Upper Hybrid – Lower Snap In

Wow! What a transformation!

This patient came to us with a severely decayed dentition, looking for options to restore his confidence, smile, and function.

After discussing many options, we ended up needing to find a compromise somewhere. With a primary desire for fixed upper teeth back, we opted to do an upper hybrid “All-On-4” and restore the lower arch with an overdenture with two implants.

While this case is one of my favorite “before and afters” – it also highlights the main difference between going with implant fixed and removable options. When we mix and match fixed and removable arches, we can do upper overdentures with 4 implants over a lower hybrid OR an upper hybrid over a lower overdenture. Patients can go with 2 or 4 implants for the lower.

For overdentures, we typically put implants in different positions as well as build and contour the bone differently than we would for a fixed hybrid. The main difference is the posterior implants – overdentures usually get straight implants and “All-On-4” traditional hybrids get angled posterior implants to improve the AP spread (the distance between the anterior and posterior implants). Thankfully in this case, we could position the 2 implants for this patient in a space that would allow him to go with either fixed or removable options in the future.

The main difference between fixed and removable is during the 3-4 months that implants take to heal. For fixed hybrids, we can attach temporary teeth to the implants on the same day as surgery, or as we say, immediately. This is because the implants get extra strength by being braced by each other. Patients still can’t use them for normal chewing or biting, temporary hybrids are for soft foods only – more for looks than function – but the patient does get beautiful fixed teeth the entire time they heal.

Removable implant solutions such as overdentures do not brace each other with the other implants. They also must be removed at night to allow the tissue to rest and breath (since it rests directly on the tissue and covers the entire ridge) and to clean the restoration. Because of this, once the old teeth come out and the implants are placed – the implants must be left to heal during the 3-4 months that they take to integrate. We can’t use them for support until they are ready. Therefore patients are stuck in a traditional immediate denture during this healing period, which rests on gums that can be sore after surgery. This is the worst part of the journey, immediate dentures that move around and often do not fit well, but thankfully after 3 months we make a new overdenture that fits the gums and implants perfectly, and snaps in and out! This is however the biggest difference between overdentures/snap in dentures and fixed hybrids — the healing period. This is best illustrated by the fact that the implants must be covered up and left to heal under the gums as opposed to immediately hooked up to the teeth.

Shoutout to SYNrG Lab for nailing the esthetics on this case!

Thanks for trusting us with your smile, bite, and your function! For more information about implants, options for restoring your smile, or the differences between fixed and removable implant solutions, follow me on Instagram @FantaskiSmiles and send a DM with any questions — or to schedule a consultation!