Teeth replacement: Dentures or dental implants – which is best for me?

 

Every day we get phone calls from people who are fed up with their dentures. By the way they speak of them, I get the impression that people know of the benefits of dental implants, and in a beat would throw out their old dentures. But there is more to it than that. When I actually consult the same people, I realise that a lot is unknown to the public. So in this article, I endeavour to unveil the good and the bad of both. Although I am definitely biased towards implants (you will soon understand why), I will discuss each option honestly and in an easy to understand way. So that, if you are weighing up both options, you will be wellequipped to make the best decision for yourself.

It is worth considering dental implants, if:

  • Your dentures can’t be adjusted to fit your mouth.
  • You are fed up with ill-fitting, loose dentures that rub your gums.
  • You have multiple severely damaged, fractured and missing teeth.
  • Your teeth are loose from advanced gum disease (periodontitis).
  • Your teeth have been excessively worn by grinding (bruxism).

What are my treatment options?

If you are anything like me, and want to get straight to the point, I’ve summarised the pros and cons in a table below. However, if you are seriously contemplating whether a denture plate or full mouth implants are better for you, please read on.

Dental Implants

  • Look and feel similar to natural teeth
  • Unlikely to affect speech or eating habits
  • No discomfort or mobility issues 
  • More durable than dentures
  • May require bone or sinus grafting if your jaw bone has deteriorated
  • Requires surgery
  • A longer process
  • Less affordable

Dentures

  • More affordable
  • More affordable
  • Less durable, needs to be replaced every few years
  • Less invasive process and requires no surgery
  • Cannot be worn overnight
  • Can affect speech and eating habits
  • Can cause discomfort due to dentures rubbing against the gums
  • Can be damaged easily

What's the difference anyway?

Dental Implants

What are individual implants?

If you are missing a couple of teeth but the rest are in a good shape, it makes sense to only replace the missing teeth. A single implant procedure uses an individual dental implant (titanium screw) that is surgically placed into the gum and jaw tissue. Once it has bonded permanently with the jaw bone and the jaw has healed around it, a single dental crown (artificial tooth) is attached.

What is an implant-supported bridge?

If you have multiple missing teeth in a cluster, implant-supported bridges can be used to replace them. An implant-supported bridge consists of a middle pontic crown (imitation tooth) that is surrounded by crowns that are attached to dental implants. For example, if you have three missing teeth, two implants holding a three unit bridge can fill in the space. This is quite different to full mouth implants where all teeth have to be replaced.

Implant Bridge

What are full mouth implants, including All on 4 and All on 6 dental implants?

Let’s dispense with the fancy words and terminology, basically it is now possible to insert a series of grade 4 or grade 5 titanium screws into jawbone and have them bond with human bone. If this isn't a miracle, I don't know what is! Whatever terminology we assign to this treatment, be it "full mouth implants", "full arch dental implants", "All on 4", or "All on 6", the concept remains the same. A bridge of spectacular pearly whites is effectively anchored to these implants permanently. It can be removed by a dentist, or in some cases by yourself, but is essentially fixed.

All-On-4 All-On-6

Dentures

What are full dentures?
A full denture is a removable prosthesis, made of acrylic, which rests purely on your gums and is not anchored to your mouth through any means. The top denture is held in by "suction" similar to a suction cap. The bottom one has no suction to help it stay in, thus many people experience difficulties with wearing the bottom denture.

Denture

What are partial dentures?

A partial denture is also a removable prosthesis but is more comfortable than a full denture. You have to have at least some of your natural teeth to be able to wear a partial denture. It uses clips to anchor to your teeth, thus there is less movement with a partial denture. Partial dentures can be made from acrylic, valplast or thinner more durable cobalt-chrome metal.

Partial Denture

The Process

What is the process with dentures?

The process of getting immediate dentures involves several trips to the dentist.

  1. We begin with an initial consultation to discuss your concerns, identify the time frame and treatment options. This is an extended consultation so you will have an opportunity to ask lots of questions. Dr Helen will begin her investigative process by examining your mouth, and assessing your current situation, overall health and suitability for dentures. For partial dentures, it is crucial that essential dental work such as cleaning and fillings is completed before beginning the process of making a denture.
  2. Next, we take initial impressions. These impressions act as a guide to create a custom fit tray (called special tray) to your mouth to take more accurate impressions.
  3. Then we take bite registration and secondary impressions. These impressions are customised specifically for your mouth and offer the highest degree of accuracy.
  4. Try-in – the fun part! This is where you will get to see what your denture is going to look like. It's important that you are 100% happy with the look of your new teeth, so we allow for time to make adjustments just in case there is something you want altered. After all, you are the co-designer of your new smile! It’s a good idea to bring a friend along with you to offer a second opinion.
  5. Then it’s time to extract the teeth. This can be done under local or general anaesthetic, depending on how comfortable you are with the procedure.
  6. You will need to follow a soft diet for the first few days following the extractions and immediate denture placement. You will gradually begin to eat more solid foods as the mouth heals.
  7. As your gums heal, your denture will need to be refitted approximately three months after the extraction and immediate denture placement. This process is referred to as a "reline". This ensures that the denture fits perfectly after the gums have healed.

 Adjusting to your new dentures may be particularly uncomfortable at first. During the first couple weeks you may experience some difficultly eating, speaking and have some soreness. This is to be expected as your mouth adjusts to the new dentures.

Denture Impression

 What's the process with full mouth implants/ All on 4?

Full mouth dental implants are typically done in stages over a couple of months. Here’s the process at our practice.

  1. We begin with an initial consultation to discuss your concerns, identify the time frame and treatment options. This is an extended consultation so you will have an opportunity to ask plenty of questions. Dr Helen will begin her investigative process by examining your mouth, and assessing your current situation, overall health and suitability for full mouth implants.
  2. Proceed with a scan (Cone Beam CT) to assess the volume and density of your jawbone and suitability for full mouth implants.
  3. Arrange a series of appointments where we take photographs, impressions of your mouth, as well as the preparation of your immediate teeth.
  4. Surgery – a qualified anaesthetist will administer general anaesthesia. You will have a relaxing day asleep while we work away removing your remaining teeth, inserting new implants and taking measurements for your new teeth. The amazing thing about immediate implants is that this will all be done in one day while you are asleep!
  5. New teeth – Voila! You will go home overnight and return the following day for your new but temporary teeth. This is exciting! Very exciting for all of us. We attach an acrylic bridge to your new implants and you can go home smiling.
  6. Recovery – the mouth heals surprisingly quickly, and provided you follow our instructions and take your medications, it usually happens uneventfully. We will give you clear instructions on what to do and not to do after your surgery as well as how to care for your new implants. It will take five to six months for your jawbone to grow around your implants, so particular care should be taken to eat soft foods and not to apply undue pressure on them. It is normal to experience some bruising and swelling, which starts to subside within a few days. With the help of anti-inflammatory medications, you shouldn't experience much pain. It often surprises patients how smooth the recovery process is.
  7. Suture (stiches) removal – you return two weeks later to have your sutures removed.
  8. You will need to see us on monthly bases for quick reviews to make sure the healing process is proceeding well.
  9. New bridge! After about five months, provided your implants have integrated with the jawbone, it’s time to make you a new, final permanent bridge. Again, we’ll see you several times to take measurements and try your new teeth in to make sure they fit and suit your face and you are happy with them.
  10. Maintenance and care. Please take care of your implants and your new teeth like you would for your natural teeth – or your most precious possession! Full dental implants can last decades with good oral hygiene. That includes seeing your dentist regularly for check-ups and cleaning (we recommend every six months), and meticulous brushing and flossing at home.

Choosing between dentures and dental implants

Which one is more comfortable?

Dentures and implants are like comparing apples with cars. They are completely different! Dental implants by design are more comfortable as they do not press down on your gums like traditional dentures do. And sadly for many people, dentures can be very uncomfortable as they move around in the mouth and irritate the gums. Dentures are removable, whereas implants are more stable and secure as they are permanently fixed. Dentures are said to only possess 15% of our natural chewing ability. While you may have to be a little bit cautious eating very hard foods with implants, they feel very similar to your natural teeth.

I have a gag reflex: What is better for me?

Do you have difficulties swallowing tablets? About 10% of the population have a strong gag reflex. It's normal. It's even thought to be of evolutionary advantage, people with a strong gag reflex often cannot tolerate dentures that extend far back into their mouth. Implants are a different story. Because no roof of the mouth coverage is needed with full mouth implants, rest assured they will not trigger your gag reflex.

Will food taste any different?

Yes! This sounds counter intuitive as when we think of tastebuds, we think of out tongue. There are many nerve endings that are responsible for detecting taste in the roof of our mouth. We have up to 10,000 taste buds, and some of them are in our soft and hard palate. So if you cover these with a denture, guess what will happen? Right, you won't taste your food properly. With implants though, the palate is uncovered so you can enjoy every flavour in your food.

Are dentures or implants more involved?

Here is one of few advantages of dentures. The process of making dentures is a lot less involved and less invasive. It takes a few weeks to make good dentures, in comparison to months, even years sometimes, to get you a good set of implant supported teeth. Placement of implants is a surgical process, which is more costly, prolonged and involves healing and many appointments.

Do I have to clean my denture or implants?

Both have to be cleaned and maintained. If you don't clean your denture, it will get stained, dirty and might look unsightly. You mouth will become a breeding ground for harmful bacteria, which in turn can affect your general health, cause your denture to deteriorate and emit an offensive odour. But, other than that, not much else will happen. Since you don't have natural teeth anymore, you cannot develop gum disease (gingivitis/periodontitis). However, if it's a partial denture we are talking about, then it's just as important to clean your teeth - you don't want to lose any more precious teeth that hold your denture in place.

The stakes are much higher if you don't clean your implants - they might just fall out. Implants are like your natural teeth - if they are not cleaned daily to remove the plaque, there is a high risk you might develop a condition called peri-implantitis. It's gum disease around an implant, just like you can develop gum disease associated with natural teeth. The problem is there is very little science on how to treat this condition. Treatment options are few and not predictable. So once you develop this condition, there is a good chance that you will lose your implants. The best way to ward off problems is to be obsessive with your home care. Clean your full mouth implants the way your dentist instructs you daily - you can't be slack with it.

Fixed-removable denture implants are made for the ease of cleaning. They feel like they are fixed in your mouth but if you pull really hard on them you could dislodge them for cleaning, rather than cleaning them in your mouth as would be the case with a fixed implant bridge.

One of few advantages of dentures is that they can be removed for cleaning. This is convenient. You can juggle it in your hands while you are lathering frothy soap over it, getting your toothbrush into its every nook and cranny. With implants, it's the next level... You have to have manual dexterity and coordination to perform this act in your mouth.

denture

Can I wear dentures of implant denture at night?

You should definitely remove your dentures at night to prevent fungus growing under it infecting your gums. I am not kidding. Candida albicans is a fungal strain that can overgrow in your mouth if you don't give you gums enough time to rest. I know you will look toothless, but you must weigh up between the possibility of fungus growing in your mouth or looking toothless at night.

With full mouth implants you are safe. Because your palate would be uncovered, the risk of fungus is not an issue so it's perfectly safe to sleep with your full implant supported denture.

However, if your dentist has told you that you have a condition called nocturnal bruxism (grinding/clenching at night), they might recommend that you wear a grinding plate (occlusal splint) to protect your implants from the destructive forces of grinding or to go for a clip on implant supported denture. Essentially, this is a denture that clips on so firmly to implants that it feels fixed rather than removable when it's in the mouth, but you can remove it on demand. By removing it when you are asleep, you have nothing to grind on, so you can protect your implants.

What if I grind at night?

We have a perfect solution for you either way. As mentioned above, removing your full denture will stop you from grinding. Alternatively, an occlusal splint can protect your implants.

Will my teeth fall out of my mouth?

If it's really important to you that you can perform a party trick by removing your teeth, then go for full dentures. You will impress to everyone's horror! If you choose fixed implant dentures on the other hand, sadly no party tricks for you. You will be seen as normal and boring.

Jokes aside, full dentures can move and wobble, especially the lower denture. Initially people say that it's difficult to keep them in the mouth but eventually you will train your muscles to keep them in. It's like learning how to drive. Initially it's daunting but eventually it becomes second nature. Perhaps with full dentures, the end outcome is not as exciting; otherwise we wouldn't have people lining up at the door for full mouth denture implants.

Partial dentures are generally more comfortable than full dentures. They are held in place by acrylic or metal clips which keep them in place. However, if you really want something fixed that you don't have to remove and that feels similar to your natural teeth, than fixed implant dental bridge is definitely for you.

Toothless

Will my face sink in with dentures?

Out of all the questions, those considering dentures most commonly ask me this one. I am not entirely sure why many online articles seem to stress this point. As long as you have some support for your lips from dentures, implants or your natural teeth, you'll be fine.

It is true that if some teeth have been missing for a long time, some bone in the mouth resorbs, making it difficult to replace teeth with implants in the future, but generally this bone resorption is not sufficient to cause your face to collapse.

Both dentures and full mouth implants will give you enough soft tissue support to look good.

Are dentures or full mouth implants more durable?

In most cases, dentures and implant dentures are both made of acrylic. There are different qualities of acrylic around, but let’s say they are both removed "and" made of the same quality of acrylic, they will wear in a similar way. Because dentures aren't fixed, they have more give. Therefore, they technically wear at a slightly lower rate than implant bridge. In my experience, both acrylic dentures and implant dentures will need to be replaced in 5 -20 years as they wear and stain. The implants however, can often still give you many years of service despite worn prosthesis.

If you choose a stronger material such as zirconia or porcelain fused to metal for your implant bridge, then you will most likely experience significantly improved durability, but the initial investment will be higher. When it comes to durability, you get what you pay for.

Wearing a night guard to protect your implant denture from grinding and avoiding very hard biscuits or crusts will significantly improve its longevity.

Are implants painful? I am averse to pain, should I go for dentures?

Surprisingly, pain is a rare complaint with implants. So, what’s our secret? Medications! We are so spoilt with modern medicine. A combination of non-steroidal anti-inflammatories, short term corticosteroids and antibiotics work a treat. These medications keep people comfortable and sleeping well at night.

Dentures on the other hand don't require surgery so technically there should be no pain involved. Right? Wrong! They move and rub the gums, resulting in sore spots. I have more patients complaining about pain and discomfort associated with dentures than with implants. Ultimately, dentures can continue to cause pain and discomfort after healing, whereas implants should be pain-free.

The most common demographic of people we see who require full mouth implants are actually people who have a dental phobia. They are often terrified to even sit in the dental chair at the beginning, but by the end of the process, they jokingly tell me that they’ve been cured of their fear. Really? Surgery cures fear? Well, that’s what my patients tell me.

Is there a warranty on dentures and implants?

When it comes to warranty in medicine, there is no such a thing. The best guarantee we have is to prevent diseases through good nutrition and home care. I encourage my patients to hold on to their teeth for as long as possible, as there is simply nothing better than your natural teeth. Medical procedures carry no guarantees and dentistry is no exception. Everyone’s mouth is different, and results are not 100% predictable. How you care for your dentures at home, the presence or absence of teeth grinding, as well as the dentist's expertise, will affect the longevity of your dentures and implants. The way I think of it, if I do my job well and you do your part by cleaning them well and wearing a night guard if instructed to, I will go out of my way to assist you financially if something goes wrong. However, we both need to take responsibility when it comes to longevity.

Can implants fail?

In Australia, dental implants have a 94–97% success rate. The overwhelming majority of people have no issues with their implants. That being said, you can have the most experienced, cautious and skilled dental surgeon and still have an implant that fails. Medical conditions and autoimmune diseases, smoking, poor oral hygiene and active infections (like gum disease) all increase the likelihood of implant failure. Implant infections are easier to treat if detected as early as possible, that’s why seeing your dentist for regular follow ups is essential. Overall, the best protection is prevention.

What about the cost?

The big question. We appreciate that the cost of Dental care in Australia is not cheap, especially for dental implants.

There are many variables in calculating the cost of implants, such as what teeth are being replaced, how broad your smile is, and the angulation, length and size of implants being used, and whether a bone graft or sinus lift is required. The average price of full arch implants in Australia is $23,000 – $27,000 per arch.

Dentures are a cost-effective solution to replace missing teeth. With the average price of dentures being $800 – $3,500 (depending on the type) in Australia, you can get many sets of dentures for the price of implants. However, over a lifetime, the cost of replacements may eventually surpass the price of dental implants.

Cost of denture and implants

What if I am not suitable for implants?

Many people who are in good health are suitable for implants. However if you are not, you will have to consider dentures or bridges.

This is the criteria a dentist will use to assess your suitability:

  • Sufficient bone density – you require a good amount of bone in the jaw for the implant to fuse to. An inadequate amount increases the risk of implant failure. If there is not enough bone density in the jaw, a bone graft may be required before proceeding. 
  • Absence of gum disease – gum disease (gingivitis and periodontist) must be treated before having implant surgery. Gum disease is an infection that can cause your gums to recede and jawbone to shrink. This compromises the stability of your implant and causes peri-implantitis (implant infection), potentially causing implants to fail.
  • Good overall health – autoimmune and chronic inflammatory diseases can cause complications. Therefore, a dentist must assess whether you are healthy enough to undergo implant surgery. This does not necessarily mean free of disease, but at least have certain conditions under control.

You only get two chances in life when it comes to your teeth. The first set is the one that you were born with, which came for free, and the second set will be your last chance and it will cost you. A lot. Most likely you will not get a third chance. So full dentures might be the only option left. Implants are not easily replaceable, as they leave a deficit when removed. So, it's crucial to understand that your best chance is getting them done right the first time.

Why some people are not suitable even for full arch implants?

Even if you are sick of your teeth, and are ready to replace them, there are very important questions that need to be asked before considering this treatment:

  1. Can your teeth be saved?  If your dentist recommends a quicker, cheaper and more effective treatment option for you, it’s in your best interest to listen. There is nothing better than your natural teeth. We understand that you might have lost all faith in them and they’ve given you trouble over the years, but if there is a good chance that we can save them, take that chance. We are happy to educate you and show you how to look after them and maintain them at home. Keeping your natural teeth is always a better option that replacing them.
  2. Are you under the age of 25?  Some rare genetic conditions and accidents can result in young adults missing their natural teeth. You would need to wait until you’re over 25 to have all your teeth replaced with implants. That’s because we need to wait until the jaw and facial bones are fully developed. In many situations, your dentist may issue a denture to fill the gap until the jaw stops growing.
  3. Do you smoke? Smoking reduces blood oxygen supply and impairs healing, hence why smokers have lower implant success rates. Both in the initial phase of healing, as well as over the long term. We encourage our patients to quit smoking permanently. This increases your chances of a good outcome. Understandably, this is easier said than done. However, we can discuss strategies to assist you and prescribe medications you can take to help you quit. If you’re not ready to quit, it doesn’t necessarily mean that you can’t have implants, it just pays to be aware of reduced surgical and long-term success rates.
  4. Is your diabetes uncontrolled? Uncontrolled diabetes can also impede healing and result in a higher risk of implant failure. Diabetes potentially renders people more susceptible to infections and vascular diseases. It's not all doom and gloom, if you work with your medical practitioner to get your diabetes under control first, you would be perfectly suitable to have dental implants.
  5. Do you have a systemic disease? Certain systemic conditions such as Leukaemia, radiotherapy and chemotherapy can impede healing, so it’s not advisable to have oral surgery until you’ve recovered.
  6. Are you taking medications for osteoporosis? Some medications such as bisphosphonates slow down bone healing and would require careful consideration before committing to implants.
  7. Have you been told you don't have enough bone even for full arch implants? For some candidates, who don’t have adequate bone and require sinus lifts and bone grafting to even place implants, full arch immediate implants aren’t the best approach. A delayed or staged approach is more appropriate. You will get to the same end result but over a longer period of time. Teeth are removed first, followed by bone grafting, which is followed by the placement of implants. With at least a couple months between each stage. You can appreciate that this process would take longer than if bone grafting was not required. This is not a contraindication as such, just a variation to the immediate approach. If a dentist determines that there is not enough bone in your mouth to anchor implants. Bone grafting could be considered before implants are placed.
  8. Do you have high blood pressure? Hypertension is one of the most common conditions in Western countries. With the help of a healthy, whole food plant-based nutrition, anti-hypertensive medications and adrenaline free local anaesthetics, blood pressure can be stabilised, ensuring that it's safe for you to undergo implant surgery.
  9. Do you have periodontal disease? Advanced gum disease is one of the most common reasons people lose their teeth and require full mouth implants. Patients often get concerned that their new implants will also be affected by this condition. This is both true and false. In assessing your risk it's important to understand that periodontal disease is not only treatable but it's also preventable. Many find this unbelievable when they are facing the prospect of losing all their teeth. Nevertheless, this is true. If your dentist treats it in time, coupled with meticulous home care, periodontitis can usually be treated.

     

    Please be mindful that the expectation of good oral hygiene never stops – even with implants. Implants can develop a similar condition called peri-implantitis. Whereby bone support is lost around your implants in a similar manner to what would happen to a natural tooth with gum disease (periodontitis). It's still not well understood and thus has limited treatment options, although this area of science is evolving. Both the skill of the surgeon as well as thorough home care of your implants can minimise the risk of this condition. In other words, with appropriate care, you would be a great candidate for implants.

  10. What if you have osteoporosis? This is one of the common questions that patients ask. Interestingly, jawbone isn't as likely to succumb to osteoporosis as weight bearing bones, so most people with osteoporosis can still undergo implant surgery. There is one caveat - you must not be taking medications which inhibit bone turnover such as Fosamax (bisphosphonate) or Prolia (denosumab). If you do, it's is important to consult with your medical doctor to assess your suitability for implant surgery.
Unsure

The verdict: Dentures or dental implants?

When it comes to restoring your smile after tooth loss, dentures can be a good, more affordable option. But sadly, for many people, dentures can be uncomfortable and restrictive. It is a dilemma faced by many patients: dentures can be uncomfortable but a full set of dental implants are also more expensive.

Hopefully this article can help you weigh up the advantages and disadvantages of each. The decision between implants and dentures is a big one. It’s best you think about it carefully and in consultation with your dentist.

Who knows, there might even be a solution you haven’t thought of yet!

Dr Helen Voronina
Smile Consultation