Advantages and shortcomings of removable implant-prostheses

It is generally assumed that a fixed tooth replacement is preferable to a removable solution. Patients often associate a removable prosthesis with age and frailty, and the idea of a floating set of dentures in a glass of water on the bedside table is rather horrifying to most. In addition, the embarrassment of a denture coming loose in a social context is one of the biggest fears of patients with removable dentures, as it reveals the tooth loss and lifts the “prosthetic privacy.” The impact of a removable denture on the patients’ well-being and social life varies largely but may be substantial in some. Implant overdentures may alleviate many shortcomings of conventional dentures, in particular in terms of stability and retention, but still require removal at least twice a day for cleaning. Fixed restorations are not associated with these psychological shortcomings, but are they preferable in all conditions? From an esthetic point of view, they require specific anatomic prerequisites to enable sufficient lip support. In contrast, removable prostheses can easily compensate substantial bone and tissue loss and provide larger freedom in positioning the dental arch where the natural teeth had been, hence facilitating the restoration of the patients’ “true me.” Removable prostheses are also easier to manage for patients with reduced dexterity and vision, common features in elders. Finally, they provide more flexibility in case of future complications, a feature that may be rather helpful in patients with reduced neuroplasticity, where a full renewal of a restoration might challenge the patient’s capability of adaptation.

After the lecture you will be able to:

• discuss the impact of tooth loss on oral function and psychological well-being
• cite the advantages of an implant-overdenture over a conventional denture
• identify the anatomical conditions required for a fixed implant restoration
• master the selection criteria for either fixed or removable implant restorations