Dental prostheses can first be divided into partial and full dentures:
Partial dentures replace part of healthy teeth, for example after extensive tooth loss in the cheek area. The still existing natural teeth remain visible and the dentist uses them (partially) to fix the partial denture.
Full dentures (also known as full dentures) are used when the entire dentition in the upper or lower jaw has to be replaced. This is especially the case when there are no more teeth at all or when the teeth that are still present are covered with the attachment as is the case with the telescopic prosthesis.
Partial prosthesis
Telescopic denture
In case of large gaps or missing teeth in the lateral area of the jaw, a so called free end situation, the standard dental care is a partial denture. This kind of denture is normally attached to the remaining teeth by clasps, has an uncomfortable palatal or lingual bar and not a really stabile retention, resulting in movements of the denture while eating or speaking and food impaction under it.
In case of total tooth loss (edentia) the only solution is a full denture. In the upper jaw the full denture is only attached by suction; therefore the denture must cover the whole palate, which may lead to gag reflex and dysgeusia (loss of taste).
In the lower jaw a full denture has always a U shape because of the tongue; therefore there is almost no suction function, which leads to an even worse retention
An ideal solution is our speciality, the Telescopic Denture. It can be attached to even a few remaining teeth or – in case of edentia – to implants.
The first step is the production of the primary crowns in a parallel milling machine, so that they are all parallel to each other. The second step is the production of the secondary crowns, which are connected with the denture and fit precisely on the primary crowns resulting in an extreme strong retention.
After the primary crowns have been glued on the remaining teeth, the telescopic denture can be inserted. The secondary crowns slide on the primary crowns with high precision; when the denture is completely inserted, no metal can be seen.
In most cases the telescopic denture can be produced without any annoying palatal or lingual bar, has a significant better retention as any partial or full denture and is therefore almost indistinguishable from natural teeth.
The telescopic denture is very easy to maintain: In case of tooth loss the denture can be easily adapted without the necessity to produce a new denture, as it might happen with other types of dentures.
Besides any necessary repair works will take place outside the mouth. As already mentioned in case of edentia a telescopic denture can also be inserted on implants.
- Very good hold
- Clip-free, aesthetically good result possible
- Easy to maintain
- Relatively favorable pillar load with sufficient number of pillars
- Expandable for tooth loss
- Well suited for periodontal patients
- Can be combined with implants
- Tooth substance must be removed more (space required for double crowns is higher)
- Risk of tooth death after grinding: 20-40%
- Overloading of the abutment teeth possible (early tooth loss)
- Caries development at the crown margin possible
- Demanding for practitioners and dental technicians
Bar-supported denture
Bar prostheses are a variant of the partial denture. Strictly speaking, they count as combined dentures because the removable dentures rest on firmly anchored support elements, the so-called bars.
The bars are attached to implants and remain permanently in the mouth. The partial prosthesis has a so-called bar rider on the underside, which snaps into the bar like a hinge.
The bar construction offers a firm hold and enables a comparatively graceful prosthesis construction with high wearing comfort.
The artificial teeth can be removed and cleaned, cleaning the bar itself is a little more complicated. It is therefore recommended that the prosthesis wearer be instructed by a prophylaxis expert.
- most proven, safe method to anchor removable dentures on implants
- Low-risk placement of the implants in the front area
- Immediate loading, immediate restoration possible
- relatively good implant care possible
- Repairs to the attached dentures are easily possible
- easy expandability if an implant is lost
- Aesthetic compensation for severe atrophy of the jaw is possible with gum-colored prosthetic saddles
- dental technically more demanding task than with pre-assembled holding elements, as a result
- Cost of this implant care increased
- Leftovers under the prosthesis are not a typical
- with 2 implants rotation (tilting) of the prosthesis over the bar possible
- prostheses feeling
- Harmful for implants when the bar is not tension-free (peri-implantitis, screw loosening, implant breakage)
- Wear of the web rider, loosening of the prosthesis hold over time (cost factor)
Model cast denture
This removable dentures is used by the dentist when many teeth are missing and implants are out of the question.
It is made of plastic and metal. The teeth are in a pink plastic base that is attached to the patient's remaining teeth using metal clips. Many patients do not like these brackets because they are very noticeable. Compared to the much more aesthetic telescopic prosthesis, which is an alternative, the staple prosthesis is a cheaper denture. Therefore, it is still chosen by many patients.
Geschiebeprothese
Auch bei der Geschiebeprothese handelt es sich um eine Form des kombinierten Zahnersatzes. Der herausnehmbare Teil besteht, wie bei allen bisherigen Varianten der Teilprothese, aus einer Kunststoffbasis, auf der die künstlichen Zähne ruhen.
Als fest verankerte Stützelemente dienen auch hier entweder über Grunde natürliche Zähne oder Implantate. Die künstliche Krone verfügt dabei über eine spezielle Konstruktion aus Matrize und Patrize, die perfekt ineinanderpassen.
Dies bietet eine gute Ästhetik, hohen Tragekomfort und guten Halt beim Sprechen und Essen, erfordert jedoch eine stabile Restbezahnung – wenn ein Stützzahn verloren geht, muss die gesamte Prothese erneuert werden. Nachteilig ist der vergleichsweise hohe Preis aufgrund der technischen Komplexität.
Durch eine Geschiebeverankerung ist es möglich, herausnehmbaren Zahnersatz klammerfrei an haltgebenden Zähnen zu befestigen. Dafür ist eine Überkronung der entsprechenden Zähne notwendig, bei denen seitlich oder an der Rückseite eine Nut eingearbeitet wird (Matrize), in die das passende Gegenstück (Patrize) der zu verankernden Prothese eingeklickt / eingeschoben werden kann. Da die Kronen ästhetisch einwandfrei gestaltet werden können, wurde diese Versorgung früher im Oberkiefer bei fehlenden Backenzähnen sehr häufig verwendet. Hier werden dann die Frontzähne mit Kronenversorgt und der herausnehmbare Backenzahnersatz dann an den Frontzahnkronen eingeklickt.
Die Kronen werden im übrigen fest auf die Zahnstümpfe eingeklebt (fester Anteil). Die Lastverteilung des herausnehmbaren Anteils verteilt sich je nach Konstruktion mehr oder minder gleich auf die Geschiebe-tragenden Zähne und auf den Kieferkamm / Zahnfleisch (Integument).
- Ästhetisch meist gut bis sehr gut
- Sichere Verankerung des Zahnersatzes
- in der Regel guter Tragekomfort
- Gesunde Zahnsubstanz muss abgetragen werden
- Risiko des Absterbens von Zähnen nach Beschleifen
- Überlastung der Pfeilerzähne möglich (frühzeitiger Zahnverlust)
- Zungenraum evtl. etwas eingeschränkt
- Knochenabbau im ersetzten Bereich wird nicht verhindert
Locator denture
Fixing a denture to implants using locators is one of the most convenient and safest ways to securely anchor the denture. This is an optimal alternative to the classic full denture (with a palate plate in the upper jaw).
For this purpose, four implants are usually inserted into the tooth-free jaw and a narrow, safe and comfortable prosthesis is attached with a kind of push-button system, the so-called locator.
- excellent firm wearing comfort
- suitable for upper and lower jaw
- enables normal eating without fear of losing the prosthesis
- an extensive palate plate is not necessary
- very high accuracy of fit and therefore easy handling of the prosthesis when inserting and easy removal, even for people with limited vision or dexterity
- no annoying web construction
- easy to clean
- retention elements can be replaced easily and inexpensively
- can also be used in addition to telescopic crowns (e.g. natural teeth are still available for anchoring on the right side, two implants on the left side do this)
- prevents pressure points and therefore prevents gingivitis
- cheaper than fixed dentures
- successful implantation depends on the jawbone
- correct handling requires some practice
Full denture
Full dentures, popularly known as "dentures", are still the standard for restoring toothless jaws with dentures. The saying "teeth are like stars: come out at night" alludes to the often not very high level of comfort of these simple prostheses, which makes wearing them difficult. But there are many full dentures ("total") that shine with an extremely satisfactory fit, impeccable function and excellent aesthetics. A denture in the upper jaw, in particular, is very satisfactory for patients under favorable conditions.
The full denture consists of a gum-colored plastic base, in which plastic teeth are anchored as a row of teeth in the position of the missing teeth. In the upper jaw, the base covers the entire palate and the entire alveolar ridge, and ends on the lip side on the movable mucosal areas. The hold develops through suction forces via a fluid gap between the base and gums (palate, alveolar ridge) and the valve function of the movable mucous membrane (inside of the lip), which can seal the gap. The more pronounced the alveolar ridge and the more sticky the saliva, the better the denture hold.
Technically, an artificial row of teeth in the upper jaw would also be able to be manufactured without complete palate coverage, but the prosthesis would fall down due to the lack of suction. This is where implants can benefit from their toothlessness.
In the lower jaw, the base of the prosthesis also covers the alveolar ridge, but the contact area is considerably smaller than in the upper jaw. In addition, consideration must be given to the tongue as well as the cheek side when expanding the base on the extended movable mucous membranes, otherwise painful rubbing points (pressure points) arise. For these reasons, the hold is fundamentally worse than in the upper jaw.
If the lower jaw has already shrunk considerably (atrophy), the prosthesis usually tends to hold poorly even with adhesive. No wonder that dental implants were the first to be successfully used to improve the hold in the lower jaw.
- Uncomplicated manufacture
- Low overall costs
- Routine procedures
- Often good aesthetic design
- Easily repairable / customizable
- Degeneration of the jawbone (atrophy) especially with wobbling prostheses
- Limited quality of life
- Psychological burden
- Disorder of sound formation
- Decreased ability to buy
- Insufficient denture retention (especially full mandibular dentures)
- pressure points
The edentulous jaw sections are molded from an initial impression and plaster models are made of them in the dental laboratory. A so-called individual impression tray is produced on these, with which the exact contours are then recorded again, especially taking into account the adjacent moving structures (floor of the mouth, tongue, cheek). The expansion of the plastic edges must not hinder the range of motion of the movable parts, as these would otherwise push the prosthesis out.
After registering the bite (should always be more effort with complete dentures and include the temporomandibular joint, e.g. facebow), the artificial teeth (made up in all sizes, shapes and colors) are placed in a wax base, which also enables quick changes provides enough hold for a fitting.
If everything is correct, the wax base will be replaced by tooth-colored denture acrylic. After polishing, the full dentures can then be used.
