The removable partial dentures are removable devices that allow one to replace many teeth. They are anchored by means of retainers (the most common being the hooks) to remaining teeth to replace some pieces and not the complete arch. Like all dentures, removable dentures seek to replace missing teeth.

In addition to teeth, these removable partial dentures can replenish bone and gum tissue when these tissues have been lost through time or infection.

By being removable, they facilitate the hygiene of both artificial and natural parts that remain in the mouth. In addition, they offer the possibility of improving chewing, aesthetics and speech. However, they have some drawbacks, and that is that they can lead to an overload of the teeth on which the hooks rest and accelerate the process of atrophy of the bone and gum on which it rests. Also at the beginning they can cause chafing on the gum and give a sensation of instability; The process of adaptation deserves a time, with special care, until the patient is not aware of wearing prostheses.

Because of these inconveniences, these removable prostheses are not usually the first option to return the patient’s smile when some teeth are missing. When the patient meets the conditions of general health and availability of bone to place dental implants, these will allow to return a situation more similar to that of natural teeth, both in aesthetics and in operation.

Even so, in our advanced dental clinic in Kirti Nagar, removable partial dentures maintain some clear indications. Its main use is as temporary prostheses to temporarily restore aesthetics to patients who must wait after receiving dental implants or bone grafts. Another minor indication that will never disappear is as definitive prostheses for patients who, due to having a serious illness, do not have the possibility of undergoing implant placement surgery.

Types of removable partial dentures

Skeletal dental prosthesis

They are called the removable prostheses that have a metal part to which the artificial teeth are anchored and the pink acrylic that imitates the gum. In turn, this metal skeleton has hooks or supports that are attached to the natural teeth present and allows to keep the prosthesis in place.

The metal part is also constituted by a more or less wide bar joining the two sides of the prosthesis. Basically it must have a major connector or armor, minor connectors, retainers, bases, occlusal supports, stabilizing elements and indirect retainers.

If you are going to opt for this treatment it is very important to know that, depending on the location, you can sacrifice part of the aesthetics (the patient is exposed to the hooks are visible) and hygiene is a key factor to prevent the remains of food are retained by the prosthesis, thus increasing the formation of plaque in other healthy teeth.

This type of prosthesis is rarely used as a provisional in dental implant treatments because its cost is higher than the partial resin.

Removable resin prostheses

Like the skeletal ones, the resin partials also need remanent teeth to sustain themselves, by forged or cast retainers. They are less used as definitive prostheses, because the skeletons offer higher quality. They are used in most cases as temporary prostheses, or when the remaining natural teeth are in poor condition.

They are made of acrylic resin, a material that tries to imitate the anatomy of the teeth and the gum, to cover the spaces that have left the lost teeth in the mouth. Likewise, it has small hooks that attach it to adjacent pieces.

Advantages of removable partial dentures

The main advantage of removable partial dentures is the possibility of replacing dental pieces economically.

If the patient opts for this treatment, it must be taken into account that good hygiene will be key to its durability and to limit the collateral damage to the remaining teeth by the plaque accumulation, increasing the possibility of decay and loss of supporting teeth.

The patient has the possibility of taking advantage of the characteristic of being removed and put, to perform a correct hygiene of the pieces, which is considered a great advantage.

Likewise, it is an advantage to use removable partials, the durability and the ability to adapt to the specific needs of the elderly.

Disadvantages of removable partial dentures

It represents a disadvantage that removable partial dentures rest on healthy teeth to hold in place within the denture. If proper hygiene is not carried out, it greatly increases the chances of suffering from serious periodontal diseases and decay, due to the accumulation of plaque.

Another of the consequences is that over time the remaining teeth that serve as support change position or move, eventually affecting the maxillofacial bone. The prosthetic structure also tends to produce discomfort and ulcerations that require checking and adjustments by the dentist.

The metallic and plastic elements can fracture with the use, reason why its retirement and immediate revision is required before the possibility of damages to other pieces or soft tissues of the buccal zone.

We must not forget to mention the aesthetic disadvantage of this type of prosthesis compared to other implantological options, since the hooks are almost always visible and the artificial pieces are far from an aspect, shape and natural tone.

Finally, a very important disadvantage is that they rarely reach the comfort of an implant treatment. Being removable they also move in the patient’s mouth, and this instability can be a problem for some patients.

If you have any questions, do not hesitate to ask our dental prosthetics experts in Valencia . In our dental clinics located in the capital of Turia , we have the best professionals at the service of your oral health.

When we want to rehabilitate a patient on implants, the choice of the type of prosthesis should be chosen at the time we plan the treatment, that is, the type of prosthesis that we use must be the one that guides us at the time of performing the surgery. There are different types of prostheses to be able to rehabilitate a patient with implants, they can be fixed or removable, and inside the fixed prosthesis they can be screwed to the implants, or cemented. Depending on each case, one option or another will be better when rehabilitating the patient.

A complete hybrid prosthesis is an acrylic prosthesis that remains fixed in the mouth thanks to the help of dental implants. It is an option in the treatment of implant rehabilitation, which allows the patient to have new fixed teeth and recover their aesthetics and masticatory function. Characteristics of hybrid prostheses:

• It is a completely fixed prosthesis
• Gives a moderate support to the upper lip
• Gives patients very good aesthetics
• It usually takes between 4 and 6 implants to rehabilitate the upper arch and 4 implants to rehabilitate the lower arch

The hybrid prosthesis consists of a metal structure to give it greater robustness, covered with acrylic and at the same time supports the artificial fixed teeth of acrylic resin. To anchor the prosthesis in the bone, 6 osseointegrated implants are required per dental arch.

The implants are communicated by a metal bar and on this bar the acrylic or resin prosthesis is fused, which will have the holes where we will have to tighten the screws to anchor the prosthesis to the bone. As advantages provided by hybrid prostheses we have that they are cheaper than porcelain crowns on metal or zirconium. In addition, in the case of having to make a change over time, it is much simpler, cheaper and faster.

The disadvantage of hybrid prostheses compared to porcelain teeth is that they are slightly less aesthetic. But currently, with the new acrylics we can achieve very high aesthetic results. On the other hand, this type of dental prosthesis improves the aesthetics more than those of porcelain in cases in which it is necessary to support the upper lip or artificial gum must be placed. Another disadvantage that we have to provide is when it comes to sanitizing the prosthesis, which will be more complicated than with removable prostheses.

The hybrid prostheses on implants are designed through the computer by a program called CAD-CAM The metal is made, either titanium or chromium-nickel, on which the artificial pink gum and the prefabricated teeth will be placed. This type of prosthesis is indicated for patients with moderate bone loss, its main advantage being that they do not have a palate and are very aesthetic, comfortable and comfortable for the patient.

This type of prosthesis is screwed onto the dental implants and for the patient they are completely fixed and can not be removed, although in the case that it is necessary to modify or touch up any part of the prosthesis, the dentist can easily remove it from the mouth of the dentist. patient.

Fixed prosthesis screwed on implants (metal-ceramic)

The ceramic metal prostheses on dental implants serve to rehabilitate the denture in completely edentulous patients.

Fixed prosthetic rehabilitation with implants is the ideal solution in fully edentulous patients. When there is an alveolar ridge and sufficient bone mass and it is possible to place a number of titanium implants of adequate length and distribution.

The aim of the treatment is that the patient can take an implant-supported prosthetic restoration as functional and aesthetic as possible. Dental implants can support single crowns, bridges, or even implant-supported prostheses with full arches. The latter can be made of different materials.

The ceramic metal prosthesis on implants combines a metal structure with ceramic teeth to achieve a better naturality of the fixed teeth and a superior aesthetic result compared to the hybrid or metal resin prosthesis.

When there is no bone loss we bet on the All-on-6® and the All-on4®. This technique is appropriate to replace all the teeth and rehablite the upper jaw and lower jaw when a serious reabsorption of the bone has not yet been detected.

It consists of placing only six implants above, in the maxilla, using the Nobel Biocare system that is commercially known as an implant as All-on-6®. And four implants below, in the jaw, using the system that is commercially known as All-on-4®, instead of using the traditional technique of unitary implants for the total rehabilitation of the mouth.

This will allow us to make and place a fixed acrylic dental prosthesis in the first twenty-four hours after surgery. What gives this type of implants its characteristic of immediate function. A few months after the surgery, the definitive dental prosthesis is placed. It is also a fixed prosthesis, tailored to the patient’s needs, and in which higher quality materials are used, providing greater aesthetics. These techniques are fast, safe and predictable.

Bruxism is the involuntary habit of grinding or squeezing the upper teeth with the lower ones without functional purposes.

It is a growing problem in today’s society, due to the increasingly intense pace of life, which increases the stress and emotional stress suffered by the patient. In fact, it can become a chronic disorder that occurs with periods of exacerbation in periods of higher academic or work stress.

What types of bruxism are there?

Bruxism can be:

• Day or wakefulness bruxism : occurs during the day. In this case, you tend to clench your teeth, but rarely to grind them,
• Night or sleep bruxism : occurs at night and usually coincide both activities, clenching and grinding teeth.

In many cases, both types coexist.

In addition, bruxism can be classified into:

• Central: tightening of the two dental structures without lateral mandibular movement.
• Eccentric:  Grinding or rubbing of some teeth against others occurs. It can be nocturnal or diurnal, although it usually occurs during sleep.

Who has it?

According to data from the Spanish Sleep Society (SES), waking bruxism could affect between 22% and 31% of the general population, with a slight predominance in women. On the other hand, the bruxism of the dream is suffered by men and women equally and would affect 8.2% of the population.

The spontaneous remission of this problem usually occurs after 40 years, although it can also disappear only at any time. In any case, according to the SES, bruxism decreases with age and, after 65 years, the percentage of incidence is significantly reduced until reaching only 3% of the elderly.

What causes bruxism?

There does not seem to be a single cause that causes this disorder, but its origin can be due to multiple factors:

• The age : bruxism is common in children, but usually goes away over the years.
• Genetic and family or hereditary factors .
• Suffer alterations in dental occlusion and / or joint and bone abnormalities .
• Suffer mandibular disorders .
• Suffer stress, anxiety or personality problems.
• Have sleep disorders and / or apnea.
• Smoking or consuming caffeine or alcohol .
• The abuse of drugs such as cocaine or amphetamines.

What are your symptoms?

Although often the person affected by bruxism is not aware of them, this disorder can cause signs and / or symptoms such as the following:

• Wear of the dental structure , especially on the edges of incisors and canines, as well as on the cusps of molars and premolars.
• Wedge-shaped lesions at the gingiva of some teeth.
• Dental mobility
• Sensation of “noticing the teeth” when getting up in the morning.
• Muscle pain that intervenes in chewing.
• Disorders in the mandibular joints such as difficulty opening the mouth, noises or clicks in the opening or closing.
• Headaches , especially in the temporal region, on both sides of the head at times upon awakening.
• Gingival recession ( moving away from the gum of the tooth).
• Dental sensitivity with cold or sweet.

How is bruxism diagnosed?

The diagnosis of bruxism is made through a clinical assessment in which the symptoms expressed by the patient and the signs of the condition that manifests itself are collected.
It must be taken into account that there is not a single sign or symptom that implies the presence of the problem, but all the parameters involved must be considered: dental wear, headache, muscle pain and / or joint noises.

How is it treated?

The treatment of bruxism varies depending on its cause, since it can be associated, in addition to morphological aspects, to sleep or behavior alterations or environmental and emotional stress. For this reason, a prosthetic treatment, a prosthetic-periodontal approach or a multidisciplinary approach may be necessary, which may include psychiatric or behavioral measures.

In general, the most widespread treatment is the use of a splint to deprogram or discharge, a rigid acrylic plate that is placed in the upper structure or in the lower one, elaborated and adjusted to the patient’s measurement. Although this splint does not prevent the tightening of teeth, it does relieve the signs and symptoms it produces and prevents tooth wear.

In very advanced cases, in which there has been a very severe wear of the teeth, restorative odontological treatments may be necessary.

Ten tips to relieve bruxism

Although bruxism occurs involuntarily, there are several habits that can help the patient to prevent it or mitigate its symptoms:

Plant face stress.

This is one of the main factors that can cause or worsen the problem, so it is advisable to try to remain calm in complicated situations and to go to sleep relaxed. It can help you achieve it by learning relaxation and breathing techniques and practicing activities such as yoga, tai chi or meditation.

Try to keep your face and jaw relaxed.

Although most of the time they clench or grind their teeth without us noticing it, try to make the conscious effort to relax your facial and jaw muscles during the day, until it becomes a habit.

Avoid movements that irritate the jaw joint.For example, do not chew gum or eat your nails.

Perform stretching regularly.

Learning and practicing physiotherapeutic stretching exercises can also help you to recover the action of the muscles and joints on each side of the head, which will help you to mitigate the symptoms.

Massage on the neck, shoulders and face.

Look in them small and painful nodules, known trigger points, which can cause discomfort and pain in these areas of the body

Apply heat to the joints.

It will help relieve inflammation. Applying ice to the muscles of the jaw can also be effective.

Use toothpaste for sensitive teeth.

It may help to alleviate some of the symptoms of bruxism such as sensitivity to cold or candy.

Sleep in the proper posture.

Better, face up and using a cervical pillow can help you relax the muscles of the jaw.

Do not remove the splint during the night.

At the beginning of the treatment, it is normal to notice pressure on the teeth, but it is important to keep the splint on throughout the night and, even, to use it during the day in times of stress.

Go to periodic check-ups to your dentist.

If you suffer bruxism, it is necessary that your dentist follow the treatment. In case you do not have any specific problem, it is also advisable to have a review at least once a year.

A fixed prosthesis consists of a device made to measure from the mouth of the patient with one or several dental pieces that is placed in the mouth to replace the loss of the teeth.

We could distinguish two types of fixed dental prostheses, those that are supported by dental implants, and those that rest on healthy teeth of the patient.

• Fixed prosthesis on teeth: In this case the prosthesis is fastened on the patient’s own healthy teeth , so that a great support and firmness is achieved. For this the dentist needs to carve and wear both in width and height the 2 teeth located at the ends of the edentulous area (without teeth), forming what is known as a stump, so that later the prosthesis can fit over them to be able to cement it and in this way to achieve a durable fixation. The main disadvantage of this type of prosthesis is precisely that it is necessary to damage two healthy teeth to achieve the fixation of the prosthesis.
• Fixed prosthesis on dental implants: In this case, the prosthesis is fastened on one or several titanium implants that act as root of the tooth, and on which the dental prosthesis is attached, either a crown or a bridge with several pieces.

Types of fixed prostheses

If we distinguish the prosthesis according to its shape we can distinguish 3 types fundamentally:

Crowns

Also known as “sleeves” by patients, they consist of individual prostheses of a single tooth . These crowns are placed on the natural tooth of the patient previously carved, or on a dental implant whether they are screwed or cemented.

These teeth are made by hand by a prosthetist in the laboratory, taking as a measure the impressions taken in the clinic and adapting the crown to the color and shape of the rest of the patient’s teeth, to achieve the greatest possible mimicry with the rest of the mouth .

There are two fundamental types of crowns: those of metal-ceramic and those that are totally ceramic.

Dental bridges

It is a type of prosthesis used for the replacement of at least one tooth, therefore consists of a minimum of 3 pieces , two of which are called retainers and which are cemented on the natural teeth that will act as pillars and support the bridge. The rest of the pieces of the bridge whose function is to replace the missing pieces are called pontics.

Complete dentures

It consists of a Gradia or Adoro hybrid prosthesis, is screwed on dental implants, and completely replaces the teeth of one or both arches . It is made with a computer-designed micro-reinforced metal reinforcement on which will be gum artificial rose and prefabricated veneer gradia (a type of composite).

Its main advantage is that they have no palate and are very aesthetic.

Denture or dental prosthesis

Advantages of fixed prostheses over removable prostheses

Fixed prostheses are much more comfortable than removable prostheses , by not having to remove it after each meal to clean it avoiding the disorder that this entails. On the other hand, the support and firmness provided by a fixed prosthesis is much higher than that of a removable prosthesis, achieving greater safety when chewing and talking.

Fixed prostheses require greater care and hygiene, as well as a review process by the senior specialist. One of the problems of dental bridges when they are fixed on teeth, is that with the passage of time it is very possible that both the bone and the gingiva of the edentulous part is decreasing, leaving visible hollows between the prosthesis and the gum that They make you lose a bit of the aesthetics and functionality of them.