Post-Operative Instructions for Fixed-Hybrid Denture Placement

Screw Retained Hybrid Process

What is a Hybrid Denture?

The fixed hybrid denture is the top tier of care for a patient missing all their teeth and wanting something much more to their natural teeth. This implant restoration is fixed or screwed into place and isn’t taken out by the patient. Only the doctor can remove it if needed at re-care appointments at Lepore Comprehensive Dentistry in Dunedin, Florida. This truly amazing restoration is perfect for someone who dislikes taking a denture in and out of their mouth.

• A special metal bar/framework is fabricated to screw into implants to increase foundation and stability, and teeth are set on top of the framework to a denture
• Fixed restorations (screwed-in) give the most bite force/ability back and can feel the most like natural teeth
• Still replaces teeth AND gums that have been lost due to irreversible bone loss
• Much less bulk of material needed compared to traditional dentures
• Requires more implants for support.
• A small space is left between the restoration and the gums to allow for cleaning – it is crucial to have excellent oral hygiene as this is harder to clean than a denture you take out
• Implants stabilize bone loss and take the pressures of the dentures off the gums.

• Step One – Pre-Surgery Case Planning
  • This will include either one or more visits that include taking diagnostic records to communicate to our laboratories our goals and objectives
  • Multiple impressions and photos will be taken for proper communication
  • If you have lost multiple teeth or have severely worn teeth, you may have collapsed your bite. If this is the case, additional visits will be required. We will take records to plan how to build your bite back.
• Step Two – Surgical Denture
  • On the day of surgery, the appropriate number of implants are placed by the surgeon. This is typically an “all-day” appointment. The surgery will take several hours with an intermission while the surgical dentures are made to fit the placement of your implants (see below). The delivery by myself (the restorative dentist) will take about an hour or more.
  • The laboratory has already fabricated your surgical denture according to the records taken in Step One
  • After the surgeon completes his part, impressions are taken using the surgical denture and special copings that insert into the implants
  • The laboratory then retro-fits your surgical denture to fit the implants that were placed at the time of surgery.
  • Once this has been completed, the denture is returned to Dr. Lepore or Dr. Dougherty, and we deliver (screw-in) the Hybrid Denture(s)
  • These dentures do not come in and out. You will be provided instructions by the surgeon and our office on how to manage your healing period to allow success in the case.
  • It is imperative that you follow the post-operative instructions. Please reference as appropriate.
• Step Three – Records and Final Impressions
  • After Osseointegration has occurred
    • Osseointegration combines the Greek and Latin words that mean bone—Osseo—and integration—to make whole. This process occurs while you heal after surgery to place your dental implants. The implanted post and the surrounding bone tissue fuse together. This usually takes a minimum of three to four months
  • Once this occurs, several appointments are needed to get to the final result. We allow at least a couple of hours for each of these appointments. When we get the clearance from the surgeon that the appropriate healing has taken place, we schedule an appointment in our office.
  • It is important to note that this process cannot be rushed. There are times when steps/visits need to be repeated to achieve a proper result.
  • At this visit, we take appropriate records (including impressions) to send to the laboratory to fabricate an acrylic “Try-In Denture.” This is made of acrylic, just like your surgical denture
  • This is a several-hour appointment
  • Should this step need to be repeated, there is typically a one-to-two-week turnaround

• Step Four – Lab Fabricates Wax Try-in Dentures
  • This typically takes two to three weeks to return from the laboratory
  • During this visit, we verify several things:
    • Esthetics – we make sure the denture teeth are appropriate in shape and color to your liking
    • Occlusion – we make sure the bite is proper and adjust if necessary
    • Phonetics – we make sure you can speak appropriately with the new position of the teeth
• Step Five – Lab Fabricates Acrylic Try-in Dentures
  • This typically takes two to three weeks to return from the laboratory
  • During this visit, we verify several things:
    • Esthetics – we make sure the denture teeth are appropriate in shape and color to your liking
    • Occlusion – we make sure the bite is proper and adjust if necessary
    • Phonetics – we make sure you can speak appropriately with the new position of the teeth

• Step Six – Lab Fabricates the final Prosthesis
  • Your final Prosthesis is made of a rigid, strong material called zirconia. Zirconia dramatically reduces the risk of bacterial growth compared to acrylic and is beautiful in appearance
  • It typically takes three to four weeks from the last visit to receive your final prostheses
  • At this visit, your final dentures are screwed into place with the necessary adjustments completed

• Step Seven – Routine Maintenance Cleanings
  • After your final hybrid dentures are delivered, you’re not entirely done yet. The most important part is maintaining your investment (hygiene). We will give you instructions and recommend tools to keep your prostheses clean. However, it is up to you to help
  • We recommend a routine cleaning (just like a traditional tooth cleaning) in our office every three months. At this visit, tarter buildup and staining are removed, and we assess the health of the implants and the tissues
  • Occasionally (at least once every one to two years), the entire Prosthesis will need to be removed from the implants and cleaned accordingly (see below). The fee is typically the same as a regular cleaning in our office

• Step Eight – Full Hybrid Removal Maintenance Cleanings
  • At least once every one to two years, each Prosthesis will need to be removed from the implants and cleaned appropriately
  • There are several reasons the Prosthesis might need to come off. You may have too much tartar to clean the Prosthesis without taking it off. It may be poorly designed so that the underside cannot be cleaned by you or us. This design problem is common and sometimes unavoidable. We strive to make the underside convex, but on occasion, it must be concave due to anatomical factors. The third reason to take it off is that we suspect a problem (perhaps with the screws of the implant denture) or need to do some maintenance
  • The fee for this type of cleaning is typically five to six times a regular cleaning PER ARCH (per Prosthesis – upper or lower). It does not cover the exam fee or any radiographs taken during that visit
  • New screws will need to be replaced every time we take them off. The fee per screw varies depending on the type of implant system the surgeon used or the case’s complexity. You have one screw per implant. The fee will be charged accordingly