By 2025 FDC Speaker Dana Marzocco, D.M.D
When I was a dental student, I distinctly remember being told, “You are not going to do many dentures or partials in practice. Implants are the future. Patients will no longer want dentures!” I have been in private practice for more than a decade, and that statement could not be further from my reality. Most removable prostheses that I fabricate are implant-supported.
There are patients who have worn a removable prosthesis for many years. Over time, there are anatomical changes that even a meticulously made denture cannot accommodate. There is a subset that does not function well in their removable prostheses.
I encounter patients who are reluctant to proceed with implant treatment. We can attribute it to a lack of understanding, fear of surgery, financial barriers or treatment time. Ill-fitting restorations or those having functional limitations need a solution.
Dentists may hesitate to offer this as a treatment option due to a lack of understanding of selecting and designing the implant overdenture. This is an overlooked option that can improve our patients’ quality of life.
An implant overdenture must be carefully treated, planned, designed and fabricated with the same precision as a fixed prosthesis. The nuances can be learned through continuing education and experience.
What are some situations where patients should consider implants over dentures?
- Difficulty with existing prosthesis.
- Shallow mandibular and/or maxillary vestibular areas.
- Atrophy of maxillary or mandibular ridges.
- Anatomical situations that contribute to limited or no retention.
These patients often struggle, rely on denture adhesive and cannot adapt to a conventional prosthesis.
What are the ideal number and position of implants?
- The anterior-posterior spread should provide a stable base.
- 2-4 mandibular implants (Fig.1).
- 4-6 maxillary implants (Fig. 2).
The anterior-posterior spread is significant as it helps to stabilize an implant-supported prosthesis. Improperly positioned implants can lead to instability during function.
How is design determined?
- Implant number and position.
- Framework or non-inclusion of framework (Fig.3).
- Selection of unsplinted abutments versus bar (Fig. 4, 5, 6).
- Tooth position and smile line analysis.
When considering design fabrication, it is critical to begin with an artificial tooth arrangement. Many components available to use in retention have vertical space requirements with varying degrees of retention.
There must be a collaboration between the surgeon and restorative dentist to ensure a successful outcome. With proper placement, design, and fabrication, implant-retained overdentures can significantly improve patients’ quality of life.
Dana Marzocco, DMD earned her dental degree from Tufts University School of Dental Medicine. She earned a certificate in prosthodontics and completed an implant fellowship from New York University. She completed a general practice residency at Montefiore Medical Center. She is a clinical assistant professor at Stony Brook University Dental School. She maintains a private practice in New Hyde Park and Fresh Meadows, NY.
Dr. Marzocco will present the courses “Implant Overdentures: Treatment Planning, Fabrication and Troubleshooting” and “Advancing Dentistry Through Digital Technology” on Saturday, June 21 at the Florida Dental Convention. Learn more and register at www.floridadentalconvention.com.
Beyond the Bite 