During a recent session of the "Tell Me More About" series, Professor Peter Rammelsberg, Director of the Dental School at Ruprecht Karl University in Heidelberg, shared his expertise on removable restorations that combine both natural teeth and dental implants. This innovative approach offers an alternative to traditional dentures, particularly beneficial for patients with residual abutment teeth.
Why Combine Teeth with Implants? The primary rationale for combining teeth and implants in a removable restoration is to optimize the existing dental structures while minimizing the need for multiple implants. When residual teeth have a favorable prognosis, they can serve effectively as abutments, providing stability and reducing the overall number of implants required. This method not only preserves natural teeth but also leverages them to enhance the functional integrity of the dental prosthesis.
Choosing Between Removable and Fixed Restorations Professor Rammelsberg explained that the decision between removable and fixed restorations depends largely on the number of available abutments (teeth and implants). Typically, fewer than four abutments might necessitate a removable solution, whereas six or more could support a fixed restoration. This decision-making process reflects a balance between maximizing functionality and maintaining oral health.
Scientific Backing and Prognosis Removable restorations that combine teeth and implants have shown promising results in terms of reliability and longevity. Although the prognosis for removable dentures is slightly lower than for fixed prostheses, it remains acceptably high. Professor Rammelsberg pointed out that incorporating natural teeth does not negatively impact the prognosis and can contribute positively to the overall outcome.
Potential Complications While this approach is beneficial, it is not without complications. The main issues typically arise from the bases of the dentures, including implant failures and losses of abutment teeth. Other concerns include perimplantitis and wear on the occlusal materials, which can be exacerbated by the masticatory forces exerted on the dentures.
Managing Masticatory Forces Understanding and managing the masticatory forces in these restorations is crucial. Professor Rammelsberg noted that when only two implants are used in the mandible, chewing forces can be significantly less than those in natural dentitions. However, using a double crown retainer prosthesis with more than two abutments can help achieve forces close to those of natural teeth, enhancing the functionality of the denture.
The Role of Attachment Systems The effectiveness of these removable restorations also hinges on the attachment system used, which needs to provide not just retention but also adequate support. Creating a rigid framework that combines both implants and natural dentition is essential for distributing forces evenly and ensuring the stability of the restoration.
Overcoming Mobility Issues Contrary to some concerns in the dental community, the natural mobility of teeth does not pose significant risks when combined with implants in removable dentures. Studies have shown that these restorations can withstand normal functional loads without leading to overloading of the implants.
Conclusion: A Viable Option with Proper Planning Professor Rammelsberg concluded that with careful planning and understanding of the materials and biomechanics involved, removable restorations combining teeth and implants offer a viable and effective option for many patients. This approach not only preserves natural teeth but also provides a functional and aesthetic solution that can be tailored to meet individual needs.
As the field of prosthodontics continues to evolve, the integration of traditional techniques with innovative approaches like this promises to enhance treatment outcomes and patient satisfaction in complex dental rehabilitations.