoration such as a hybrid bridge, which is covered next. Hybrid bridges
Hybrid bridges are a midway between removable implant retained dentures and full jaw reconstruction with crowns and bridges. You do not take the hybrid bridge out; however, a dentist can remove it when needed.
For you, it is a large bridge that goes around the whole jaw, replacing all of the teeth in that jaw.
Why would a hybrid need to be removed? There are several reasons.
One, the most common, is for cleaning of your implants, especially if you are having difficulty maintaining them yourself and have started to develop perimplantitis, which will be reviewed further on in the section on cleaning and maintenance. Another reason would be repairs or sometimes replacement of worn teeth, dependent upon the materials used to make the hybrid bridge.
Hybrid bridge prostheses can be made of several materials, and which option is right for you will best be discussed with your dentist, this is just an overview of the options available.
The first option is all acrylic with attachment ports that are usually metal and filled with either acrylic or composite resin once it is in place.
This option is usually used as a long term temporary restoration while you are healing, especially when this restoration is put in the same day as your implants are put in. It has the advantage of being highly modifiable and easily repaired, however, it is not as strong as the other options and will wear out faster and can break easier.
The second option is acrylic denture teeth and gums attached to and surrounding a metal bar framework. The bar provides additional strength for the restoration while the acrylic teeth and gums provide ease of repair or replacement. While the bar gives much more strength, the acrylic teeth can eventually wear down and need to be replaced.
How long this takes depends upon what you do with your teeth; eating abrasive foods and
grinding/clenching your teeth will cause faster wear, just like they do to natural teeth. The bar acrylic combination also requires a larger amount of space between your jaw and the biting surface of the opposite jaw, so it is a better option for people who have already had bone loss, either from periodontal disease of from having worn a denture for a significant amount of time. Otherwise, some of your jaw bone will need to be reshaped in order to allow room for your hybrid bridge.
The third option is much more like a very large bridge on natural teeth, being made out of the same materials as crowns and bridges for natural teeth. This is either porcelain fused to a metal framework or some of the porcelain/ceramic options such as Zirconia. These are the strongest of the hybrid bridge options; however, repairs to these are a bit more difficult. These have the same wear rate as crowns on natural teeth, so much longer lasting than acrylic teeth options. Being the strongest of the hybrids, they also require the least space for a hybrid between your jaw and the biting surface opposite it, which reduces the need to remove bone to allow your restoration to be placed.