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Help your patients make an informed choice regarding their tooth replacement.
Edentulous patients have quite a few options to choose from to replace their teeth. The problem is patients may or may not know about the benefits of the treatment. As a result, they want an option that is familiar, like dentures, but that might not deliver the best patient experience.
As a dental professional, you know some replacement options for the edentulous patient will lead to higher patient satisfaction. However, you do not want to push your patient into anything they do not want.
Today, we take a closer look at implant-retained overdentures, one of the tooth replacement options that deliver high patient satisfaction, and how they help the patient. We will also explore how two clinicians use this information to position these benefits properly to the patient in a solutions-based way.
A better solution might start with a worse one
Patients choose conventional removable dentures for a couple of different reasons. John M. McMahon, DDS, a private-practice dentist for the past eight years in Jenison, MI, and a fourth-generation dentist in his family, says many times the decision is financial. However, it is also a matter of comfort level and awareness.
Dr. McMahon says that stems from a couple of different things. First, is the level of experience of the clinician and whether they feel they have the right team and resources in place to deliver some of the more advanced tooth replacement therapies. Second, it comes from a place of wanting to provide the experience the patient expects rather than introducing them to a new idea.
“Everybody’s heard of dentures, but I feel like not as many have heard or understood the principles of what implant-supported overdentures or what a full-arch fixed hybrid is,” Dr. McMahon says. “It's the comfort of the provider and their willingness to sit down and connect with patients and explain the pros and cons of the treatment.”
Clark Damon, DDS, a private practice dentist in the Amarillo and Dallas metro areas and a lecturer on implants for Nobel Biocare says it can also be a case of hearing they don’t need implants. Their friends and family tell them they will be satisfied with conventional dentures.
“Typically, it’s going to be someone in the family who does not value dentistry or is one who has accommodated well,” Dr. Damon explains.
Dr. Damon says some people can adapt well to conventional dentures and never have any problems. However, all people are not the same, particularly not when it comes to anatomy in the oral cavity.
“Differing anatomy poses different challenges. You have to be able to personalize the patient’s condition,” Dr. Damon says.
In his experience, Dr. Damon says patients that opt for the implant-supported overdenture after extractions have a better healing process and patient experience than those that choose a conventional denture. Patients expecting overdentures once the healing process is complete know there is more to come. He says they know their tooth replacement will be better once they have the final overdenture snapped-on.
“The patients who did not opt for it at the time of the surgery have a much harder transition,” Dr. Damon says. “They often don't have the correct expectations, putting more pressure on the team and the doctor.”
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Patients prefer implant-supported overdentures
Research suggests when compared to conventional dentures, patients prefer implant-supported mandibular overdentures. In a study published in 2012 in the International Journal Oral Maxillofacial Implants, 20 edentulous patients received implant-supported mandibular and maxillary dentures.1
One patient dropped out of the study, but the remaining 19 had significant improvements in patient satisfaction over their previous appliances, described as “old dentures.”2 Furthermore, the study participants preferred the implant-supported overdenture to their former apparatus.
It is also important to note patients had no significant variance in satisfaction between the two types of attachments, ball, or Locator. There was no preference for either type of attachment either.3 The only finding related to attachment type was the Locator required more post-insertion care than the ball.4
The benefits of overdentures.
For some of your patients, the benefits of the implant overdenture will lead to a far better outcome to replace their teeth. As the Foundation for Oral Rehabilitation puts it, implant overdentures improve on the drawbacks of conventional dentures.5 They improve retention, stability, and replacement of the hard and soft tissues patients have lost, which lead to excellent esthetic outcomes, improved phonetics and functionality.6 In other words, they look better, help patients speak more clearly and chew better than conventional dentures.
These improvements over conventional dentures have implications for a patient’s overall health. The stability of the denture afforded by the implants encourages improved mastication. Therefore, the digestive system has an easier time breaking down food and allows the body to absorb more nutrients.7 Furthermore, adhesives are not necessary, which is also an improvement over conventional dentures as the adhesive ends up in the patients’ digestive tract.
Also, the esthetic benefits are more than a better-looking smile. When you lose the bone in your jaw, the distance between the nose and chin decreases, which creates a sunken-in look.8 Implants help retain bone and reduce the risk of making patients appear older than they are.
Finally, patients find implant overdentures more comfortable. Implant overdentures are not prone to slipping, so they won’t come out when a patient is talking or eating. They also don’t rock on the soft tissue the way conventional dentures can, which can cause sores.9 You know all these benefits, but your patients don’t. Explaining the benefits of an implant-supported overdenture could help them make a decision that will lead to a better quality of life.
Explain 'use it or lose it' situation for bone
Dr. McMahon says you need to explain the concept of “use it or lose it” as it pertains to bone loss. He says some patients with a well-fitting complete conventional denture might not understand the concept of bone resorption and that it will continue, even after their teeth are gone.
While bone resorption affects patients both young and old, Dr. McMahon says he emphasizes the point with younger patients. He wants to ensure these younger patients hold onto the bone, so they have more options later on in life. If patients choose to forgo implants and continue to suffer bone resorption, they might lose options that require healthy bone down the road.
Dr. McMahon first explains to younger patients the effect on bones. Then, he follows up with the fact that dental implants can stop the bone resorption and begin stimulation for bone regrowth. Dr. McMahon says when you use this approach, more patients might choose the implant-retained overdenture.
“They're not realizing in the long run, they're going to be losing bone in both dimensions in the maxillary,” Dr. McMahon says. “I often say, ‘I don't want to have this conversation, having not told you about the benefits of going with some implant-supported prostheses.”
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Bring up bite force
Dr. Damon says he brings up the bone loss when a patient is in an existing denture, but for many patients, bone resorption is not compelling because the concept is abstract. Instead, he takes a different approach focusing on the practical benefits.
“Patients care more about how this choice affects them on their day-to-day,” Dr. Damon says. “They care more about what they can eat with it and how it impacts them.”
Both Dr. Damon and Dr. McMahon explain bite force with their patients regarding the different tooth replacement options. If natural teeth have 100 percent bite force function and complete dentures have 10 percent bite force function, the implant-supported overdenture has 50 to 60 percent. (Fixed-implant prostheses are at 90 to 95 percent).
Both doctors show a graph that demonstrates the bite force of the various tooth replacement solutions. In Dr. McMahon’s office, it is called the Relative Function Capacity Chart.
“It conveys a very simplified version. You can explain its quality of life, and how the different solutions affect what you can chew, and what you can taste. It’s what you can enjoy,” Dr. McMahon says.
Show them, don’t tell them
Dr. Damon believes in having patients touch and try the snap-on appliance. First, he explains the implant-supported overdenture has increased bite force and stability benefits that will allow them to bite into more things and chew harder than a conventional denture. Then, he gives them the model and tells them to try to pull the overdenture off.
“They are all surprised at how retentive everything is,” Dr. Damon says. “Show them so they can see it for themselves. When I only describe it, I never have success but once it’s in their hand, they get it.”
Recount success stories
Dr. McMahon says a lot of times you are converting someone over to an overdenture from a partial or complete denture that was ill-fitting and inhibiting their taste or limiting it. He believes sharing stories about the benefits of the overdenture will help them relate to the quality of life improvement an implant-supported overdenture might provide.
“It’s the level of confidence that comes with it, the change in the perspective on it and what they can bite into with it. How you can smile and laugh without having to worry about it coming out or having to question it,” Dr. McMahon says. “You gain a renewed sense of confidence with it.
1Krennmair G1, Seemann R, Fazekas A, Ewers R, Piehslinger E.“Patient preference and satisfaction with implant-supported mandibular overdentures retained with ball or locator attachments: a crossover clinical trial.” Int J Oral Maxillofac Implants. 2012 Nov-Dec;27(6):1560-8. Accessed via web: 18 June 2019. < https://www.ncbi.nlm.nih.gov/pubmed/23189311>.
5“Implant overdentures, introduction.” www.for.org. Web. 18 June 2018. < https://www.for.org/en/treat/treatment-guidelines/edentulous/treatment-options/implant-prosthetics-removable/implant-overdenture-overview/implant-overdentures-introduction?_ga=2.75734613.1177513840.1560807947-1349738826.1553556300>.
7“What are overdentures.” www.teethinplace.com. Web. 13 June 2019. <http://www.teethinplace.com/inplace-what-are-overdentures>.