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 of the their teeth, and wanting something much more to their natural teeth. This is an implant restoration that is fixed, or screwed into place, and isn’t taken out by the patient. It can only be removed by the doctor if needed at recare appointments. This is a truly amazing restoration that is perfect for someone who does not like the idea of 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) gives 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 very important to have great 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 includes taking diagnostic records to communicate to our laboratories our goals and objectives.
  • Multiple impressions and phots 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.
  • Your surgical denture has already been fabricated by the laboratory 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 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 is a process that 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 3-4 months.
  • Once this occurs, several appointments are needed to get to the final result. For each of these appointments, we allot at least a couple of hours. 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 you 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 repeated, there is typically a 1-2 week turnaround.

• Step Four – Lab Fabricates Wax Try-in Dentures
  • This typically takes 2-3 weeks to return from the laboratory
  • At 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 appropriate 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 2-3 weeks to return from the laboratory
  • At 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 appropriate and adjust if necessary
    • Phonetics – we make sure you can speak appropriately with the new position of the teeth.
• Step Six – Lab Fabricates final Prosthesis

o   Your final prosthesis is made of a rigid, strong material called zirconia. Zirconia greatly reduces the risk of bacterial growth compared to acrylic and is beautiful is appearance.

o   It typically takes 3-4 weeks from the last visit to receive your final prostheses.

o   At this visit your final dentures are screwed into place with the necessary adjustments completed.

• Step Seven – Routine Maintenance Cleanings

o   After your final hybrid dentures are delivered, you’re not quite 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.

o   We recommend a routine cleaning (just like a traditional tooth cleaning) in our office every 3 months. At this visit, tarter buildup and staining is removed and we assess the health of the implants and the tissues.

o   Occasionally (at least once every 1-2 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 normal cleaning in our office.

• Step Eight – Full Hybrid Removal Maintenance Cleanings

o   At least once every 1-2 years, each prosthesis will need to be removed from the implants and cleaned appropriately.

o   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.

o   The fee for this type of cleaning is typically 5-6 times a normal cleaning PER ARCH (per prosthesis – upper or lower). It does not cover the exam fee or any radiographs taken during that visit.

o   New screws will need to be replaced every other time we take it off. The fee per screw varies depending on the type of implant system the surgeon used or the complexity of the case. You have one screw per implant. The fee will be charged accordingly.