Removable dentures or dental implants? – Jonathan Fleet

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  Posted by: The Probe      3rd May 2018

Despite recent advances in dental care, edentulism remains a global problem.[1] There are many possible reasons for this, including the aging population, socio-economic factors and general attitudes towards dental care. There are only two viable treatment options for fully edentulous patients – removable dentures or an implant-retained prosthesis.

Both of these treatments have their advantages and shortcomings and can benefit patients in different ways depending on what they feel most comfortable with and their lifestyle habits.

What problems do edentate patients face?

Edentulism causes many complications that can have a negative impact on a patient’s life. Due to the esthetic problems associated with edentulism, the condition has a significant effect on patients’ sense of self worth and has even been associated with depression in younger age groups.[2]

There are functional issues for edentulous patients as well, as a lack of teeth can restrict what food they can eat. Edentulous individuals will often avoid food that is difficult to chew such as fruit and vegetables, which can lead to further problems such as a poor quality of diet.[3] These issues go to show that providing functional, esthetic solutions to edentulous patients should be of primary concern when exploring treatment options.

 

Treatment longevity 

Both removable dentures and dental implants can provide a long-lasting solution for edentulous patients. However, due to the different natures of their application, their lifespans are difficult to compare.

Removable prostheses experience wear and tear over time, meaning that they have to be replaced. Due to this gradual wear it’s generally considered that complete dentures will last between 5-10 years.[4] However, factors such as bone resorption may create a loss of retention at any point during the treatment lifetime, which can cause dentures to become loose and poorly fitting.[5] In these cases it’s likely to be best to replace the denture to return the patient to normal function.

Due to the relative newness of dental implants compared to dentures, studies that assess the full lifespan of implants are few and far between, especially as follow up studies tend to concentrate on only 5 year or 10 year focus periods. However, one study that assessed loaded implant survival rates among a group of patients after 15 years found the survival rate to be 95.2%,[6] implying that, in most cases, dental implants can offer a long lasting solution. Guidelines also suggest that good maintenance and regular check ups throughout the duration of their lifetime make implants more likely to last longer, especially when patients adhere to care instructions given to them at the time of implant surgery and follow suggestions to reduce the chance of infections such as peri-implantitis.[7]

However, it must be remembered that replacing implants could be significantly more difficult than the making of a new removable prosthesis, so this should be considered when explaining treatment longevity to patients.

 

Risks for patients

Regular wear of dentures can cause a number of problems for patients over time. Perhaps the most troubling of these is the bone resorption that occurs once teeth are extracted or fall out. Research has shown that patients who wear complete dentures experience enhanced alveolar ridge resorption, resulting in significant bone loss.[8] This can lead to dentures needing to be refitted.

Another common problem is denture stomatitis – an uncomfortable, thrush-like infection that affects the mucosal layer. One study found that up to 25 – 67% of denture wearers experienced this condition.[9] Furthermore, wearing dentures can cause all manner of oral lesions that are sore and unpleasant, [10] making continued wear an uncomfortable experience.

One risk associated with dental implant surgery is that of peri-implantitis.[11] The condition presents a serious problem as areas affected with the disease can experience bone loss, which, in the worst-case scenario, can result in the failure of the implant(s).[12] Research suggests that there are certain factors that can increase the risk of peri-implantitis occurring, including whether the patient is a smoker, whether they’ve had a history of periodontitis and their general oral hygiene.12 One piece of research that compared various studies on peri-implantitis found that rates of infection varied between 5.4% and 11.4%.11

This shows that patient lifestyles should be considered when treatment planning for edentulous patients.

 

Functionality

 

Well-fitting dentures can restore bite force and chewing functionality to the patient. However, without the use of a good denture adhesive, research has found that only weak bite forces can be withstood and this can restrict what denture wearers eat while also effecting their masticatory abilities.[13] This could lead to issues with malnutrition. Furthermore, even with adhesive, removable dentures can be prone to movement and can even fall out during function, making them an unreliable solution in some cases.

On the other hand, implant-supported bridges are especially effective for fully edentulous patients. Offering high stability, they have been found to quickly restore functionality, helping patients to experience a normal lifestyle, fast.[14]

A trusted treatment for edentate patients, the All-on-4® treatment concept from Nobel Biocare is such a solution. A fast way to return function and provide high quality esthetics, the concept also has proven high implant survival rates[15] meaning it will return patients to a higher standard of life for the long-term.

 

Always give options

Every fully edentulous patient is different and will have different needs. By taking the time to discuss their lifestyle, their preferences and their questions about both treatments you can help them make the right decision between dental implants and complete dentures.

 

For more information, contact Nobel Biocare on 0208 756 3300, or visit www.nobelbiocare.com

 

 

 

 

[1] Emami, E., Souza, R., Kabawat. M., Feine, J. The Impact of Edentulism on General Oral Health. International Journal of Dentistry 2013; 2013: 7.

[2] Tyrovolas, S., Koyanagi, A., Panagiotakos, D., Haro, J. Kassebaum, N., Chrepa, V., Kotsakis, G. Population Prevalence of Edentulism and its Association with Depression and Self-Rated Health. Scientific Reports 2016; 6: 37083.

[3] Savoca, R., Arcury, T., Leng, X., Chen, H., Bell, R., Anderson, A., Kohrman, T., Gilbert, G., Quandt, S. Impact of Denture Usage Patterns on Dietary Quality and Food avoidance Among Older Adults. J Nutr Gerontol Geriatr 2011; 30(1): 86–102.

[4] Schwass, D., Lyons, K., Purton, D. How Long Will it Last? The Expected Longevity of Prosthodontic and Restorative Treatment. New Zealand Dental Journal 2013; 109(3): 98-105.

[5] Bilhan, H., Erdogan, O., Ergin, S., Celik, M., Ates, G., Geckili, O. Complication Rates and Patient Satisfaction with Removable Dentures. J Adv Prosthodont 2012; 4: 109-15.

[6] Song, S., Lee, J., Um, H., Chang, B. Factors Affecting the Survival of Implants: A Long-Term Retrospective Study. J Dent Rehabil Appli Sci 2015; 31(1): 10-19.

[7] Ucer, C., Wright, S., Scher, E. West, N., Retzepi, M., Simpson, S., Slade, K., Donos, N. ADI Guidelines: On Peri-Implant Monitoring and Maintenance. Link: https://www.dentinaltubules.com/sites/default/files/upload/attachments/ADI%20-%20implant%20monitoring%20%26%20maintenance.pdf [Last Accessed March18].

[8] Knezovie-Zlatarie, D., Celebic, A., Lazic, B. Resorptive Changes of Maxillary and Mandibular Bone Structures in Removable Denture Wearers. Acta Stomat Croat 2002; 261-265.

[9] Naik, A., Pai, R. A Study of Factors Contributing to Denture Stomatitis in a North Indian Community. International Journal of Dentistry 2011; 2011: 589064.

[10] Mubarak, S., Hmud, A., Chandrasekharan, S., Ali, A. Prevalence of Denture-Related Oral Lesions Among Patients Attending College of Dentistry, University of Dammam: A Clinico-Pathological Study. Journal of International Society of Preventive & Community Dentistry 2015; 5(6): 506-512.

[11] Valente, N., Andreana, S. Peri-implant Disease: What We Know and What We Need to Know. Journal of Periodontal and Implant Science 2016; 46(3): 136-151.

[12] Prathapachandran, J., Suresh, N., Management of Peri-implantitis. Dental Research Journal 2012; 9(5): 516-521.

[13] Tarib, N., Bakar, M., Murat, M., Ahmad, M., Kamarudin, K. Masticatory Efficacy and Bite Force in Complete Dentures: A Study of Denture Adhesive. Hong Kong Dentistry Journal 2010; 7: 67-73.

[14] Weinstein, R., Agliardi, E., Fabbro, MD., Romeo, D., Francetti, L. Immediate Rehabilitation of the Extremely Atrophic Mandible With Fixed Full-Prosthesis Supported by Four Implants. Clinical Implant dentistry and Related Research 2012; 14:434-441.

[15] Malo, P., de Aroujo Nobre, M., Lopes, A., Moss, S., Molina, G. A Longitudinal Study of the Survival of All-on-4 Implants in the Mandible With Up to 10 Years of Follow Up. J Am Dent Assoc 2011; 142: 310-320.


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