Fixed vs. Removable Bridge

Choosing between a removable bridge and a fixed bridge

Dear Doctor,
I went to my general dentist for implants. I have no teeth in one jaw and he has recommended that I see a prosthodontist. I went to the prosthodontist, and he is recommending implants but instead of permanent teeth (fixed bridgework) he is recommending removable teeth (an overdenture) that fits on top of the implants. I was surprised. Do you think this is a good way for me to go?

Dear Valerie,
Both your general dentist and prosthodontist (a specialist in advanced crown, bridge and denture work) are right. For those patients who have lost all their teeth, but have not lost significant bone, a fixed bridge (permanent non-removable teeth) may be the treatment of choice since the new bridge is not needed for facial and lip support. However, not all patients are candidates for this treatment. For those patients who have lost all their teeth and/or significant bone, facial and lip support, a removable overdenture, which fits “over” the implants, will often be the treatment of choice.

The decision-making process is a balance between patient preferences and the remaining bone, gum tissue, lip and cheek support.

Overdentures can be made with a full palate covered by denture plastic in the upper jaw or they can have an open palate design. The significance of the choice, to a large extent, is determined by a patient's personal experience. This approach to treatment is sometimes “patient-driven.” Your motivation and experiences, both physically and emotionally, will in part determine your satisfaction with the replacement teeth whether fixed or removable.

In order to achieve your goals, it is very important that you express your thoughts and experiences to your dentist or prosthodontist. The decision-making process is a balance between patient preferences and the remaining bone, gum tissue, lip and cheek support. For those patients with severe loss of these remaining structures, a removable overdenture will offer several advantages over the fixed type which include:

1. Aesthetics: This is often the determining factor. With an understanding of the art and science of facial aesthetics, a removable yet stable denture supported by implants can replace lost tissues, re-establish facial harmony and truly result in a “makeover” with results often described as remarkable.
2. Speech enhancement: Patients describe speech as a major factor in the satisfaction with their denture. All implant supported dentures or bridgework especially on the upper jaw may alter speech, but speech is generally shown to be better with a removable denture as compared to the fixed bridgework for those patients who have previously worn a denture.
3. Hygiene: It is very important to have direct access to clean the tissues surrounding the underlying implants. This design may optimally preserve bone.
4. Long-term maintenance: All full jaw implant supported fixed bridgework or removable dentures will require some maintenance. If designed well overdenture maintenance should be easier and more cost effective for both the patient and dentist.

To summarize a removable overdenture will be similar to the fixed bridgework, both supported by implants, in terms of comfort and ability to chew, but the overdenture will offer significant advantages for those patients with severe loss of bone, gum, lip and cheek support. The bottom line is that loss of teeth affects people on an entirely personal level, and that the treatment needs to be highly individualized to be successful. Make sure you give thought to what you want and need, then express yourself to your dentist so your objectives can be met. Good Luck!