Getting Started with Implant Overdentures

Getting Started with Implant Overdentures. Photo courtesy of lightmachine/stock.adobe.com.

When considering edentulous and partially edentulous patients, it’s important to understand each patient’s specific needs when considering denture options. One option that may be worth a closer look for patients that desire retention, stability, and function is implant overdentures. Implant overdentures are a removable denture option that are fixed into the gums for edentulous patients. Ankur Gupta, DDS, is a practicing dentist, and finds that many of his patients aren’t looking for the big, expensive full implant option, but find the less expensive denture option to be unappealing.

“It's like deciding between a bicycle and a Mercedes-Benz®. You’re going to be frustrated with the bike. The bike has limitations, and it's not always comfortable. But you're also not going to get the Mercedes if it's not financially feasible,” says Dr Gupta. “That was frustrating for me. And I would say about 10 years into my career, I realized that a perfect middle ground is still giving somebody a removable option.”

That’s when Dr Gupta began offering his patients an implant overdenture solution. Through it, patients receive an implant denture that snaps into a stable post installed inside the gum. The stable post is typically a metal screw that is placed directly into the gum in a procedure done by the implant dentist.

These overdenture implants are then paired with an abutment for better, smoother integration and enhanced esthetics. According to Dr Gupta, patients appreciate any option that eliminates the bulky discomfort of traditional dentures, while remaining relatively affordable in comparison to a full set of dental implants. Dr Gupta returns to the transportation analogy.

“An implant overdenture would be in the middle of a bike and a Mercedes. It's like the affordable option, but it's still very comfortable. Because as many would agree, driving a Chevy [car] is much more comfortable than riding a bike,” he says. “I actually started using that analogy in my office when patients had failing dentition. I told them, ‘Ok, well, there's the bike option, there's the Mercedes option, but this is kind of the one in the middle.’ And that really resonated with people.”

The First Steps

Getting started with the first step in implant overdentures was a bit daunting to Dr Gupta at first. Because there was so much education on the “Mercedes” full implant bridges and fixed implant options, he found that there was far less focus on implant overdentures when it came to finding resources.

“In the earlier part of my career, I wanted to do this, I wanted to do it well. But I didn't really know what resources to seek out in order to learn how to do it well,” he says.

Thankfully, as time has gone on and implant overdentures have become a more popular option, education on this subject has expanded and become more accessible. Still, Dr Gupta found that it was difficult at first.

“For me, I had to learn a lot of this on my own, I had to figure out first the steps to successfully place those dental implants in the right location, with the right angulation far away from any important anatomical structures, and do that successfully,” says Dr Gupta. “Then I had to learn how to add the little restorative components that created that snap that I was talking about—the snap that allows a denture to snap into those dental implants.”

There are many components with implant overdentures, a fact that was daunting to Dr Gupta when he first began his implant overdenture journey.

“There's the little, tiny component that attaches to the implant, then there's the little, tiny metal component that attaches to the denture, and then there's these little retentive components that attach that, snap the actual, those 2 components that I just said into each other,” says Dr Gupta. “That's just a lot of tiny, confusing, and complicated pieces that I never learned about in dental school. And so, mucking through the waters like I did was not something I would recommend to any dentists.”

Technology and resources have improved considerably over the years and placing implant overdentures has been made easier through many avenues, including digital imaging. Catapult Founder Lou Graham, DDS, says that 3D digital imaging is the way forward for implant cases, including implant overdentures.

“2D imaging is just not adequate today. Because with 2D imaging, you can't really see the difference of the width of the buccal and lingual bone. So, you're guessing,” says Dr Graham. “We would take a 3D image, and routinely the 3D image is of both the maxillary and mandibular arch and looking at occlusion, then you would take either a digital scan, like a 3Shape and iTero, a Medit, or a traditional impression. And send that to your laboratory or implant planning company to plant this.”

Digital imaging, and more specifically 3D digital imaging, allow a full and robust view of a patient’s mouth. When patients require implant overdentures, understanding where to start is bolstered through the use of high-quality digital images.

The Implant Overdenture Process

After scanning and using these digital images, the dentist needs to surgically place these implants using all the information they have available in a way that doesn’t interfere with the jaw or sinus structures. Then a locator is added to ‘locate’ where the implant overdenture and the gum will connect.

“And that locator is going to come out of their gums like a trailer hitch would come out of their gums.” As Dr Gupta describes it.

Then comes the denture design. Each overdenture must be specifically designed with not only the right fit, but also the esthetics that overdenture patients require. This includes the proper color for both the tooth and the gingiva. After that overdenture is designed it is then placed in the patient’s mouth with all pieces and components necessary to facilitate that ‘snap’ into place.

With these implant overdentures, clinicians can better serve patients, a fact that can help patients who may have received old implants or dentures that just don’t cut it anymore, according to Dr Graham.

“I think the bottom line is, what have we learned? And how do we best use what we've learned to optimize successful strategies, whether with many implants, overdentures, traditional implants, because we now have 25 years, 30 years of experience with implants, mini-implants and Overdentures,” says Dr Graham. “And I would say, we are now starting to optimize our success based on what we've learned and learning across the board how implants connect with each other.”

Dr Gupta has received positive feedback from his patients that have received implant overdentures. And he says that that is the crux of it all—better serving patients through technology, and that dentists need to work toward being more flexible with new techniques.

“I think the really sad thing about the state of dentistry is that there's actually not that many dentists who utilize the incredible amount of technology that will make patients’ lives better. Because we're stuck in our own ways, and a lot of dentists they're like, ‘listen, I learned how to do things a certain way in dental school 20 years ago, and I'm not that interested in learning that there are better ways to make people's lives that much better,

“But how could we think that when everything else around us is so much better? Technology has delivered so much more convenience and technology has provided so many more tools,” he continues. “It's surprising to me, that there are still so many dentists who still say, ‘Ok, you either get a denture that you'll hate, or you have to spend 50 grand, and go to this super ultra-specialist downtown, who will basically make you a new set of teeth that are fixed implants. Is it possible that there couldn't be a middle ground?”

The Future for Implant Overdentures

As with any dental specialty, implant overdentures will only continue to improve with time. As patients and clinicians learn more about this type of implant treatment, a wider adoption of this “Chevy” affordable, effective option may be possible. There is a greater potential to serve patients continually, according to Dr Graham.

“So I think the crux is how do we optimize success?” says Dr Graham. “How do we maintain these and I think it becomes fundamental to understand how best to prepare these patients, treat these patients, and then maintain these patients.”