Why dentures or implants?
A removable denture can replace loose, broken, decayed, periodontal/advanced gum diseased dentition/teeth. If some teeth are still present, the removable teeth are called a partial. Reduced dental treatment, frustration, pain, and embarrassment are some benefits of denture treatment. Dentures are the least costly and quickest new smile solution to improve smile esthetics and eat comfortably. Dentures can also provide facial enhancement by adding support, contour, and reduce the effects of aging skin. A more youthful appearance and vitality are quickly achieved as the Denture replaces lost/damaged bone, soft tissue (gums), teeth, and the drape of facial soft tissue with support. The prosthetics (the Denture) is what makes for a pretty smile. However, implants are a good option for those wishing to have the most support, bone health, retention, function, security, and life-like results. When implants (surgical titanium roots placed in the jaw) support and retain a denture, it is called an Overdenture.
Reasons for Implants – Implant treatment can provide denture support, aid in retention, or support teeth that don’t come out. Implants are manufactured and surgically inserted into the jaw bone. They look much like the root of a tooth. Implants have attachments or connections designed to retain and support implant crowns, bridges, or dentures. The attachments support teeth, bridges, keep dentures off sensitive gums, reduce movement- especially in the lower jaw, improve function, chewing ability, support and maintain healthy bone (as opposed to a conventional denture that will lose bone over time).
Increasing the number of implants allowing for the most ‘natural’ tooth-like solution to missing teeth. Not every tooth to be replaced needs to have an implant. Typically, the upper jaw can have a good portion of teeth replaced and supported by a minimum of 4 implants, but 6-8 implants are usually needed. The lower jaw may need as few as two implants for significant improvement when attaching to a removable denture, referred to as an overdenture. The person’s unique jaw type, functional needs, if the teeth are removable or permanently attached to the implants determine how many implants are required.
A denture teeth replacement option is both a surgical and restorative treatment. There are two main ways to get your new teeth—conventional dental treatment (the team approach) or the single practitioner approach.
Conventional dental treatment (Team approach) steps are as follows: Evaluation in a general dental office that treats denture or implant patients, impressions for the insertable teeth, and laboratory fabrication of temporary teeth. (This is the first restorative part of denture/implant treatment). The patient is referred for consultation at a surgery office. The surgical office then removes teeth or may place implants and is the surgical treatment part of the Denture or implant plan. The patient then will be referred back to the general dentist to make adjustments and follow up care during healing. The general dentist may fabricate crowns or other devices to attach to the implants. This is the last part of the Restorative treatment.
Teeth that are inserted at the same time as the surgery are called an immediate denture. The patient needs to feel confident that both the surgeon and the general dentist will work together for a good result. Careful planning is necessary. The traditional team approach to denture treatment requires general dentists, oral surgeons, periodontists, or prosthodontists to provide various aspects of this treatment in a team approach and usually in separate locations.
The second way to get your new smile is the single practitioner approach. Today, many challenges of the first-time denture wearer can be reduced or eliminated with a single practitioner approach to denture treatment. Some dentists provide both Surgical and Restorative care in one office. Credentialed dentists with surgical and restorative training are often a good match for people wanting start to finish care. Another benefit to the single practitioner approach to implant or denture treatments is one office that manages both restorative and surgical disciplines to streamline the process of new teeth and usually with fewer appointments. Implant treatment is also surgical and restorative treatment. Complexity and cost increase when treatment is for the first time denture wearer, the bone foundation for good implant placement is needed, and both an implant and tooth-supported solution to missing teeth is the treatment goal.
Dentists specializing in implant treatment have the necessary training, experience, and skills to have excellent outcomes for most Denture and/or implant treatment. They provide a single practitioner approach to all phases of Denture or implant care. Practitioners with specialty qualifications and experience can be found at ABOI.org. The American Academy of Implant Dentistry or the International Congress of Oral Implantology are educational organizations to further the skills and knowledge of members with interests in this kind of dentistry. Membership in these organizations helps assure the public that the practitioner has a committed interest and expertise in reconstructive dentistry.
In contrast, a conventional team approach requires oral surgeons or periodontist specialists that remove teeth and place implants and bone grafting but do not provide the attached teeth. Not all periodontists or oral surgeons place implants. The general dentist is responsible for designing the replacement teeth, having the laboratory fabricate the intermediate and final prosthetics (tooth/teeth), attaching the teeth to the implants, and coordinating the practitioners involved in treatment.
How do I know if Dentures or Implants, or both are right for me?
No two people are alike, and neither are their needs for implant or denture-only treatment. Frequently the first step people take is to have a denture solution. If this option does not meet the needs of the individual, an implant option is a next step to the most stable and supportive tooth replacement option. Once the infection is resolved and the bone foundation is solid, dentists can more simply add implants for either a non-removable or removable teeth replacement solution using the implants for support.
The benefit of having a denture before implant placement is as follows: People may find they are satisfied with their new Denture (s), and there is no need for additional care. There has been a surge of practitioners and dental centers placing implants before the denture solution. In those situations, the recipient has committed to the cost and treatment direction before knowing if the denture solution was sufficient. The least costly and most predictable approach to a whole jaw implant treatment plan is to remove disease, regeneration of bone, and healing for foundation and then implant placement.
There are some additional risks in cases where implants are placed at the time of extraction to shorten the treatment time. Immediate implant placement at tooth extraction has a somewhat lower probability of success because they are often placed in tooth positions that have had infection or damage before the implantation. Also, dental laboratories have had to make disclaimers on immediate implant placement as there is the potential for not having enough room to restore the teeth on the implants. Often removing more healthy bone is required for the implant to be securely inserted, allowing room for the teeth replacements and providing the initial anchorage and support required when trying to provide immediate implant-supported teeth. (All on 4, Teeth in a Day & Clear Choice plans)
Tooth replacement has more determinants than just putting the implant in the same place as the tooth. For these reasons, immediate placement of implants at the time of extraction requires good informed consent and discussion. The discussion should include what happens if the implant fails.
In an upper or lower jaw reconstruction, the fewer the implants, the more concern this can be. A failed implant can mean more time and surgery before dentists can insert the final teeth. Dental clinics promote all on 4 and Teeth in a Day as a quick solution. These treatment plans rely on the fewest implants, reduction of bone (less regeneration of bone), placement of implants in less than ideal sites, and at angles. They are most subject to problems if one implant fails.
Take-Home Message: Commercialized Quick Treatment- Resection vs. Phased Treatment-Regeneration
The safest, most predictable, and least risk option when teeth are to be removed, and implants are considered the elimination of disease followed by regeneration, then immediate temporary dentures, and lastly, implant placement. The final restoration can then be a removable overdenture or a non-removable bridge. These are called phased treatment or regeneration treatment plans.
The prospective implant candidate should understand an increased shared risk (patient & practitioner) when attempting to get implant-supported teeth as quickly as possible. There can be unintended costs of revision or redoing an implant(s), increasing treatment time, or changing to a different modality (type of teeth replacement) due to complications. Lastly, the attached bridge has considerable strain to keep early implant loading stable. Often, revisions or repairs are needed to the teeth and bridge, and rarely are patients guaranteed they will have the non-removable teeth on the day of surgery. Frequently they will need a temporary denture even with the best of intentions, planning, and promises.
What affects the Cost of Implants and Dentures?
Implant treatment costs are higher when less bone is available or more support is required (additional implants). Treating one site with an implant and crown costs more per tooth than when treating multiple sites. When multiple implants are involved, often an overall case fee is charged. For example, the cost decreases as additional implants are done in a given area vs. one implant at each visit.
Cost of implant treatment increases when bone or tissue foundation needs improvement. Implants must be surrounded and supported by healthy bone and tissue. Some bone regeneration may be required and termed minor. The more advanced regeneration, the more the cost.
Surgical costs to remove teeth are affected by anesthesia/sedation options, how teeth are removed (surgical vs. non-surgical), and shaping/smoothing sharp, irregular bony contours to reduce the likelihood denture pressure over sensitive gums occurs. (alveoloplasty). These are standard procedures required for denture treatment.
One way to reduce future costs and prevent bone foundation problems is to have the surgeon place bone preservation or regeneration materials at tooth extraction. Regeneration at the extraction of the tooth usually saves money for a future implant support option because there is less need for a bone graft at the time of implant placement. Additionally, it empirically makes sense not to leave a hole at extraction but to have a medium that encourages the maximum growth and support of the tissues and bone around the extraction.
Regardless of the plan, a bridge, implant, or removable plan, regeneration will be a good choice at extraction. Without site preservation or regeneration at extraction, you can be assured there will be bone loss and less than ideal shape and support for the teeth replacement option chosen.
Bottom line, surgical costs are affected by the client’s choices to maintain, preserve and protect healthy bone and tissues when the teeth are removed. The more bone you want to preserve and maintain, the more the costs are at extraction. Also, prices are affected by anesthesia. Local(numbing), nitrous oxide (inhalation relaxant), oral sedation (pill for reduced anxiety), IV sedation for semi-conscious treatment, or deep/general anesthesia affect the final surgical costs.
Cost of the Final bridgework or Fitting to the Denture (overdenture)
These are the restorative costs. Not every tooth to be replaced needs an implant. For example- bridges that are not removable can replace several teeth and attach to two implants. Removable dentures can have as few as two implants to improve function and retention. Often the long-term cost of conventional removable partials or dentures over a lifetime will cost more than the upfront costs of implant-supported teeth. There are many reasons the answer for ‘how much it costs’ can’t be determined without an exam or consultation. Often supportive information and diagnostics, like CBCT cone beam CAT scans for jaws, provide the clinician and the patient with several ways to address their concerns.
3 Major FAQs
Does it hurt?
Today’s dentistry and sedation options should provide comfortable treatment and recovery. Usually, a day or two of light activity is recommended after surgery. Asda.org
Does it cost a lot?
A driveway replacement or a synthetic deck is what a complete upper or lower jaw treatment may cost. $25,000 is not uncommon for an upper or lower jaw rehabilitation with non-removable teeth attached to implants. Costs can be higher in some situations.
Removal of teeth and placement of an immediate denture is around $5,000-$10,000.
A removable overdenture plan that attaches the denture to two implants may be $8,000-$12,000.
A single implant placement without bone regeneration is $2,000. Restoring the implant adds another $2,000. Generally, without an office consultation, the single implant option can be estimated at $4,000-$5,600.
The single-tooth implant plan compared to the cost of a tooth-supported bridge is similar. A tooth-supported bridge requires treatment of the teeth on either side of the missing tooth. The implant treatment plan only treats the missing space, leaving the other teeth whole.
How do I pay for it?
There are several ways to defray costs. Staging some care now and some care later is one option. CareCredit is one health care finance option that offers no interest for six months. If interest rates are low, your bank or credit card are other options. Some people leverage some of their retirement savings to invest in a better future for eating and smiling in the years to come. Some dental insurance companies have benefits, but most plans don’t cover implants or offer reduced reimbursement.
Where do I start?
Get a few consults to gauge treatment costs as well as options. It is essential to compare apples to apples if you will. Beware that dental treatment is not a commodity. It is a healthcare decision that will affect you for a lifetime. Some treatment plans require amputation or removal of bone for implants to be placed. Once the bone is removed, there won’t be many options should an implant fail or have a future problem, especially if the case is planned on just four implants. Other plans regenerate and preserve bone to reduce risks and improve outcomes. Consumers must know what is being recommended to achieve the intended result.
- RESEARCH potential providers. Determine if a single practitioner start to finish care is best for you or a multi-practitioner team approach is better. You may be better able to make that decision after a couple of consultations.
- CHECK REVIEWS AND CREDENTIALS
- GET A CONSULTATION: Compare game plans and be sure you are talking about the same thing. No two people have the same situation.
- IDENTIFY THE TYPE OF PLAN- Resection or Regeneration. Resection Plans- require bone removal to place implants.(see above: All on 4, Teeth in a Day & Clear Choice promotion). Regeneration Plans focus on maintaining or growing bone. Sometimes referred to as phased care plans, they start with removal of disease, regeneration for a healthy foundation, then implant placement followed by attachment of the teeth.)
- TRUST YOUR GUT and move forward
Take-Home Benefit Message
Benefits of dentures or implants: Dentures offer those with troubled teeth a relatively quick result and an improved smile. Over time bone resorbs and relining or remaking the denture are needed. Implants can provide bone maintenance as they function to stimulate bone as well as support teeth. Implant treatment provides the most natural approach to teeth replacements. However, implants don’t make the person handsome or pretty. The prosthetics (what goes on top of the implant(s)) make the smile.
If you would like to schedule a free consultation for dentures or implants, give us a call at 913-491-9119 – for the best choice amongst all options Contributing Author: Christopher Rooney, DDS ABOI/ID is a diplomate in implant dentistry, holds certifications in dental anesthesia and IV sedation, provides multi-discipline surgery and restorative dentistry in Leawood, KS and has been providing denture and implant care for over 25 years. Convergentdentistry.com