This blog is a continuation of the last blog on implant therapy. This time I am going to talk about prostheses supported by implants.

The prostheses that implants can support are a crown, a bridge or a denture (hence called overdenture). The fees for implants and prostheses are usually high because of the expensive costs of the many machines, equipment, instruments, parts and accessories, sundries, sterilization wraps (and pouches) and the charges from the dental laboratories making the prostheses.

At Affinity Dental Care, we use three implant systems: Straumann, Conelog and Molaris implants. All three are high-quality implants that cost over $600 per implant. Additional parts are needed to go onto the implants, like healing caps (the cover screw on the implant) and healing abutment (the long conical cylinder that attaches to the implant and sticks out of the gums). When making the prostheses, there are additional costs for the impression, implant to the crown interface, overdenture attachment, and the making of the crown etc. They can cost at least $750. Not to mention the costs of the numerous sundries like sterilized saline, irrigation tubing, syringes, gauze and protective sheets etc.

The cost can be even higher when bone graft and membrane are involved.

Our expenses to place an implant and a crown onto it can easily be $1,500. Not to mention the special machines and instruments specifically for the procedures in the process.

Implant surgery and placement can be unpredictable, complications can arise, and additional surgeries, remakes and repairs may be needed. Usually, we only charge our patients the costs for the extra supplies and lab bills to our patients.

There can be some inadvertent complications to the prostheses:

An implant involves many procedures. Each procedure requires precisions. Pre-surgical examination and treatment planning is essential. Even with careful preparations, complications can happen. They can be:

  1. Breakage/fracture/loosening
    With time, you may inadvertently break/fracture/loosen the prosthesis, the implant(s), or the implant component(s). In particular, your prosthesis is connected to the implants by small internal screws that you can inadvertently loosen or fracture. Usually, these complications can be fixed relatively quickly, and fractured prostheses can be replaced without further complications.

  2. Implant failure/infection
    Implants supporting the prostheses can fail or can become infected. The treatment may require surgical intervention(s) and may have significant implications for your prosthesis, appearance, and usability. Occasionally, a new prosthesis may need to be made, or the design of the current prosthesis may be modified significantly as a result. The costs of managing failed, or infected implants and a new prosthesis or repairs/modifications to the existing prosthesis are not usually included in the initial estimate. This cost can be high and higher than the initial treatment’s cost. The time needed to manage such situations can also be significant.
  3. Adaptation/acustomization/expectations/realities of your mouth
    Although the prosthesis can come close to the appearance and functionality of your original teeth, it is not a perfect copy or replica of your teeth. However, we seek improvement over your current situation and not perfection. We cannot guarantee the delivery of a “perfect smile” or teeth that feel “just  like your own teeth.”  Expectations can be unrealistic if you expect implant-supported teeth to look and feel just like natural teeth, especially when you have lost the teeth for a long time and the site has severe bone resorption. As a result, the implant-supported teeth will not have the actual gums supporting the implant crown with the natural contour. However, it can appear very naturally with pink gum appearance. Rarely have some patients been unable to become comfortable with their new implant-supported prosthesis.

  4. Changes over time
    Your mouth will undergo slow changes with time. Your gums may shrink, and adjacent teeth may drift, be extracted or change colour. Your prosthesis will also undergo slow changes over the years. The surface may wear and change its colour. The gums around may shrink or grow more prominent. Such changes are very slow but may impact the appearance, functionality or longevity of your implant-supported prosthesis and may lead to a need or desire on your part for modification or remake of the prosthesis.

  5. Temporary prosthesis
    Frequently, a  temporary crown/bridge/denture/retainer is needed to help you cope with the missing teeth until the completion of treatment. These temporary appliances have limitations of fit, appearance, and durability. In particular, they can be brittle, dislodge easily, and wear/disintegrate quickly. There may be treatment times when you are advised not to wear your temporary prosthesis so that the surgical tissues can heal undisturbed. You will usually be informed of this in advance.

    Rarely are some patients unable to wear their temporary prostheses (mainly temporary dentures). There is usually no harm if the patient stops wearing the temporary denture(s). About overdentures

All prosthodontic prostheses require a period of adaptation after their insertion (i.e., when you become accustomed to the new prosthesis), including feel, speech, bite, self-biting etc. The prosthesis may appear foreign, uncomfortable, and annoying during this adaptation period. These issues are typical and will become better with time. Some of the common problems are outlined below.

  • Feel: Your prosthesis may feel big and bulky. You may feel extra fullness in your lips or insufficient space for your tongue.
  • Speech: You may notice that some sounds or speech, in general, are negatively affected. This phenomenon is typically much more noticeable to you than to others. We advise reading out loud to allow for your speech to improve. Some clinical situations are particularly likely to result in temporary (and, occasionally, permanent speech effects). These clinical situations include replacements of upper front teeth and patients who wore upper removable dentures for an extended period before transitioning to a fixed implant-supported bridge.
  • Food impaction: You may notice food annoying getting caught between, around, or under your prosthesis. We will do our best to address this. However, occasionally this problem cannot be eliminated completely.
  • Bite: We will create a bite for your prosthesis that is even, comfortable, and least damaging to your prosthesis and your remaining teeth. However, your implant-supported prosthesis cannot and will not feel exactly like your own natural teeth.
  • Self-biting: Your gums and tongue are not accustomed to the presence of the new prosthesis. You may notice biting your tongue or lip until they become accustomed. This problem can be very uncomfortable. Eating slowly is usually a good strategy until your mouth becomes used to the new prosthesis.
  • Saliva: Excessive salivation is very common after inserting a new prosthesis. Excessive salivation typically resolves quickly as your mouth learns that the new prosthesis in your mouth is not a candy.
  • Denture sores: Patients who receive removable dentures or overdentures should expect that the dentures will cause some temporary gum irritation. This is usually easily improved through adjustments to your denture by the dentist. Several appointments may be needed.

Your overdentures are retained to the implants by clips with plastic inserts. These inserts will wear over time and require yearly (or sooner) replacements.

  • Relines
    Your gums will continue changing their shape as you age. This will likely cause your overdenture to lose its precise fit to the gums. As a result, it may start feeling loose, and you may notice food collecting underneath after several years. Your removable dentures/overdentures will need regular relines every few years as the need arises. 
  • Retention
    An overdenture is a removable prosthesis. You may discover at your treatment’s conclusion that you wish your removable prosthesis to be even more retentive than possible with the current design. This can often be accomplished where appropriate by placing additional implants and fabricating a brand new prosthesis. 

About crown(s)/bridge(s)

  • Crowns and bridges are held to the implants by small internal screws. These screws fit through small channels in your crown(s)/bridge(s). The very top of the channel(s) is covered with small filling(s) after the treatment. This small filling may occasionally dislodge, leaving the channel open. This represents no danger or risk for anything other than the possible annoyance of food getting stuck inside the hole. The hole can be easily resealed with a new filling.
  • Cleaning
    Your teeth and new prosthesis must be kept impeccably clean by you at home and professionally cleaned regularly at a dentist’s office. Failure to do so may cause the development of an infection and may cause the loss of your implant(s) or the prosthesis. 
  • Monitoring
    You must return for regular recall assessments. These assessments include a clinical exam and radiograph(s) (Xrays). Many problems that may occur with implant treatment will not be noticeable to you at first until it is too late. It is your responsibility to bring to our immediate attention any complications that you may encounter. Failure to do so may cause a simple-to-fix problem to become more extensive and expensive.

This second blog, together with the first one, is the information we at Affinity Dental Care provide to our patients to help them understand the implant therapy and make the right decision on the treatment. Our goal is to give the patients the proper treatments suitable for their conditions and help them achieve healthiness and confidence that will last.