Removable dentures with partial absence of teeth: which are better?

The authors | Last update: 2019

When for one reason or another there is a loss of one or several teeth, a logical question arises - how, in fact, could they be restored? And so that it was not very expensive (implantation is not affordable for everyone), and that the denture looked beautiful and did not cause discomfort when talking and chewing food.

In addition, as practice shows, many people fear that a removable denture may simply fall out of your mouth at the most inopportune moment (for example, during a conversation), or it will be too noticeable to others, being associated with a “false jaw”.

All these fears are partly really not without reason - there are many negative reviews about dentures when the patient was never able to get used to the removable structure, and she went “to the far corner of the table”. However, fortunately, there are also partial removable dentures that are comfortable to wear and have a high level of aesthetics.

On a note

Partial is a denture that replaces 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 preserved teeth in the mouth, from the point of view of the forthcoming prosthetics, is much better than if there were no teeth at all - after all, there are supports for which this or that construction can be fixed. Therefore, it is important not to rush to the removal of diseased teeth, if there is even the slightest chance of curing them and preserving them for the future.

Next, we will see what types of partial removable dentures exist today, what are the pros and cons of each option, and which one may be the best choice in a particular clinical situation ...

Types of Partial Removable Dentures

Among removable dentures used in the partial absence of teeth in the oral cavity, the following types occupy a significant niche in orthopedics:

Acrylic (plate). Acrylic plate denture got its name due to the fact that the basis of this design is a plate that transfers the chewing load to the palate and gums. Such prostheses are made of rigid acrylic plastic. There are full acrylic dentures and partial ones. Partial acrylic prosthesis has special metal hooks (clasps) for fixing for supporting teeth. A removable acrylic prosthesis can be used with almost any degree of tooth loss (especially with significant, and it doesn’t matter in which section - end, side or front);
Nylon - differ from acrylic primarily in their elasticity - they are soft. This property implies their advantages and disadvantages - they are more comfortable to wear, but they hold on to the mouth worse and distribute the masticatory load, as a result of which the gum atrophy under the prosthesis can go at an accelerated pace;
Clasp (from the German "bugel" - arc) - have a power frame in the form of a metal or plastic arc, on which a base with artificial teeth is welded. In the vast majority of cases, a clasp prosthesis in terms of functional characteristics will be much better than a plate or nylon prosthesis;
Immediate dentures (so-called butterfly prostheses). Commonly used to replace 1-2 teeth. The base of the butterfly prosthesis can be made of acrylic plastic or nylon and has hooks for fastening to the abutment teeth;
The so-called removable dentures of the new generation without the sky (another name is Sandwich).They are a combination of a hard base made of acrylic plastic and elastic polyurethane crowns that are pulled over abutment teeth. Artificial teeth are installed in the plastic base. This is not the best option for prosthetics, as it is inferior not only to clasp dentures, but also standard acrylic in a number of characteristics.

Let's take a closer look at the pros and cons of each of these options.

Features of prosthetics with acrylic dentures

Acrylic prostheses have been used in dentistry for more than 50 years, and during this time a tremendous experience has been gained in their use both in full removable prosthetics (when there is not a single tooth in the oral cavity), and in partial. Now they continue to be installed in large numbers, especially in Russia - due to the fact that they are cheap, affordable, have a fairly long service life and are relatively simple to manufacture.

Affordability and cheapness often become a decisive factor of choice not only for the patient himself, but also for an orthopedic surgeon with a small production base (for example, in villages) or insufficient experience with other, more complex and expensive prosthetics options.

The photograph below shows a partial acrylic prosthesis:

Clasps of the prosthesis (hooks) are not only metal, but also plastic and combined. The materials used greatly affect the cost of the product - for example, instead of stainless steel, a gold or gold-platinum alloy can be used as a metal for clasps (for allergies to stainless steel).

On a note

The acrylic prosthesis is retained not only due to clamming fixation, but also due to the fit to the relief of the mucous membrane - it seems to be attached to the sky and gums. Therefore, the reliability of its fixation in the oral cavity will substantially depend on the accuracy of the manufacture of the prosthesis.

Here are some indications for using partial acrylic dentures:

Unilateral and bilateral end defects on the upper or lower jaw (in other words, when distant chewing teeth are absent on any jaw on the right or left). 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 using them as a support under the bridge (for example, against the background of periodontitis, the supporting teeth could simply become loose);
Included defects in the dentition (that is, limited on both sides by the teeth in the mouth), including in the absence of only one tooth;
The presence in the oral cavity of only single teeth on 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 on the lower jaw:

The significant disadvantages of partial acrylic dentures are:

Overlapping a large area of hard palate. Due to this, the taste perception is partially reduced (since the taste buds located on the palate are closed), and diction may also deteriorate. And just there is an unpleasant sensation of a massive foreign object in the mouth;
Not the highest aesthetics, especially if the holding hooks fall into the smile zone;
Due to its rigidity, the structure can rub the mucosa, causing pain when chewing;
The reliability of fixation of a partial acrylic prosthesis can hardly be called good, especially for the lower jaw (on the upper jaw it can still more or less reliably stick to the palate). In the end, you may need to use a special cream to improve fixation;
Fragility (when dropped, the prosthesis can easily crack);
Microporosity (with insufficient care, this leads to the appearance of bacterial plaque and discoloration of the plastic);
And also individual intolerance is often observed due to an allergy to the plastic monomer, which is actively released into the oral cavity from an acrylic base.

It is also useful to read: Fixed adhesive bridges

Be that as it may, with a partial absence of teeth, the use of an acrylic prosthesis is today the most popular budget option for prosthetics.

Advantages and disadvantages of removable nylon dentures

Soft nylon prostheses are used in both 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 hard acrylic dentures. However, about the shortcomings of such products in advertising is silent, but meanwhile, it is useful to know about some of the nuances in advance.

But first, we note the most significant advantages of partial nylon prostheses:

Due to their softness and flexibility, they are more comfortable to wear, adaptation (getting used to them) is faster;
Such prostheses, as a rule, have smaller sizes and weight than acrylic ones, therefore they less disturb articulation;
From aesthetics point of view, nylon prostheses look much better than standard acrylic and clasp dentures, since they are practically not visible from the outside. Hooks of nylon prostheses have a color close to the color of the gums (unlike metal hooks of partial acrylic and clasp dentures);
Allergic reactions do not occur on nylon - it is a biocompatible material.

At the same time, nylon dentures have serious shortcomings that significantly limit their widespread use in orthopedic practice:

The main disadvantage is caused by just the same flexibility of nylon, its softness - the soft design unevenly distributes the chewing load, as a result of which the bone under the prosthesis quickly atrophies (and at the same time, the gum sags, the prosthetic bed's relief changes, and the design ceases to fit snugly on the mucosa);
In addition, soft nylon hooks, unlike metal hooks, are not able to securely fix the prosthesis to 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 (while chewing), air easily penetrates under the nylon base;
At the same time, the cost of nylon dentures is much higher than that of acrylics (on average, the price is from 30,000 to 50,000 rubles).

If you read the patient reviews about nylon prostheses, it becomes clear that the choice of this option can hardly be 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).

On a note

There are also polypropylene dentures that are very similar to nylon. However, unlike nylon, polypropylene has more rigidity, therefore products based on it distribute the chewing load better, and they have to be adjusted less often.

Clasp dentures with partial loss of teeth

Clasp prostheses in most cases will be the best option for removable prosthetics with partial loss of teeth.

Here are some of the key benefits of arch prostheses:

Due to the rigidity of the structure, a uniform distribution of the masticatory load between the abutment teeth and the soft tissues of the prosthetic bed is achieved (the bone will not atrophy as quickly as under separate sections of nylon prostheses);
With a locking system of fixation (attachments), a high esthetics is realized - no hooks or other extraneous elements will be visible. The same can be achieved by fixation on the so-called telescopic crowns (we will talk about ways to fix arch prostheses a bit later)
It is much easier to get used to a removable clasp prosthesis than to a plate 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 impaired diction are practically excluded);
The reliability of fixation of the prosthesis in the mouth is very high. Moreover, it is possible to reliably fix the structure even in difficult cases - when there are end defects of the dentition (in this case, fastening on micro-locks is used);
The clasp design allows not only to return the lost function (normal chewing) and aesthetics after tooth extraction, but can also have a therapeutic effect when special splint clasp prostheses are used that eliminate the mobility of tooth groups;
A durable clasp prosthesis, unlike acrylic, is not so easy to break.

There are several ways to attach clasp prostheses to abutments:

Using a clasp system (hooks). Usually they are made of metal, but there are also plastic clasps. Such hooks securely clasp the supporting teeth, transferring part of the chewing load to them;
Using attachments (micro-lock mounts). Part of the lock is in the prosthesis, and the other part is in the ceramic-metal crown, previously fixed to the abutment. When putting on the prosthesis, the micro-lock latches, ensuring reliable retention of the removable structure;
Using telescopic crowns. On the supporting teeth, metal crowns (fixed) are pre-fixed. The clasp prosthesis also contains crowns that are simply worn on the crowns of the supporting teeth. This type of mount is characterized by high aesthetics and reliability.

Each of these methods of fixation of clasp prostheses has its advantages and disadvantages. So, clasp clasps are the easiest to manufacture and affordable, but with a smile, metal hooks located on the outside of the teeth can be noticeable, which affects the aesthetics.

As for the lock mounts (attachments) and mounts on telescopic crowns - they are almost invisible from the side, which gives excellent aesthetics and wearing comfort. However, such prostheses are difficult to manufacture and, in addition, the turning of a decent amount of supporting teeth under the crowns is required.

Despite a number of disadvantages, clasp prostheses can still be considered the best option for prosthetics with a partial absence of teeth - both in terms of wearing comfort, functionality and aesthetics, and in terms of price. Yes, clasp prosthesis will cost more than acrylic, but much cheaper than prosthetics on implants would cost.

On a note

On average, clasp prostheses with fixation on the clasps cost about 25-40 thousand rubles. But the prices for structures with micro-locks are almost two times higher - a bilateral prosthesis on two attachments can cost about 80-100 thousand rubles.

Removable butterfly prosthesis for immediate replacement of lost teeth

Imagine that you have 1 or 2 teeth removed. While the hole is healing and a fixed bridge is being manufactured (or an implant is supposed to be installed in the future), it will take some time to walk with a gap in the dentition, which many patients would like to avoid.

It is for such cases that the best option would be to use a removable denture prosthesis - in other words, a butterfly prosthesis (Latin “immediateatus” means “immediate”, that is, it refers to the possibility of replacing a tooth with a prosthesis immediately after removal). Such a prosthesis was called a butterfly because of the external similarity of its base and hooks with the wings of a butterfly.

The photos below show removable butterfly prostheses:

A removable butterfly prosthesis can be made on both the upper and lower jaw. It is held mainly due to the hooks of adjacent teeth.The base and hooks can be made of acrylic plastic or nylon (in the latter case, a particularly good aesthetic is achieved).

On a note

Generally speaking, the implant prosthesis is a temporary construction for the period of rehabilitation until the manufacture of fixed prostheses (for example, bridges). But, as practice shows, some patients use the butterfly prosthesis constantly, not wanting to grind their teeth under the crowns of the bridge and without finances, not implantation.

In general, we can say that butterfly prostheses can not only restore the aesthetics immediately after tooth (or teeth) are removed, but also improve chewing functions, allowing you to evenly distribute the load and avoiding overloading of teeth that limit the “gap”.

It is also useful to read: Clasp dentures on the upper jaw: photos and nuances of prosthetics

It is interesting

The use of removable prostheses with partial loss of teeth has not only an aesthetic and functional value for the patient, but with a competent approach, he maintains the health of the entire dentition. This is especially true for the prevention of diseases of the temporomandibular joint, periodontal disease (gum disease) near the remaining teeth, as well as maintaining a normal bite.

About removable dentures of the new generation without the sky

The so-called new-generation removable dentures without a palate (sandwiches) really have an important advantage over standard plate prostheses, namely they do not block the palate (therefore, they do not reduce the taste sensitivity, do not cause a gag reflex, they do not impair articulation, and they do not create the sensation of a massive foreign object in the mouth, etc.)

Recall that sandwiches have a rigid acrylic part with artificial teeth combined with elastic polyurethane crowns that are pulled over abutment teeth.

Despite positioning in advertising as new-generation designs, sandwiches have serious drawbacks:

Polyurethane crowns, pulled on the supporting teeth, may look too massive (the wall thickness of such crowns can reach 1.5 mm);
After fixation, the stability of the removable structure in the mouth will be much lower than that of the clasp prosthesis (the elastic polyurethane part will bend when chewing);
The small area of the basis, although it contributes to the convenience of wearing the prosthesis (less interferes with the mouth), however, causes strong pressure on the prosthetic bed. In turn, this can lead to pain when chewing food.

Therefore, despite the fact that the design of the prostheses is quite original, in general, they are much inferior to clasp ones in functional and aesthetic characteristics.

On a note

If we talk about the convenience of wearing due to the lack of overlap of the palate, it is worth noting that with removable arch prostheses on the upper jaw, due to the stiff arc, the overlap of the palate can also be minimal. In the case of using clasp prostheses for the lower jaw, the hyoid space is also blocked to a minimum.

Conditionally removable dentures on intracanal implants

In the absence of a significant number of teeth in the oral cavity and especially not very good condition of the crown part of the remaining teeth, a good option for prosthetics may be the use of a conditionally removable prosthesis with installation on the so-called intracanal implants.

To install this design, you must have at least 2 (and preferably 4) teeth on one jaw (upper or lower). The essence of the method is as follows:

The crown parts of the remaining teeth are cut to the level of the gums;
A titanium implant having a spherical abutment is screwed into the root canal of each tooth;
A prosthesis is made, having on the inner side of the recess with special locks for the spherical implant abutment.

As a result, the removable denture is attached very securely, it is not visible from the side, they can chew even hard food without any fears and discomfort, it is comfortable to wear. At the same time, preservation of tooth roots minimizes atrophic processes in the jaw bone.

The disadvantages of this type of prosthetics:

high price;
low prevalence of this service in clinics;
not suitable for every clinical situation (the patient does not always have the required number of teeth, and even if there is, the condition of their roots is not always satisfactory).

Rules for caring for removable dentures and a few words about their repair

After passing the removable denture to the patient, the orthopedic dentist explains how to properly care for him so that the design lasts as long as possible.

General recommendations in this case suggest the following:

Daily clean the denture with a toothbrush with non-abrasive paste;
Rinse with water after eating;
Use special disinfectant solutions;
Store dentures in boiled water or in a special solution;
If you feel pain during the operation of the prosthesis, it is important to immediately visit a dentist to find the cause of the pain.

It is useful to use special hygiene products for removable dentures:

Toothbrushes for dentures. Sometimes such brushes have two-sided placement of bristles - for the outer and inner surfaces of the prosthesis;
Denture cleansing tablets (Corega, effervescent tablets Dentipur, President, ROCS, Protefix, etc.). After the tablet is dissolved, a solution is obtained where the removable prosthesis is immersed - this eliminates plaque and provides an antibacterial effect.

It often happens that after a few years of wearing the prosthesis, the prosthetic bed (mucous membrane) sags and the structure becomes uncomfortable to use - for example, the lamellar structure may not stick well to the sky, food may fall under it, it begins to rub the gum, etc. Therefore, after receiving the prosthesis, it is advisable to apply for routine examinations at least 1 time every six months for correction and professional design hygiene.

It is better to entrust the repair (repair) of dentures to specialists, since an attempt to independently restore the structure can only accelerate the process of atrophy of the jaw bone due to the uneven load transmitted by the ill-repaired prosthesis to the prosthetic bed.

The repair options can be very different: gluing parts of a cracked laminar denture, repairing a clammer, installing a fallen artificial tooth, relocating so that the structure fits snugly against the mucosa, etc.

On a note

The big disadvantage of a removable nylon prosthesis is the inability to relocate it. Meanwhile, relocation is extremely important, since over the years, atrophy of bone tissue under the prosthesis occurs and the shape of the alveolar bone changes, which violates normal chewing and aesthetics. If it is not a problem to relocate acrylic plate prostheses, it is practically impossible to relocate dentures made of nylon and polypropylene in a quality manner - it is easier to buy a new product.

How much does a partial denture installation cost today

The prices of partial removable prosthetics depend on many factors:

From the level of the clinic (economy, premium, business class);
Is prosthetics performed in Moscow or elsewhere in the region (in Moscow, prices are almost always higher);
From the choice of design and materials used.

With a partial absence of teeth, the most budgetary is the prosthetics with plate acrylic prostheses with metal clasps (this is not always aesthetically pleasing, since metal hooks are clearly visible in the smile zone; other disadvantages of such designs have already been mentioned above).

The table below shows approximate prices for partial dentures in Moscow in mid-2017:

Type of prosthesis	Price, thousand rubles
Partial Removable Acrylic	15-20
Partial Removable Nylon	25-50
Clasp Clasp	30-50
Clasp splint	40-50
Clasp on locks (attachments)	80-100
Prosthetic butterfly	8-10

In conclusion, it is worth noting that even in the absence of a small number of teeth in the oral cavity, one should not overly delay prosthetics. Even the choice of the most inexpensive prosthesis will be much better for the entire dentofacial system than if you do nothing and walk with holes in your mouth.

At the same time, do not follow the lead of advertising and immediately focus on the now fashionable nylon prostheses. If implantation is not taken into account (due to its high cost), then using the clasp prosthesis will be the most practical and perfect option for prosthetics.

Be healthy!