Total prosthesis

Where teeth become loose, for example, in cases of generalized inflammation occurring of the teeth-supporting structures (periodontal disease), dentist are often left with no other option than to remove these teeth. Where teeth become scarce in either the upper or lower jaw, then not many treatment alternatives are left to patients. For many patients, a complete loss of all their teeth leads to a drastic deterioration in their quality of life. Problems with speech, detrimental effects to social life, and poor aesthetics due to a tooth-less jaw are just a few examples of why dentures are such an important treatment for some patients.

It may seem like patients are left with few alternatives when they reach this stage, but this is not the case. Modern dentistry, through constant scientific progress, can now offer many different treatment options. We can even help you in these so-called ‘difficult scenarios’. One of these prosthetic treatment options is called the ‘total prosthesis’.

The tooth-replacement treatment options that dentists now have at their disposal are often not too easy to understand:

Where the patient has none of their own teeth left, a removable denture solution may be the tooth-replacement used by the dentist:

A total prosthesis, which uses a suction effect to stick to the palate, completely covering it.

A total prosthesis which does not adhere to the palate, but rather fixes onto two implants.

A total prosthesis, therefore, replaces a complete set of teeth (upper or lower) with a base of synthetic material onto which artificial teeth are implanted, fitting in with the bite of the opposing set of teeth. This are called dental prostheses.

In cases of complete replacement of teeth without implants, the dental prosthesis is termed a total prosthesis and can be removed. These removable dentures (prostheses) mean that there are no problems when it comes to removing the dentures, for example for cleaning.

There are many different solutions available of this type. Whenever dentures can be removed, how they fit onto the jaw becomes the most important element. This is not least because the comfort of the prosthesis plays the most important role for patients.

Comfort means that the fit and grip is pleasant, speech is impeded as little as possible, and the correct functioning of the prosthesis can be guaranteed. Critically speaking, total prostheses only have one advantage when compared to implant-supported prostheses. This is the reduced treatment cost, resulting in a set of synthetic teeth allowing patients to eat more comfortably again.  

The best wearing comfort, in cases of upper or lower jaws with no teeth and only little bone material remaining, is offered by a full-prosthesis treatment combined with implants. Only two implants are necessary per jaw, providing an anchored base onto which the prosthesis can be fitted into place. When comparing any treatments of this sort, this variant represents the best solution that your dentist can offer you in the case of a tooth-less bite with little bone material. If the bone material is suitable for further implants, and no bone grafting is required, then a fixed solution without the need for a removable prosthesis is possible with single bridges or circular bridges.

With your own teeth:

The following fall into the category of combined dentures (removed/fixed):

Model-cast prostheses, that use cast clasps to attach to the remaining teeth, using the jaw ridge to support the prosthesis.

Telescopic prostheses, which anchor onto a crown (or telescopic crown), also relying on the jaw ridge to support the prosthesis.

The following fall into the category of fixed dentures:

Fixing of bridges or crowns onto individual teeth or implants (not removable!).

Advantages of full prostheses:

  • The cheapest option

Disadvantages of total prostheses:

  • Poor fit

  • Speech impaired

  • Deterioration of bone due to lack of stress placed on bone

  • Ability to eat impaired 

  • Palate is covered (impairs taste)

  • Pressure spots

  • Inconvenient adhesive creams

  • Regular maintenance appointments required 

A list in order of comfort, function (speech, eating, fit) and aesthetics

Total prosthesis +
Model-cast prosthesis +
Telescopic prosthesis ++
Implant-supported prosthesis +++++
Fixed prosthesis +++++++++

Model-cast prosthesis or clasp prosthesis

Where some natural teeth still remain, the dentist has more treatment options at his/her disposal. One standard treatment is the model-cast prosthesis. Patients are generally recommended against this type of dental prosthesis as the remaining solid teeth are over-stressed by the clasps, which may cause these teeth to become loose. The problem here is that the strain is applied too high up on the tooth (referred to by dentists as coronal strain), and over time the natural tooth cannot bear up against this forces.

Model-cast prosthesis or clasp prosthesis

Another standard treatment uses telescopic prostheses, with telescopic crowns or double crowns. This treatment allows for an improved fit. In this treatment, metal caps (including some alloys that are almost pure gold) are fixed onto the available teeth, called primary crowns or telescopic crowns. A metal cap (secondary crown) is then also incorporated onto the prosthesis, which must fit the primary crown with a high level of precision. Achieving this friction (tight fit) between the two telescopic crowns poses a challenge to both the dentist and the dental technicians working in the laboratory.

This means a tight fit can be achieved for the prosthesis based on the natural teeth. If natural teeth are also lost, replacing these lost teeth does not pose a problem.

Unfortunately, this type of prosthesis also has problems. To adjust this standard treatment to each patient using the telescopic crowns requires a great deal of high-precision steps to be carried out. These are time-consuming, and thus expensive.

Spherical-head prosthesis with 2 implants

Unlike the telescopic crowns which are fitted onto natural teeth, spherical-head prostheses are anchored onto two implants. This type of prosthesis provides a high level of comfort for patients that cannot afford a fixed prosthesis, or in cases where the bone material has been reabsorbed to too great an extent for a fixed prosthesis. In this case, the prosthesis is supported by the jaw ridge and is anchored in place by two spherical heads which are each screwed onto an implant. The costs for this prosthesis treatment are somewhat lower when compared to a fixed prosthesis solution, such as crowns or bridges.

The procedure is similar to that of a standard implant procedure. After implantation has been carried out by an implantology specialist, the titanium implants are left for 8 weeks to heal in place. 

Impressions taken previously of the upper or lower jaw are important to guarantee the correct fit of the denture. Bite registration (a verification of the correct bite) is later carried out to ensure a solid fit onto the jaw.  In the first weeks after fitting, the dentist assesses the prosthesis. By now, even at this early stage, the jaw will have adjusted to the new dentures. The dentist may still need to carry out some finishing touches on the synthetic full prosthesis. See this page for more information about removable dentures .

Frequently asked questions

What is a complete denture (total prosthesis)?

A total prosthesis can offer a replacement for all of the teeth when all the teeth are missing. As such, they are classed under the tooth-replacement treatments (prosthetics). They are made from a denture base, which covers the entire palate (in the case of the upper jaw) and the entire jaw ridge (in the case of the lower jaw). Synthetic teeth are fixed into this base, with the aim being that these teeth feel as natural as possible as part of the bite. Impressions are taken to achieve this.

Why do complete dentures not last?

The fit of a complete denture in the mouth can only be achieved using a suction effect. In the lower jaw, the denture tends to fit better due to gravity's pull. In the upper jaw, as you might expect, holding the denture in place is more difficult. The material must be adapted to both the jaw and soft tissues of the mouth exactly enough to create the suction effect. Due to the constantly changing resilience of the soft tissues and the anatomy of the jaw, this is difficult to accomplish over a longer time period. For this reason, all the other treatment options offer more advantages compared to complete dentures.