What are dentures

Dentures are removable false teeth that are worn to replace missing teeth. If you have missing teeth, wearing dentures can make eating, chewing and speaking easier rather than just replacing missing teeth. Dentures can also avoid a loss of confidence in the way you look. Muscles in the face will sag without teeth, making you look older and dentures can help fill out a person’s face and profile. Dentures can be made to closely resemble your natural teeth so that your appearance does not change much. Dentures may even improve the look of your smile. Most people take a few months to adjust to wearing a new set of dentures.

They help with chewing and eliminate potential problems caused by gaps. You should remove your dentures at least once a day to clean them.

Dentures can be made of:

• Acrylic resin – polymethyl methacrylate (PMMA)
• Metal
• A combination of acrylic and metal
• Nylon-like material commonly used in flexible dentures ¹

If you’re having your teeth removed, you might choose to have dentures inserted on the same day. This is called an immediate denture. Your dentist will take measurements and make models of your jaw during a preliminary visit. You don’t have to be without teeth during the healing period, but may need to have the denture relined or remade after your jaw and gums have healed.

Your dentist might ask you if you would wait a few months before getting dentures. This allows your gums to heal so you won’t need as much adjustment once the dentures are in place. This is called an conventional denture.

Overdenture – sometimes some of your teeth can be saved to preserve your jawbone and provide stability and support for the denture. An overdenture fits over a small number of remaining natural teeth after they have been prepared by your dentist. Implants (implant-retained denture) can serve the same function, too.

“Permanent dentures” is deceptive and misleading because permanent dentures are retained by screws or dental cement onto dental implants and cannot be removed by a patient; they can only be removed by your prosthodontist. Eventually even these “permanent dentures” may wear or break or become stained and discolored and will require replacement. Typically, soreness should be resolved within two weeks; if it persists, likely something in the denture needs to be adjusted. You should see your prosthodontist as soon as possible.

Wearing dentures might feel strange at first. Most people take a few months to get used to how they feel. The dentures may feel loose while the muscles of your cheek and tongue learn to keep them in place. It is not unusual to experience minor irritation or soreness. You may find that saliva flow temporarily increases. As your mouth becomes accustomed to the dentures, these problems should go away. At first, you might need follow-up appointments so the dentist can make adjustments. After you have become used to the dentures, you’ll still need an appointment with your dentist, at least yearly, to check they fit correctly. If any problem persists, particularly irritation or soreness, be sure to consult your dentist.

You’ll need to learn how to take care of your dentures daily. The American College Prosthodontists recommends brushing your dentures nightly with regular hand soap and lukewarm water, using a soft-bristle toothbrush.

You should also brush your gums and tongue each day with a soft-bristle toothbrush, with or without toothpaste. It’s also a good idea to rinse your mouth with salty water.

Like your teeth, your dentures should be brushed daily to remove food particles and plaque. Brushing also can help keep the teeth from staining.

• Rinse your dentures before brushing to remove any loose food or debris.
• Use a soft bristle toothbrush and mild soap and water or a special denture cleaner (a non-abrasive cleanser available from most supermarkets or pharmacies) to gently brush all the surfaces of the dentures so they don’t get scratched. Standard toothpaste is NOT recommended.
• If your denture gets a build-up of tartar on it, try soaking it in a mixture of 1-part white vinegar and 4-parts water, or ask your dentist to polish it for you.
  Remove your dentures while you sleep to allow your gums to rest.
• When brushing, clean your mouth thoroughly—including your gums, cheeks, roof of your mouth and tongue to remove any plaque. This can help reduce the risk of oral irritation and bad breath.
• When you’re not wearing your dentures, put them in a safe place covered in water to keep them from warping. If they do become dry, soak them in water before putting them in your mouth.
• Occasionally, denture wearers may use adhesives. Adhesives come in many forms: creams, powders, pads/wafers, strips or liquids. If you use one of these products, read the instructions, and use them exactly as directed. Your dentist can recommend appropriate cleansers and adhesives; look for products with the American Dental Association Seal of Acceptance. Products with the American Dental Association Seal have been evaluated for safety and effectiveness.
• Always fit your dentures correctly to stop them from moving around in your mouth. If they do not fit you properly, visit your dentist. Never use force to get your dentures in or out.
• If you are in pain, get advice on pain relief medicines you can take.
• If you smoke, try to cut down or quit.

If you have any questions about your dentures, or if they stop fitting well or become damaged, contact your dentist or prosthodontist. Be sure to schedule regular dental checkups, too. The dentist/prosthodontist will examine your mouth to see if your dentures continue to fit properly.

When might you need dentures?

If you have missing teeth, your dentist might speak to you about getting dentures fitted. Dentures are specially made to fit your mouth.

Eating with dentures

When you first start wearing dentures, you should eat soft foods cut into small pieces and chew slowly, using both sides of your mouth.

Avoid chewing gum and any food that’s sticky, hard or has sharp edges.

You can gradually start to eat other types of food until you’re back to your old diet. Never use toothpicks.

Dental hygiene

Keeping your mouth clean is just as important when you wear dentures. You should brush your remaining teeth, gums and tongue every morning and evening with fluoride toothpaste to prevent tooth decay, gum disease and other dental problems.

Denture adhesive

If your dentures fit properly, you shouldn’t necessarily need to use denture fixative (adhesive). However, if your jawbone has shrunk significantly, adhesive may be the only way to help retain your dentures. Your dentist or clinical dental technician will advise you if this is the case.

At first, some people feel more confident with their dentures if they use adhesive. Follow the manufacturer’s instructions and avoid using excessive amounts.

Adhesive can be removed from the denture by brushing with soap and water. Remnants of adhesive left in the mouth may need to be removed with some damp kitchen roll or a clean damp flannel.

When to see your dentist

You should continue to see your dentist regularly if you have dentures (even if you have complete dentures) so they can check for any problems.

Your dentures should last several years if you take good care of them. However, your gums and jawbone will eventually shrink, which means the dentures may not fit as well as they used to and can become loose, or they may become worn.

See your dentist as soon as possible if:

• your dentures click when you’re talking
• your dentures tend to slip, or you feel they no longer fit properly
• your dentures feel uncomfortable
• your dentures are visibly worn
• you have signs of gum disease or tooth decay, such as bleeding gums or bad breath

If poorly fitting or worn dentures aren’t replaced, they can cause great discomfort and lead to mouth sores, infections or problems eating and speaking.

Types of dentures

Dentures may replace all or only some of the teeth. The dentures that replace all the teeth are known as complete dentures and they rest on the gums that cover the jawbones. The stability and retention of these dentures can be improved by attaching them to dental implants. Dentures that replace some but not all of the teeth are known as partial dentures. They attach to the teeth that are still present and also cover and rest on the gums and bone where the teeth are missing. Dental implants can also be used to restore and stabilize partial dentures as well.

There are three main types of dentures:

1. A full denture: Replacing all your natural teeth, full dentures rest on your upper or lower jaws or both, providing support to your face and giving it a natural, more “filled-in” look.
2. A partial denture for patients missing several teeth, but not all of their teeth, a removable partial denture may be recommended. This type of denture uses the remaining teeth to hold or anchor the removable bridge in place. A partial denture is held in place by clasps around your remaining teeth.
3. An implant-retained denture replaces one or more teeth and is fitted through implants in your jaw.

Dentures are customised by your dentist or prosthodontist to fit your mouth to prevent them from being the cause of bleeding gums, swelling, and ulcers; however, even the best made dentures will feel a little irritating at first as you adjust to how they feel in your mouth. You may need to return to your clinician for minor adjustments.

If you’re having teeth removed and need a denture, your dentist/prosthodontist may suggest waiting a few months after the teeth have been removed so that your gums can heal and the need for adjustment is minimized. However, if you need a denture immediately after a tooth is removed and it is fitted during the same visit (an ‘immediate’ denture), then more frequent adjustment may be necessary.

Even when your dentures are comfortably in place, it’s still important to see your dentist regularly so they can make sure they are fitting you correctly and remain beneficial to your oral health. A yearly check-up, which involves monitoring of cheek, tongue, gums and palate, and screening for oral cancer, is usually all that’s required.

Figure 1. Full dentures

Figure 2. Types of full dentures

Removable Partial Dentures

Typically, a removable partial denture is made of a metal framework with pink plastic to replace the gum tissue and plastic or resin denture teeth. The number of missing teeth and their location will affect the comfort and stability of the removable partial denture. The use of dental implants may increase the stability of a removable partial denture, or dental implants may be the best solution for replacing the missing teeth.

Figure 3. Partial dentures

Figure 4. Types of partial dentures

How dentures are fitted

Complete dentures

A full denture will be fitted if all your upper or lower teeth need to be removed or you’re having an old complete denture replaced.

The denture will usually be fitted as soon as your teeth are removed, which means you won’t be without teeth. The denture will fit snugly over your gums and jawbone.

However, if you have dentures fitted immediately after the removal of several teeth, the gums and bone will alter in shape fairly quickly and the dentures will probably need relining or remaking after a few months.

Occasionally, your gums may need to be left to heal and alter in shape for several months before dentures can be fitted.

You can either see a dentist or a qualified clinical dental technician to have your dentures made and fitted. The difference between a dentist and a clinical dental technician (in terms of producing dentures) is outlined below.

• A dentist – will take measurements and impressions (moulds) of your mouth, and then order your full or partial dentures from a dental technician.
• A clinical dental technician – will provide a full set of dentures directly without you having to see your dentist (although you should still have regular dental check-ups with your dentist).

A trial denture will be created from the impressions taken of your mouth. The dentist or clinical dental technician will try this in your mouth to assess the fit and for you to assess the appearance. The shape and color may be adjusted before the final denture is produced.

Partial dentures

A partial denture is designed to fill in the gaps left by one or more missing teeth. It’s a plastic, nylon or metal plate with a number of false teeth attached to it. It usually clips onto some of your natural teeth via metal clasps, which hold it securely in place in your mouth. It can easily be unclipped and removed.

Occasionally, the clips can be made of a tooth- or gum-colored material, although this type of clip isn’t always suitable, because it tends to be more brittle than metal.

Your dentist can measure your mouth and order a partial denture for you, or you can see a qualified clinical dental technician, who can provide a partial denture for you directly after you’ve first seen your dentist for a treatment plan and certificate of oral health.

A fixed bridge is an alternative to a partial denture and may be suitable for some people. Crowns are put on the teeth either side of the gap and joined together by a false tooth that’s put in the gap.

How to care for your dentures

Whitening: It is not possible to whiten dentures like natural teeth because dentures are made of plastic. To minimize staining, properly clean your dentures daily to remove food and plaque bacteria. Brushing with a denture brush or soft toothbrush will prevent dentures from becoming permanently stained and keep your mouth healthy. Moisten the brush and apply a non-abrasive soap or denture paste (regular toothpaste is too abrasive). Brush every surface, inside and out, scrubbing gently. A variety of over-the-counter denture cleanser products may be safely used (by following the manufacturer’s instructions) to remove most stains. Do not use bleach on your dentures unless your dentist or prosthodontist gives you special instructions on using bleach. Dilute household bleach can be used to clean and disinfect your dentures, but don’t use bleach until you see your prosthodontist for instructions. More stubborn stains may require removal by your prosthodontist.

Brushing: Even if you wear full dentures, you still have to practice good dental hygiene. Brush your gums, tongue and roof of your mouth every morning with a soft-bristled brush before you insert your dentures to stimulate circulation in your tissues and help remove plaque. Do not brush your dentures with normal toothpaste. Toothpastes are designed to be used on teeth, and they often contain materials and chemicals that help whiten and strengthen teeth, but may harm dentures, which are made of a very durable plastic. Even though the plastic is strong, it is not as strong as the enamel of teeth and may be scratched by using toothpaste to clean your dentures. You should use a dish washing liquid and a special denture brush to clean your dentures by hand every day. After rinsing them thoroughly, soak your dentures in water-based cleaning solution overnight.

Repairing broken dentures: The best solution is to return to the prosthodontist who made your dentures and have the cracked denture repaired professionally. It may seem easy to fix, but it is important that the repair is done correctly to prevent problems with chewing and to avoid any sore spots. The prosthodontist also needs to check the denture and adjust it after it is repaired. The denture may be too old and may no longer fit closely to your gums, and you may need a new denture.

You typically should AVOID:

• Abrasive cleaning materials. Avoid stiff-bristled brushes, strong cleansers and harsh toothpaste, as these are too abrasive and can damage your dentures.
• Whitening toothpastes. Toothpastes advertised as whitening pastes often contain peroxide, which does little to change the color of denture teeth.
• Bleach-containing products. Don’t use any bleaching products because these can weaken dentures and change their color. Don’t soak dentures with metal attachments in solutions that contain chlorine because it can tarnish and corrode the metal.
• Hot water. Avoid hot or boiling water that could warp your dentures.

Cleaning dentures

It’s important to regularly remove plaque and food deposits from your dentures, because unclean dentures can also lead to problems, such as bad breath, gum disease, tooth decay and oral thrush.

Clean your dentures as often as you would normal teeth (at least twice a day – every morning and night). You should:

• Remove and rinse dentures after eating. Run water over your dentures to remove food debris and other loose particles. You may want to place a towel on the counter or in the sink or put some water in the sink so the dentures won’t break if you drop them.
• Brush your dentures with soap and water before soaking them to remove food particles
• Soak them in a fizzy solution of denture-cleaning tablets to remove stains and bacteria (follow the manufacturer’s instructions)
• Brush them again, as you would your normal teeth (but don’t scrub them too hard)

Dentures may break if you drop them, so you should clean them over a bowl or sink filled with water, or something soft such as a folded towel.

Can I sleep in my dentures?

Yes, you can wear your dentures at night but it is preferred that they be removed. You should remove your dentures at night and this will give your gums and bone a chance to relax from the pressure of the denture during the day. If you need to wear your dentures for social reasons or to prevent your jaws from over closing, you should find time during the day to properly clean your mouth and your prostheses. You should never wear your dentures 24 hours a day without preforming proper oral hygiene. Dentures should be cleaned at night and stored in water during the night.

Can I eat normally with dentures?

Most patients need to learn how to use dentures properly and as a result, it takes a little time to get used to them. After a while, you should be able to eat fairly normally, but it may take more time to get comfortable with harder foods or sticky foods. Using a small amount of denture adhesive (no more than three or four pea-sized dabs on each denture) may help stabilize the dentures and help hold them in place while you learn how to get comfortable with them and may make the learning process easier.

Chewing gum: Dentures and chewing gum do not usually work well together, no matter which brand of chewing gum you decide to try. The gum typically sticks to the acrylic plastic in the denture and may break a seal on the dentures, which will loosen them as a result. Gum may remain stuck to the denture and eventually harden and discolor. Ultimately, if you wear dentures, you should avoid chewing gum.

How much pain is involved with getting dentures?

When you’re first fitted for new dentures, it’s normal to experience minor irritation, which should fade as your mouth becomes accustomed to them. The period of pain varies. If you’ve previously worn dentures and now have a new set it may take longer. Similarly, if you had some natural teeth present that were removed at the time of the new dentures, the areas where the extractions were performed may be painful or uncomfortable for up to several weeks after the removal of the teeth. Regular visits to your prosthodontist to adjust the dentures as you go through the normal healing process are recommended.

As a new denture wearer, the bottom denture seems loose. What should I do?

In most cases, the lower denture is much less stable than the upper denture. This is due to the shape of the gums on the lower ridge and movement of the denture caused by the tongue. Ask your prosthodontist about supporting your lower denture with dental implants. Implants can be used to stabilize and retain the lower denture allowing you to chew more efficiently and feel the confidence of knowing that your denture will stay in place.

How do you know when it’s time to reline dentures?

If the dentures no longer fit as well as they once did, you may need to have a procedure done to refit the base of the denture, called a “reline”. Check with your prosthodontist to see if your dentures can be relined. It is best not to reline your dentures with over-the-counter reline kits. This procedure, which can be done by your prosthodontist, will enable your dentures to have a tighter, better fit.

After a reline, what should I do about excess saliva?

You may consider having the upper denture checked to see if it positioned properly. Sometimes dentures can be made in a position that does not allow the lips to close resulting in excess saliva. If swallowing is not impaired, you should be able to clear your mouth and the amount of saliva will generally decrease. If this does not happen, you should see your prosthodontist to correct the problem.

What do I do if my dentures feel very heavy and it is difficult to close my mouth?

While it may take time to simply adjust to the new dentures, it is likely that if teeth were removed the same day that the dentures were given to you, then you will need follow up with your prosthodontist to assure that they continue to fit properly as you heal. If you did not have any teeth extracted and simply had new dentures made, there should be fewer adjustments. These adjustments should be more minor in nature. The heavy feeling may be because you have not previously worn dentures or partial dentures. If that is the case, it will take several weeks to completely adapt to the feel of them.

After a very long time of denture wearing, I’m losing gum and bone. Can this be fixed?

Research shows that once the teeth are removed, the jaw bone shrinks and changes shape. Typically, dentures should be checked every year, and often they should be remade when they lose their fit and are loose in your mouth after 5-10 years of use. By using dental adhesive, you may have masked the loose fit of your dentures. Even though you have adapted to these dentures, you are not receiving the function and appearance you deserve. Also, it is important that you take your dentures out at night to allow your gum tissues to rest and decrease the possibility of sore spots.

My dentures will not stay in no matter what kind of adhesive I use. What should I do?

Relines of dentures should improve the fit of the base of the denture to the jaw. However, if your jaw has been without natural teeth for some time, it may be difficult to make the denture stable if there is little jawbone. Soft tissues beneath dentures can also become easily irritated by wearing dentures continually (24 hours a day). You should refrain from wearing dentures at night as this gives the skin a chance to recover from wearing them during the day. Your dentist or prosthodontist should make sure that the skin inside the mouth is healthy and take steps to treat it properly before relining. If there is enough jawbone available, relines can often be done well. If not, it may be necessary to revisit the need for either remaking or redesigning the denture.

Is it possible to get dentures after not having teeth for a long time?

It’s hard to predict how much of the upper and lower jaw will remain after 20 years without teeth. When teeth are removed, often the bone that held them in slowly shrinks over time. This doesn’t happen to everyone, but it’s normal after tooth removal. It’s important that dentures are made properly to fit well and keep minimum stress on the bone. It’s not likely that you’ll have all the bone you started with after 20 years of not wearing a denture. Your dentist or prosthodontist should annually examine your mouth to assure ideal oral health, including the bone level that would be below your dentures.

The back of my dentures pop up when eating. What do I do?

Your dentures may be ill-fitting or the position of the implants may not be the most favorable. Usually this can be resolved by improving the fit of the denture or by adding (more) implants. Your prosthodontist can help you with this situation.

After applying adhesive, it’s very difficult to remove dentures. How do I remove them without pain?

If you are using your denture adhesive correctly, there should not be a lot of adhesive left on your gums and palate when you remove your denture. Patients use a variety of methods to remove the adhesive: a piece of gauze, a tissue, a damp washcloth, or a wet toothbrush. Use no more than three or four pea-sized dabs of adhesive on each denture.

What is the average cost of dentures?

Denture fees vary widely based on many factors including the complexity of your particular treatment, the time required to accomplish the treatment, and the location of the dental practice. Denture fees can vary depending on your needs and the prevailing fees in your community. Payment terms also vary according to the business requirements of the specific practice. The best way to determine fees for the services you require is to visit with your prosthodontist and discuss the care you may need.

You may also contact your state or local dental society to find out if the organization has any resources for the public related to the cost of dental services. You may want to seek the care of a prosthodontist, a dentist with three years of training beyond dental school who specializes in the care and maintenance of dentures.

Dentures vs Implants

Dental implants are metal screws made of titanium directly implanted (surgically placed) into the gum and jawbone where teeth are missing. Dental implants replace the roots of missing teeth and support single crowns, large bridges or dentures and replace missing teeth. Once the dental implant integrates to your bone, a structure called an abutment is connected to the implant and then the artificial tooth/teeth are attached. Therefore, there are 3 parts to an “implant tooth”: the dental implant itself, the abutment, and the artificial tooth. State-of-the-art technology makes it possible for these implant-supported replacement teeth to look, feel, and function like natural teeth. Dental implants are available privately but can be expensive.

Titanium is “biocompatible”, meaning it is not rejected by the body and the metal will fuse with the surrounding living bone. Dental implants can last a lifetime and can improve your appearance, your confidence, and your ability to eat the foods you like, and participate in an active lifestyle, without worrying about your teeth. Dental implants are made of titanium and can never get dental decay!

There are many types of dental implants and many ways to use dental implants to achieve your goals of a pleasing smile and good chewing function. Visit with your dentist or prosthodontist to find out how dental implants can improve your life and if you are a good candidate for dental implants. Be aware that not all general dentists and dental specialists perform dental implant therapy in their practice. Dental implants like all dental procedures require dental education and additional training. A prosthodontist is a specialist with an additional three years of training after dental school who focuses on the restoration and replacement of teeth, including dentures for even the most complex cases. A prosthodontist also will be able to help determine if another treatment option might be more suited to your particular situation.

There are a variety of circumstances that may lead to missing teeth and the need for dental implants.

Dental implants are surgically placed in your jawbone, where they serve as the roots of missing teeth. Because the titanium in the implants fuses with your jawbone, the implants won’t slip, make noise or cause bone damage the way that fixed bridgework or dentures might. And the materials can’t decay like your own teeth that support regular bridgework can.

In general, dental implants may be right for you if you:

• Have one or more missing teeth
• Have a jawbone that’s reached full growth
• Have adequate bone to secure the implants or are able to have a bone graft
• Have healthy oral tissues
• Don’t have health conditions that will affect bone healing
• Are unable or unwilling to wear dentures
• Ill-fitting and loose dentures
• Want to improve your speech
• Are willing to commit several months to the process

Most patients find that a dental implant is secure, stable and a good replacement for their own tooth.

There are generally three phases to getting a dental implant:

1. First, the dentist surgically places the implant into the jawbone. Your dentist may recommend a diet of soft foods, cold foods and warm soup during the healing process.
2. Next, the bone around the implant heals in a process called osseointegration. What makes an implant so strong is that the bone actually grows around it and holds it in place. Osseointegration means “combines with the bone” and takes time. Some patients might need to wait until the implant is completely integrated, up to several months, before replacement teeth can be attached to the implant. Other patients can have the implants and replacement teeth placed all in one visit.
3. Finally, it’s time for the placement of the artificial tooth/teeth. For a single tooth implant, your dentist will customize a new tooth for you, called a dental crown. The crown will be based on size, shape, color and fit, and will be designed to blend in with your other teeth. If you are replacing more than a single tooth, custom-made bridges or dentures will be made to fit your mouth and your implants. (Note: The replacement teeth usually take some time to make. In the meantime, your dentist may give you a temporary crown, bridge or denture to help you eat and speak normally until the permanent replacement is ready.)

If you are interested in dental implants, it’s a good idea to discuss it carefully with your dentist first. If you are in good general health this treatment may be an option for you. In fact, your health is more of a factor than your age. You may be medically evaluated by a physician before any implant surgery is scheduled.

Chronic illnesses, such as diabetes or leukemia, may interfere with healing after surgery. Patients with these issues may not be good candidates for implants. Using tobacco can also slow healing.

Dental implant surgery risks

Like any surgery, dental implant surgery poses some health risks. Problems are rare, though, and when they do occur they’re usually minor and easily treated. Risks include:

• Infection at the implant site
• Injury or damage to surrounding structures, such as other teeth or blood vessels
• Nerve damage, which can cause pain, numbness or tingling in your natural teeth, gums, lips or chin
• Sinus problems, when dental implants placed in the upper jaw protrude into one of your sinus cavities

How you prepare for dental implants

Because dental implants require one or more surgical procedures, you must have a thorough evaluation to prepare for the process, including a:

• Comprehensive dental exam. You may have dental X-rays taken and models made of your teeth and mouth.
• Treatment plan. Tailored to your situation, this plan takes into account factors such as how many teeth you need to have replaced and the condition of your jawbone. The planning process may involve a variety of dental specialists, including a doctor who specializes in conditions of the mouth, jaw and face (oral and maxillofacial surgeon), a dentist who works with the structures that support teeth (periodontist) and a dentist who will restore the implants with crowns, bridges or dentures.

Tell your doctor about any medical conditions and any medications you take, including prescription and over-the-counter drugs and supplements. If you have certain heart conditions or orthopedic implants, your doctor may prescribe antibiotics before surgery to help prevent infection.

To control pain, anesthesia options during surgery include local anesthesia, sedation or general anesthesia. Talk to your dental specialist about which option is best for you. Your dental care team will instruct you about eating and drinking before surgery, depending on what type of anesthesia you have. If you’re having general anesthesia, plan to have someone take you home after surgery and expect to rest for the remainder of the day.

What you can expect during a dental implant

Dental implant surgery is usually an outpatient surgery performed in stages:

• Your damaged tooth is removed.
• Your jawbone is prepared for surgery, a process that may involve bone grafting.
• After your jawbone heals, your oral surgeon places the dental implant metal post in your jawbone.
• You go through a healing period that may last several months.
• Your oral surgeon places the abutment, which is an extension of the implant metal post. (In some cases, when the implant is very stable, this can be done at the same time that the implant is placed.)
• After the soft tissue heals, your dentist will make molds of your teeth and jawbone and later place the final tooth or teeth.

The entire process can take many months from start to finish. Much of that time is devoted to healing and waiting for the growth of new bone in your jaw.

When bone grafting is required

If your jawbone isn’t thick enough or is too soft, you may need bone grafting before you can have dental implant surgery. That’s because the powerful chewing action of your mouth exerts great pressure on your bone, and if it can’t support the implant, the surgery likely would fail. A bone graft can create a more solid base for the implant.

In bone grafting, a piece of bone is removed from another part of your jaw or your body — your hip, for example — and transplanted to your jawbone. Another option is to use artificial bone (bone commercially available) to place in these areas. It may take several months for the transplanted bone to grow enough new bone to support a dental implant.

In some cases, you may need only minor bone grafting, which can be done at the same time as the implant surgery. The condition of your jawbone determines how you proceed.

Placing the dental implant

During surgery to place the dental implant, your oral surgeon makes a cut to open your gum and expose the bone. Holes are drilled into the bone where the dental implant metal post will be placed. Since the post will serve as the tooth root, it’s implanted deep into the bone.

At this point, you’ll still have a gap where your tooth is missing. A type of partial, temporary denture can be placed for appearance, if needed. You can remove this denture for cleaning and while you sleep.

Waiting for bone growth

Once the metal implant post is placed in your jawbone, osseointegration begins. During this process, the jawbone grows into and unites with the surface of the dental implant. This process, which can take several months, helps provide a solid base for your new artificial tooth — just as roots do for your natural teeth.

Placing the abutment

When osseointegration is complete, you may need additional surgery to place the abutment — the piece where the crown will eventually attach. This minor surgery is typically done with local anesthesia in an outpatient setting.

To place the abutment:

• Your oral surgeon reopens your gum to expose the dental implant
• The abutment is attached to the dental implant
• The gum tissue is then closed around, but not over, the abutment

In some cases, the abutment is attached to the dental implant metal post when the post is implanted. That means you won’t need an extra surgical step. Because the abutment juts past the gumline, however, it’s visible when you open your mouth — and it will be that way until your dentist completes the tooth prosthesis. Some people don’t like that appearance and prefer to have the abutment placed in a separate procedure.

Choosing your new artificial teeth

After the abutment is placed, your gums must heal for one or two weeks before the artificial tooth can be attached. Once your gums heal, you’ll have more impressions made of your mouth and remaining teeth. These impressions are used to make the crown — your realistic-looking artificial tooth. The crown can’t be placed until your jawbone is strong enough to support use of the new tooth.

You and your dental specialist can choose artificial teeth that are either removable, fixed or a combination of both.

• Removable. This type is similar to a conventional removable denture. It contains artificial white teeth surrounded by pink plastic gum. It’s mounted on a metal frame that’s attached to the implant abutment, and it snaps securely into place. It can be easily removed for repair or daily cleaning.
• Fixed. In this type, an artificial tooth is permanently screwed or cemented onto an individual implant abutment. You can’t remove the tooth for cleaning or during sleep. If affordability isn’t a concern, you can opt to replace several missing teeth this way. Most of the time, each crown is attached to its own dental implant. However, because implants are exceptionally strong, several teeth can be replaced by one implant if they’re bridged together.

After the dental implants procedure

Whether you have dental implant surgery in one stage or multiple stages, you may experience some of the typical discomforts associated with any type of dental surgery, such as:

• Swelling of your gums and face
• Bruising of your skin and gums
• Pain at the implant site
• Minor bleeding

If swelling, discomfort or any other problem gets worse in the days after surgery, contact your oral surgeon. You may need pain medications or antibiotics.

After each stage of surgery, you may need to eat soft foods while the surgical site heals. Typically, your surgeon will use stitches that dissolve on their own. If your stitches aren’t self-dissolving, your doctor removes them.

Dental implants results

Most dental implants are successful. Sometimes, however, the bone fails to fuse sufficiently to the metal implant. Smoking, for example, can contribute to implant failure and complications.

If the bone fails to fuse sufficiently, the implant is removed, the bone is cleaned up, and you can try the procedure again in two or three months.

You can help your dental work — and remaining natural teeth — last longer if you:

• Practice excellent oral hygiene. Just as with your natural teeth, keep implants, artificial teeth and gum tissue clean. Specially designed brushes, such as an interdental brush that slides between teeth, can help clean the nooks and crannies around teeth, gums and metal posts.
• See your dentist regularly. Schedule regular dental checkups to ensure the health and proper functioning of your implants.
• Avoid damaging habits. Don’t chew hard items, such as ice and hard candy, which can break your crowns — or your natural teeth. Avoid tooth-staining tobacco and caffeine products. Get treatment if you grind your teeth.

Figure 5. Dental implants

What are the disadvantages of dental implants?

Like any minor oral surgical procedure, there is a risk of infection, inflammation, and pain, but your prosthodontist will discuss how these can be managed for your specific situation. If there is no available bone to place the implant, then bone and gum grafting procedures may be required, which can increase the cost of your treatment. However, the upfront investment can pay off in the long term.

How much do implants cost and does insurance cover the cost?

In general, the cost of replacing a single tooth with a dental implant is almost the same as replacing it with a regular fixed bridge. Dental implant treatment may qualify for some insurance coverage, but situations vary. The cost will vary by patient needs, bone quantity, and region. A prosthodontist will make an assessment based on your unique needs.

What is the success rate of dental implants?

It varies from individual to individual and with health and habits. For a healthy individual with good oral hygiene and good health, dental implants are predictably successful with reported success rates above 90-95 percent.

Do dental implants last?

Unlike natural teeth, dental implants are not susceptible to dental disease such as decay; however, the health of the gums is vital to maintaining lasting implant success. Conscientious home care by the patient and regular professional cleanings and check-ups are essential elements for dental implant sustainability. Each patient is different, and success relies upon diagnosis and planning, medical history, and a variety of other factors.

What if I want “metal-free” implants?

There is no such thing as “metal-free” teeth. Almost all materials used for teeth replacements have some sort of metal ions in them. Dental implants are made of titanium alloy (similar to hip implants, shoulder implants, and knee implants), which is highly biocompatible, and an allergy to titanium is extremely rare! Currently, there are no proven alternatives to titanium dental implants.

How do dental implants help if I have full dentures or partial dentures?

Actually implants are most popularly used in patients who wear full dentures or partial dentures. Dental implants can be used to provide retention and support for a removable implant overdenture, which basically snaps on the implants! Therefore the partial or full denture does not move and reduces the dependency on denture adhesives/denture glue. Or, dental implants can be used for a fixed denture, where a patient’s dentures are fixed/bolted to the implants through titanium components. Only the dentist can remove this from the mouth.

Can dentures be made into implants?

Dentures cannot be “made into implants”. Implants are metal screws placed into the jawbone to help anchor and support artificial teeth (dentures). It may be possible to have implants placed beneath existing dentures to aid in the stabilization and support for those dentures. This could only be done if the current dentures were otherwise in excellent condition. You should consult with your prosthodontist to have your existing dentures carefully examined.

Are dental implants removable like dentures or do they stay in your mouth?

No, dental implants are fixed solidly in the bone and allow teeth to be replaced in a manner that is closest to natural teeth.

What do I do if the screws in the denture are loosening?

If you had implants inserted, it sounds like the implants were intended to help stabilize the denture, in which case, they should reduce the movement. If your dentures rub your cheeks or if you’re biting your cheeks, you should return to the dentist or prosthodontist who made the dentures to continue to have the fit and bite refined. You should visit your dentist or prosthodontist to remedy these difficulties.

1. The use of nylon as a denture-base material. Stafford GD, Huggett R, MacGregor AR, Graham J. J Dent. 1986 Feb; 14(1):18-22. https://www.sciencedirect.com/science/article/pii/0300571286900977[↩]