Material of choice opposing a maxillary complete denture?
I have a patient with an upper edentulous ridge restored with an acrylic complete denture. The mandibular ridge has six well spaced implants. The plan is to provide a fixed screw retained prosthesis. Would acrylic – metal (ie a hybrid prosthesis) be the first choice? What would be an ideal choice of materials for this?
16 Comments on Material of choice opposing a maxillary complete denture?
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Merlin P. Ohmer, DDS, MAG
11/2/2017
I would consider a Locator retained lower acrylic denture. Ensure no occlusion on the anterior teeth. That will cause wear of the anterior maxillary ridge.
Mark Huels, CDT, MICOI
11/2/2017
Your thought of the hybrid is what I've seen work best opposing a tissue supported denture. Be sure the teeth in the hybrid are good quality wear resistant.
mwjohnson dds, ms
11/2/2017
Don't use locators when there's six implants. Locators are meant for two implants in the anterior not six spaced out. Use compatible materials to the maxillary denture. I use Ivoclar phonares or Hereaus Kulzer "Mondial" denture teeth for decreased wear. Material also depends on interocclusal space. Hopefully your surgeon removed enough bone (15mm interocclusal space) for abutments, the framework then enough acrylic retain the teeth. Keep occlusion on the posteriors as stated above to eliminate the risk of "combination syndrome" and damage to the premaxillary segment.
Merlin P. Ohmer, DDS, MAG
11/2/2017
Two implants are not enough for a stable and good result with Locators. Six is fine. A little overkill, but against an acrylic upper, I would prefer as little trauma as possible.
Dr G A
11/2/2017
In case interocclusal space is <15mm, how detrimental would a metal ceramic screw retained prosthesis be? Keeping in mind the continuous breakage of acrylic due to lack of space.
resormbre
11/14/2017
You can always "sleep" the middle two implants and use 4 locators, or even sleep 4 and just use 2 locators.
Dr R Y
11/2/2017
Acrylic implant retained over denture with telescopic crown give you best result, patient can remove easily without putting pressure on implant .
Dr. GC
11/3/2017
If feasible for patient traditional fixed bridgework should be fine. Best case scenario because opposing a removable. Should be a slam dunk.
Mwj dds,ms
11/3/2017
Ceramometal would work fine. Several challenges though. With ceramometal the implant placement is much more critical. They should be in the long axis of the proposed teeth so the access holes are in the proper positions. Otherwise custom abutments will be needed then a cement retained restoration. When planning for ceramometal there is a lot more preplanning that needs to be done.
Dr F O
11/3/2017
What about the imbalance between the arches due to the difference in material. Acrylic versus ceramic? Wouldn't that lead to a faster rate of resorting in the maxillary arch?
Mark Huels, CDT, MICOI
11/3/2017
Dr F O you are correct about opposing denture teeth with porcelain. The hybrid will give the advantages of fixed bridgework without prematurely wearing out the opposing teeth.
DentureGuy
11/3/2017
What ever restoration you choose the most important thing is to keep the occlusion on the posterior teeth with no anterior contacts. The higher the predicted wear the more you will need to follow the case to watch for the coming shift in occlusion as wear occurs
Dr. Joe Orti DDS
11/3/2017
Fixed bridge metal with ceramage which is a resin with zirconia nano particles instead of metal/porcelain. Easy to adapt, easy to adjust, easy to make addition if needed and easy on occlusion. Same cost as porcelain, check with your lab.
Dr R Y
11/4/2017
I did the same case in 2011, it works great
only one time I tighten the telescopic crown
MJFDDS
11/6/2017
I think a good option would be a Pekkton framework with acrylic teeth. This is becoming a popular alternative to all acrylic or metal and acrylic due to the more favorable modulus of elasticity.
Mark Huels, CDT, MICOI
11/7/2017
I stand by the hybrid opposing a tissue supported denture. There won't be excessive biting force to concern yourself with a resilient lower.
