When, for one reason or another, the loss of one or several teeth occurs, a natural question arises – how could they be restored? Moreover, so that it is not very expensive (implantation is not affordable for everyone), and that the denture looks beautiful and does not cause discomfort when talking and chewing food.
In addition, as practice shows, many people are afraid that a removable denture may simply fall out of the mouth at the most inappropriate moment (for example, during a conversation), or it will be too noticeable to others, associating with the “false jaw”.
All these fears are partly really not unfounded – there are quite a few negative reviews about dentures when the patient could not get used to the removable design, and she was sent “to the far corner of the table”. However, fortunately, there are also partial dentures that are comfortable to wear and have a high level of aesthetics.
Partial is called a denture, replacing one or more lost teeth. There are also complete dentures used in the complete absence of teeth on one or two jaws at once.
In general, the situation when there are at least a few teeth remaining in the mouth is much better from the point of view of the upcoming prosthesis than if there were no teeth at all – there are supports for which this or that structure can be fixed. Therefore, it is important not to hurry with the removal of sick teeth, if there is even the slightest chance to cure them and save for the future.
Next, we will look at what types of partial dentures exist today, what are the pros and cons of each option and which one may be the best choice in a given clinical situation …
Types of partial dentures
Among removable dentures used in the partial absence of teeth in the oral cavity, the following types of orthopedic occupy a significant niche:
- Acrylic (laminar). Acrylic plate denture got its name due to the fact that the basis of this design is a plate that transfers chewing load on the palate and gums. Such artificial limbs are made of rigid acrylic plastic. There are full and partial acrylic dentures. Partial acrylic prosthesis has special metal hooks (clasps) for fixation by supporting teeth. Removable acrylic prosthesis can be used with almost any degree of tooth loss (especially significant, and it does not matter in which department – terminal, lateral or front);
- Nylon – different from acrylic primarily for its elasticity – they are soft. Their advantages and disadvantages result from this property – they are more comfortable to wear, but they hold up worse in the mouth and distribute the chewing load worse, as a result of which the gingival atrophy under the prosthesis can proceed at an accelerated rate;
- Byugelnye (from the German "bugel" – arc) – have a power frame in the form of a metal or plastic arc, onto which a base with artificial teeth is welded. In the overwhelming majority of cases, the bump prosthesis in terms of its functional characteristics will be much better than the laminar or nylon prosthesis;
- Immediate dentures (so-called butterfly artificial limbs). Usually used to replace 1-2 teeth. The basis of the butterfly prosthesis can be made of acrylic plastic or nylon and has hooks for fastening over the supporting teeth;
- The so-called dentures of the new generation without the sky (another name – Sandwich). They are a combination of a hard base made of acrylic plastic and elastic polyurethane crowns, which are tensioned onto the supporting teeth. Artificial teeth are set in the plastic base. This is not the best option for prosthetics, as it is inferior in terms of a number of characteristics not only to the clasped prostheses, but also standard acrylic ones.
Let’s take a closer look at the pros and cons of each of these options.
Features of prosthetics with acrylic prostheses
Acrylic prostheses have been used in dentistry for more than 50 years, and during this time they have gained tremendous experience in their use both in a complete removable prosthesis (when there is not a single tooth in the oral cavity), or in part. Now they continue to be installed in huge quantities, especially in Russia – due to the fact that they are cheap, affordable, have a rather long service life and are relatively simple to manufacture.
Accessibility and low cost often become the decisive factor of choice not only for the patient himself, but also for the orthopedic surgeon with a small production base (for example, in the townships) or insufficient experience with other, more complex and expensive prosthetic variants.
The photo below shows a partial acrylic prosthesis:
Klammer prosthesis (hooks) are not only metal, but there are also plastic and combined. The materials used strongly influence the cost of the product – for example, a gold or gold / platinum alloy can be used as a metal for clasps instead of stainless steel (for allergies to stainless steel).
An acrylic prosthesis is held not only by the clamping fixation, but also by adhering to the relief of the mucous membrane – it sticks to the sky and the gums. Therefore, the reliability of its fixation in the oral cavity will significantly depend on the manufacture of the prosthesis.
Here are some of the indications for the use of partial acrylic prostheses:
- Unilateral and bilateral terminal defects in the upper or lower jaw (in other words, when any jaw on the right or on the left has no distant chewing teeth). In such a situation, it is not possible to put a bridge, as there is no one of the supports for the “bridge”;
- When the condition of the remaining teeth does not allow them to be used as a support for the bridge (for example, against the background of periodontitis, the supporting teeth could simply loosen);
- Included defects of the dentition (that is, bounded on both sides by teeth in the mouth), including in the absence of only one tooth;
- The presence in the oral cavity only single teeth in the upper and lower jaw;
- The presence of contraindications to prosthetics on implants.
In other words, the scope of partial acrylic prostheses is very wide – they can be used in the vast majority of clinical cases.
The photo below shows a partial acrylic prosthesis in the lower jaw:
Significant disadvantages of partial acrylic dentures are:
- The overlap of a large area of hard palate. Due to this, the taste perception is partly reduced (as the taste buds located on the palate are closed), and the diction may also deteriorate. Yes, and just there is an unpleasant sensation of a massive foreign object in the mouth;
- Not the highest aesthetics, especially if the retaining hooks fall into the smile zone;
- By virtue of its rigidity, the structure may rub the mucous membrane, causing pain during chewing;
- The reliability of fixing a partial acrylic prosthesis can hardly be called good, especially for the lower jaw (in the upper jaw it can more or less reliably stick to the palate). As a result, you may need to use a special cream to improve fixation;
- Fragility (when falling, the prosthesis can easily crack);
- Microporosity (with insufficient care, this leads to the appearance of bacterial plaque and a change in the color of the plastic);
- Also, individual intolerance is often observed due to an allergy to plastic monomer, which is actively released into the oral cavity from an acrylic base.
Anyway, with the partial absence of teeth, the use of an acrylic prosthesis is today the most popular budget option for prosthetics.
Advantages and disadvantages of removable dentures made of nylon
Soft nylon prostheses are used both with the complete and partial absence of teeth in the oral cavity. Moreover, they are positioned in the advertising of dental clinics as a modern and more convenient alternative to rigid acrylic prostheses. However, about the shortcomings of such products in advertising is silent, and meanwhile, it is useful to know about some nuances in advance.
But first, we note the most significant advantages of partial nylon prostheses:
- By virtue of their softness and flexibility, they are more comfortable to wear, and adaptation (habituation) is faster;
- Such prostheses, as a rule, have smaller dimensions and weight than acrylic ones, therefore they less disturb the articulation;
- From the point of view of aesthetics, nylon dentures look much better than standard acrylic and byugelny ones, since they are practically not visible from the outside. The hooks of the nylon prostheses have a color close to the color of the gums (unlike the metal hooks of partial acrylic and byugel dentures);
- There is no allergic reaction to nylon – it is a biocompatible material.
However, there are nylon dentures and serious drawbacks, significantly limiting their widespread use in orthopedic practice:
- The main disadvantage is due just to the flexibility of nylon, its softness – the soft design does not evenly distribute the chewing load, as a result of which the bone under the prosthesis quickly atrophies (and with it the gingiva sags, the relief of the prosthetic bed changes, and the design ceases to fit snugly to the mucous membrane);
- In addition, soft nylon hooks, unlike metal ones, are not able to reliably fix the prosthesis on the remaining teeth;
- Due to the softness of the prosthesis, the stability of its suction to the mucous membranes is low – with a slight load (during chewing) under the nylon base, air easily penetrates;
- At the same time, nylon dentures are much higher than acrylic (the average price is from 30,000 to 50,000 rubles).
If you read the reviews of patients on nylon prostheses, it becomes clear that the choice of this option can hardly be considered justified, especially in the absence of a significant number of teeth in the oral cavity (in this case, all the disadvantages will appear even stronger).
There are also polypropylene dentures, which are very similar to nylon. However, unlike nylon, polypropylene has more stiffness, therefore products based on it distribute chewing load better, and they have to be corrected less often.
Clasp dentures with partial loss of teeth
It is the byugel dentures in most cases that will be the best option for removable dentures with partial loss of teeth.
Here are some of the key advantages of the denture prosthesis:
- Due to the rigidity of the structure, a uniform distribution of the chewing load between the supporting teeth and the soft tissues of the prosthetic bed is achieved (the bone will not atrophy as quickly as under certain sections of nylon prostheses);
- With the locking system of fixation (attachments) high aesthetics are realized – no hooks and other foreign elements will be visible. The same can be achieved by fixing on the so-called telescopic crowns (the methods of fixing the bugel prostheses will be discussed below);
- It is much easier to get used to a removable clasp prosthesis than to a laminar prosthesis, since it takes up less space in the mouth and does not cover the entire palate (which means that the gag reflex, prosthetic stomatitis and dysplasia are practically excluded);
- Reliability of fixation of the prosthesis in the mouth is very high. Moreover, the design can be reliably fixed even in difficult cases – when there are end defects of the dentition (in this case, the fastening on the micro locks is used);
- The bugel design not only allows the return of the lost function (normal chewing) and aesthetics after the extraction of teeth, but can also have a healing effect when special splint byugel dentures are used, eliminating the mobility of groups of teeth;
- Durable byugelny prosthesis, unlike acrylic, is not so easy to break.
There are several ways of attaching the partial dentures to abutment teeth:
- With the help of clasps (hooks). Usually they are made of metal, but there are also plastic clasps. Such hooks securely grip the abutment teeth, transferring to them part of the chewing load;
- With the help of attachments (microlock fasteners). A part of the lock is in the prosthesis, and the other part is in a metal-ceramic crown, previously fixed to the abutment tooth. When the prosthesis is put on, the micro lock will snap into place, ensuring a secure hold on the removable structure;
- Using telescopic crowns. On the abutment teeth are pre-fixed metal crowns (non-removable). The cusp denture also contains crowns that are simply put on the crowns of the abutment teeth. This type of fastening is characterized by high aesthetics and reliability.
Each of the specified methods of fixing the clasp dentures has its advantages and disadvantages. Thus, the clasped clasp bars are the easiest to manufacture and are affordable, but with a smile, metal hooks can be seen, located on the outer side of the teeth, which impairs aesthetics.
As for the castle mounts (attachments) and mounts on telescopic crowns – they are almost invisible from the side, which gives excellent aesthetics and wearing comfort. However, such dentures are difficult to manufacture and, moreover, turning a decent amount of abutment teeth under the crowns is required.
Despite a number of drawbacks, by-the-body dentures can still be considered the best option for prosthetics with partial absence of teeth – both in terms of wearing comfort, functionality and aesthetics, and in terms of price. Yes, a clasp prosthesis will cost more than acrylic, but much cheaper than prosthetics on implants would cost.
On average, denture prostheses with fixation on clasps cost about 25-40 thousand rubles. But the prices for constructions with microlock fastenings are almost twice as high – a double-sided prosthesis for two attachments can cost around 80-100 thousand rubles.
Removable prosthesis "butterfly" for the immediate replacement of lost teeth
Imagine a situation that you have removed 1 or 2 teeth. While the hole is healing and a non-removable bridge is being made (or an implant is to be installed in the future), it will take some time to walk with a hole in the dentition, which many patients would like to avoid.
For such cases, the best option would be to use a removable immediate denture – otherwise, a butterfly prosthesis (lat. "Immediatus" means "direct", that is, it is about the possibility of replacing a tooth with a prosthesis immediately after removal). This prosthesis was called the butterfly because of the external similarity of its base and hooks with butterfly wings.
The photographs below show removable prostheses-butterflies:
A removable prosthetic butterfly can be made on both the upper and lower jaw. It is retained mainly due to the girth of the hooks of the adjacent teeth. The basis and hooks can be made of acrylic plastic or nylon (in the latter case, a particularly good aesthetics is achieved).
Generally speaking, an immediate prosthesis is a temporary structure for the rehabilitation period before the manufacture of fixed prostheses (for example, bridges). But, as practice shows, some patients use the prosthesis-bow tie all the time, not wanting to grind their teeth under the crown of a bridge-like prosthesis and having no funds or implantation.
In general, it can be said that the butterfly prostheses allow not only restoring aesthetics immediately after tooth extraction (or teeth), but also improve the chewing functions, allowing you to evenly distribute the load and avoid overloading the teeth, limiting the “tear”.
The use of removable dentures with partial loss of teeth is not only aesthetic and functional value for the patient, but with the right approach, it preserves the health of the entire dental system. This is especially true for the prevention of diseases of the temporomandibular joint, periodontal disease (gum disease) near the remaining teeth, as well as the preservation of a normal bite.
About removable dentures of a new generation without sky
The so-called removable dentures of the new generation without the sky (sandwiches) really have an important advantage over standard laminar dentures, namely, they do not overlap the sky (therefore, do not reduce taste sensitivity, do not cause gag reflex, do not impair articulation, do not create the feeling of a massive foreign object in the mouth and
Recall that in sandwiches a rigid acrylic part with artificial teeth is combined with elastic polyurethane crowns, which are stretched onto the supporting teeth.
Despite the positioning in advertising as a new generation of constructions, sandwiches have serious disadvantages:
- Polyurethane crowns, stretched on the abutment teeth, may look too massive (the thickness of the walls of such crowns can reach