Dental Prosthetics

"Denture" is not the name of one thing; it covers solutions that differ considerably. Which one suits you depends on how many teeth are missing and on the state of the bone.

• A complete denture. Made when no teeth remain in the jaw. It is retained by suction across the palate in the upper jaw and by tissue support in the lower.
• An immediate denture. Fitted on the day of extraction so you are not without teeth while healing. It is also used where implants are planned, moving to the definitive solution once healing is complete.
• A partial denture. Made where some teeth remain; it takes support from those teeth and from the tissue. The connection is either by metal clasps or by precision attachments that do not show.
• An implant overdenture. A removable denture locked onto two to four implants by retentive attachments — the "clip-on" solution.
• A fixed implant prosthesis. A bridge screwed onto four to six implants and not removed by the patient. All-on-4 and All-on-6 belong here.

The difference between these four is not only comfort; their effect on bone differs too. Tissue-supported dentures spread chewing force across the gum and the bone beneath; that force does not preserve bone — it accelerates its loss. With implant-supported solutions, force passes through the implant directly into bone and resorption in that area stops.

A note on terminology: a precision attachment is the concealed connection used in a partial denture on remaining teeth. "Clip-on" describes the retentive attachments used on implant overdentures. They are not the same thing, and it is worth asking which is meant when reading a quote.

This is the most important distinction for a complete-denture patient and it is rarely explained.

An upper denture usually retains well. The palate provides a large surface; a thin film of saliva between the denture and the palate creates suction and holds it in place. Most patients adapt to an upper denture within a few weeks.

A lower denture is difficult. There is no broad supporting surface like the palate; the denture sits as a horseshoe on a narrow ridge of bone while the tongue, cheeks and lips displace it constantly. Most patients complaining about a lower denture are up against anatomy rather than against a dentist's error.

That difference grows over the years. As bone resorbs the lower ridge flattens and the surface available for retention shrinks. In a patient who has worn dentures for twenty years the lower ridge may be almost completely flat.

The practical consequence: two implants in the lower jaw, locking the denture in place, change the situation entirely. We present that not as an upgrade but as the natural complement to a lower complete denture — because the overwhelming majority of complaints come from the lower.

This is the option most patients have never heard of and are most pleased with when they do. It sits between a conventional denture and a fully fixed bridge.

Two to four implants are placed in the lower jaw. Attachments fitted inside the denture lock onto them; the denture can be taken out by hand but does not move while speaking or eating.

The return is disproportionate: two implants mean far less surgery and far less cost than four or six, yet they largely solve the complaint patients actually have — the denture moving. For someone struggling with a lower denture this is usually the highest-return intervention available.

One point of honesty: in the upper jaw, an overdenture on two implants generally does not free the palate. Opening the palate reliably requires four or more well-distributed implants. If being rid of the palate is your aim, that is a four-implant conversation and it should be settled before surgery.

Attachment systems include ball, locator-type and bar-retained designs. Which suits depends on the position of the implants, how parallel they are and the space between them.

Where the implants are placed and how they heal follows the same protocol as any other implant case: planning from a CBCT, three to six months of integration, and the attachments connected at a second visit. During healing your existing denture is hollowed over the sites and soft-lined, so you are never without something to wear.

With implant support there are two routes, and the choice is not only about comfort.

The fixed option has a clear advantage: it feels like your own teeth and there is nothing to take out. But two points deserve stating plainly.

First, cleaning. Under a fixed bridge has to be cleaned daily by the patient, using super floss and interdental brushes. That is harder than washing a removable denture at a basin, and it can be a genuine problem for patients with reduced dexterity.

Second, lip support. In a patient with advanced bone loss the lip and cheek collapse inwards because of the lost volume. The flange of a removable denture restores that volume; a fixed bridge generally cannot. In those cases "fixed is better" is not true, and it becomes visible together at the try-in stage.

The decision is made together after a CBCT and examination. A choice made without the maintenance burden and the limits of both options being explained is a choice made on incomplete information.

A denture is made rather than fitted. That distinction explains why the result needs a sequence of appointments.

1. Primary impression. A general impression taken in a stock tray.
2. Secondary impression in a custom tray. A precise impression taken in a tray made for your mouth, recording tissue movement as well. Most of the retention is won at this step.
3. Jaw relation record. The position of the jaws relative to one another and the vertical height are established. Get this wrong and the denture will not be comfortable however good it looks.
4. Wax try-in. The teeth are set in wax and tried in your mouth. Appearance, tooth shade, the midline and speech are assessed here.
5. Finishing and fit. The denture is processed in acrylic, polished and fitted.
6. Adjustment appointments. Pressure points are relieved over the first weeks; these appointments are part of the plan.

The fourth step must not be skipped. The wax try-in is your opportunity to see the tooth arrangement, the lip support and the midline while they can still be changed, and to have a say. "The teeth look too even" or "too white" belongs at that moment; after the denture is processed, the same change means remaking it.

A workflow that goes straight from impression to finished denture is quick, and it removes the only stage at which your opinion could alter the result. Here the wax try-in is never skipped, and if it is not liked the teeth are re-set.

A newly fitted denture does not feel settled in the first days, and that is normal. A few adjustment appointments are needed to relieve pressure points over the first weeks; those are a standard part of the process rather than a problem. We state how many adjustment appointments are included in the quote.

Most of what happens in the first weeks with a new denture is ordinary, and knowing what is normal makes the process easier.

• Bulkiness and a sense of something foreign. Marked in the first days, gone within a few weeks.
• Increased saliva. The mouth reacting to a new surface; it lasts a few days.
• Changes in speech. Particularly with "s" sounds. Reading aloud speeds up adaptation.
• Pressure points. Soreness at a specific spot is normal and is corrected by adjustment. Do not file the denture yourself — it turns a fixable problem into an unfixable one.
• Difficulty chewing. Start with soft food and progress gradually. Chewing small pieces on the back teeth works better than biting.
• Changes in taste and temperature. With an upper denture covering the palate, the temperature and texture of food feel different. Taste buds are on the tongue, so taste itself is largely preserved.

Adaptation varies between individuals; usually two to eight weeks. It is shorter in patients who have worn dentures before. A first-time denture wearer needs patience, and attending the adjustment appointments is the most decisive factor in that period.

On adhesives, let us be clear. Adhesive does not substitute for a well-made denture; it provides temporary confidence. If you can only manage your denture with adhesive, that is a sign it needs relining or remaking. Adhesive hides that need and lets the underlying problem progress.

Denture care has two parts: the denture itself and the tissues beneath it. The second is more neglected and more important.

• Remove and rinse after every meal. Food debris collects underneath.
• Clean daily with a denture brush. Ordinary toothpaste is abrasive and scratches acrylic; use a cleaner made for dentures.
• Leave it out at night. To rest the tissues and to reduce the risk of fungal infection. Store it in water or a cleaning solution overnight.
• Brush the mouth and gums. Even without teeth, the gums, palate and tongue should be brushed with a soft brush.
• Protect the remaining teeth. In a partial denture the teeth carrying clasps decay faster and need particular attention.
• An annual check-up. Even with no teeth.

The reason for the annual check is the mouth rather than the denture. Because bone continues to resorb, the fit between denture and tissue deteriorates over time; a well-fitting denture starts to move within a few years. The answer is usually not a new denture but a reline: the fitting surface is renewed to match the present tissue. Done in good time, relining extends the life of a denture considerably.

Implant overdentures carry one additional maintenance item: the retentive inserts wear with use and are replaced periodically. That is part of the design rather than a failure, and it is a cost that should be stated at the outset. Replacement is a short appointment.

One rule, without exception: any ulcer, sore spot or swelling that has not healed within two to three weeks must not be treated as another pressure point to adjust; it must be examined. In long-term denture wearers this rule matters particularly, and it is not negotiable.

Partial denture wearers have one additional follow-up item: the gum health of the teeth carrying the clasps. Those teeth take extra load and plaque collects around the clasp. At the annual check their periodontal condition is assessed separately; losing an abutment tooth means remaking the denture as well.

Like every treatment carried out here, dentures carry a lifetime guarantee on materials and workmanship. The need for relining as bone resorbs, and wear of the retentive inserts, are known maintenance items rather than defects; which of these falls within the guarantee is set out in writing.

The decision rests on three things: how many teeth are missing, the state of the bone, and whether you are open to surgery.

"First option considered" is deliberate wording. These are not recommendations but the options looked at first at the examination. What actually suits is decided by CBCT and clinical examination.

Not wanting surgery is an entirely legitimate preference and we do not question it. What follows is making the removable denture as well as it can be made: a precise impression in a custom tray, an accurate jaw relation record and a try-in that is never skipped. The difference between a well-made complete denture and a rushed one is very obvious in daily life.

Budget is a legitimate constraint too and is worth discussing. A staged plan is often possible: begin with a removable denture, and add implants later to convert the same denture into a clip-on system. Planning that transition from the start is far more economical than remaking everything later.

At the consultation every option that suits you is explained with its timeline, its cost and its maintenance burden. Our implant page covers the surgical side in detail and our bridge page sets out the fixed alternative.