Hybrid Denture
A hybrid denture (also called fixed detachable) is the combination of fixed and removable dentures for completely edentulous patients. It consists of acrylic and denture teeth connected with a metal structure screwed onto the implants.
Hybrid dentures are a good solution for patients who have lost all their teeth and have not been able to undergo bone grafting, as they can also help correct suboptimal implant positions. Patients cannot remove the denture themselves, which has the psychological advantage of making them feel like they have their own teeth. This type of denture also requires regular maintenance by a dentist.
Hybrid dentures differ from overdentures in several ways. First, they are fully supported by implants, which helps preserve existing bone and prevents further bone loss in the posterior region. Second, they are smaller than overdentures because they do not require soft tissue support, which is more comfortable for the patient. Third, they are much more stable than overdentures or dentures because they are screwed to implants, making them fixed and eliminating the need for adhesives.
The metal structure can be fabricated using traditional wax and casting techniques or CAD CAM technology. For the success of the restoration, a passive fit on the implants must be ensured.
The number of implants required for this restoration is controversial. There is a so-called all-on-4 protocol, where only 4 implants are placed to support this prosthesis. However, more implants are recommended to provide more support, and if one fails, the prosthesis can still be viable. The more implants, the better the load distribution and predictability.
Implant position is important, but can also be corrected with angled multi-unit abutments. Guided surgical techniques are an invaluable aid in achieving ideal implant position in both the lingual-facial and mesial-distal planes and providing adequate screw access - from occlusal in the posterior region and lingual in the anterior region.
When creating a treatment plan for patients, certain considerations must be taken into account with hybrid dentures. There must be sufficient interocclusal space for a proper prosthetic design including implants, abutments, acrylic and teeth. Patients who require lip support to compensate for tooth and bone loss may not achieve good esthetic results with hybrid dentures, since they do not have labial flanges as dentures do.
Patients must also be instructed in exhaustive oral hygiene, as they cannot remove the prosthesis, and proper removal of plaque and debris must be ensured to ensure implant stability and avoid peri-implantitis. This treatment is not recommended for elderly patients who are unable to clean these prostheses and who may find in overdentures a better alternative.
