A New Take on an Old Idea: Alternatives for Denture Wearers

Trying to get used to a denture can be traumatic if you have recently lost your teeth.    Upper dentures cover the entire palate, which may cause a gagging or choking sensation and diminish the taste of food.   Lower dentures are likely to loosen while eating, requiring gooey denture adhesives.   Over time, dentures may become painful, causing ulceration of tissues in the mouth.  Even when they fit well, dentures only provide 20 percent of the biting strength of real teeth.  Eventually the bone that supports them starts getting re-absorbed into the body and the dentures have to be repeatedly relined.   The caved-in appearance of the face in elderly denture wearers is due to bone re-absorption.

Implants are the modern, high tech alternative to dentures, but many denture wearers assume that they’re not affordable.   In fact, implants don’t have to be astronomically expensive and there are a number of alternatives when it comes to cost.  Overdentures, the least expensive alternative, are basically dentures that snap onto implants but are much more comfortable. Smaller than dentures, they require less coverage of the palate and lower gums, and they’re fixed, not mobile.   Since they’re anchored to the jawbone, they give you more chewing power, which in turn maintains bone density.

The simplest, most inexpensive overdenture is attached to two implants in the lower jaw and four or more in the upper.   These overdentures are still partially supported by the gums, but they’re much more comfortable, are removable and can be cleaned daily.  If there isn’t enough bone for traditional implants to support overdentures, Manhattan periodontist Nicholas Toscano, DDS, Co-Editor in Chief of the Journal of Implant and Advanced Clinical Dentistry uses an “all-in-four” system.  “Four implants are placed on both the top and bottom angled in such a way as to avoid the nerves and provide stability for the denture,” explains Dr. Toscano.

“If you want a more permanent solution you can go for the more expensive fixed bone anchor bridge, requiring six or eight implants to be placed on the top and bottom —to support a denture which is screwed in permanently,” explains Tim Kosinski, DDS Assistant Professor at the University of Detroit Mercy School of Dentistry.  “For some people the permanence of the denture is very important, they don’t want teeth that come out.  However, the fixed overdenture can be difficult to keep clean so we try to design them so they’re maintainable.”

Kyle Salsburg, of Olympia, Washington got full upper and lower fixed implant- supported overdentures when she was 83 from  Jim Janakievski, DDS.  Even though he says “Many patients have difficulty flossing and effectively cleaning this type of prosthesis, which can lead to gum inflammation and new decay,” she has no problem cleaning them.  “I clean them myself with a waterpik and Jim takes them off twice a year for cleaning.  They cost quite a bit of money but luckily I could afford them. These are so much better than dentures.   You can forget about them.  They’re like your own teeth.”

The next, most expensive, restoration is implant-supported crowns, which are the most like your real teeth.  “With 10 implants you can create regular porcelain crown and bridgework” says Dr. Koskinski.  “These teeth are done with the latest high tech cad cam (computer-aided) technology.  Depending on how much bone you have, you could even have individual teeth that are indistinguishable from your real teeth.”

The cost for any of these restorations ranges from the price of a Hyundai to a BMW, or more, depending on where you live.  In Detroit where Dr. Kosinski practices, implants range from $1,000 to $1,700 each.   In New York City, where Dr. Toscano practices, they start at $1,800 and go up to $2,500.    Then you need to pay for the overdenture or crowns.   An overdenture costs from $3,000 to $5,000 and crowns range from $1,200 to $2,500 a tooth.  In total you will pay from $10,000 to $50,000 per arch, depending on how sophisticated a restoration you choose.

There is no doubt that the cost is worth it.  Freelance writer Mary Mihaly of Cleveland, Ohio wore dentures since she was 20, but by 50 her lower jaw had eroded significantly, impacting both her looks and chewing function.   It took her a year to afford her overdenture, even with financing, but she doesn’t regret it.  “I look better, my face is longer, and you can see my bottom teeth.”    Many dentists will make credit arrangements.

Before you sink your life savings into implants, however, be sure to do your homework.  Dr. Kosinski suggests asking your dentist the following questions:  “How long have you been doing this?  How many overdentures have you done?  Where did you get your training? Can I talk to your patients who have had this done?”  Dr. Kosinksi asks his patients to write a letter that new patients can read.”

Dr. Toscano also emphasizes the importance of educating yourself about implants before you sink thousands on your mouth.  “Ask the dentist what lab he uses. Then look into that lab’s quality on the internet.  Ask the dentist how much of the bill is lab work and how much his labor.   Some dentists save money by having lab work done in China and it doesn’t last.  When you buy a car you’re looking at craftsmanship, so why not look at the same thing when you buy a new set of teeth.”

Sources:

Kosinski, Tim, DDS, Detroit, Michigan, www.drkosinski.com, phone interview by author, May 15,  2011.

Janakievski, Jim DDS, Tacoma, Washington, “Dental Implants for Long-Term Oral Health,” unpublished article, May 15, 2011.

Mihaly, Mary, Cleveland, Ohio, phone interview by author,  August 30, 2005.

Salsburg, Kyle ,  Olympia, Washington, phone interview by author, May 18, 2011.

Toscano, Nicolas DDS, New York City, New York, www.manhattanperiodontist.com,  phone interview by author, May 15, 2011.