A denture that covers the palate, or fixed teeth on implants?

A full upper denture relies on one thing alone to stay in place: the suction created by the thin layer of saliva between the broad acrylic plate covering the palate and the lining of the palate itself. It is that plate, not the teeth on the denture, that does the real work. This is why an upper denture cannot be made smaller; without the palate being covered there is no retention. Because the lower jaw has no surface of this kind, a lower denture holds far less well from the outset and moves with every movement of the tongue.

Covering the palate is first felt at mealtimes. Taste is not the tongue's work alone: there are taste buds on the soft palate too, and the surface of the palate senses the temperature of food, its texture and how it feels as a whole in the mouth. When an acrylic plate is laid over this surface, it is taken out of play. Patients usually describe this by saying 'I can't taste anything'; what has actually happened is that half of what tells you what food is like in your mouth has been lost. You no longer measure the heat of a hot soup with your palate, only with your tongue.

The second effect is on speech. In Turkish, the sounds s, sh, t, d, n and l are all produced at the point where the tongue touches the palate. When a plate several millimetres thick is laid over the palate, the point the tongue has learned by heart over the years shifts. The result is familiar: whistling s sounds, slurred sh sounds, a voice its owner finds strange. In time the tongue adjusts to the new surface, but that adjustment has to be made all over again with every new denture.

The third is the gag reflex. For the suction that keeps it in place, the back edge of an upper denture has to reach as far as the border where the hard palate ends and the soft palate begins. In people with a sensitive gag reflex, that is exactly the area that sets the reflex off. These patients cannot keep the denture in their mouth, they have the back edge shortened, the shortened denture does not stay in and the cycle starts again. For them, a denture that covers the palate is a solution that does not work from the outset.

Denture adhesive solves none of these three problems; it only reinforces retention for a while. Cream or powder, it is an extra layer between the denture and the lining of the mouth: it dissolves during the day, it has to be cleaned off the palate as well as the denture in the evening, and when it is not cleaned off it creates conditions under which a fungal infection can take hold. The real point is this: the need for adhesive does not stay the same. A product used now and then at first turns, over the years, into something you have to repeat every morning. Using more of it is news about the bone underneath, not about the denture.

Here is what happens on the bone side. A natural tooth passes the force of chewing into the bone through its root, and as long as the bone receives that load it renews itself. When a tooth is taken out, the root goes, the load goes and the bone in that area starts to diminish. A denture does not put that cycle back: it passes the load not into the bone but onto the ridge, pressing down through the gum. The ridge gets lower over the years. That is why a denture that fitted the palate perfectly on the day it was delivered moves a little more every year.

A denture that covers the palate is therefore not a one-off job but an ongoing cycle. It starts to move, the denture is relined, which means material is added underneath to match the new shape of the bone, it does the job for a while longer, then it moves again. Beyond a certain point relining is not enough and the denture is replaced completely. With every replacement, the tongue has to get used to a new surface and speech has to settle again; and all the while the bone carries on diminishing.

With fixed teeth on implants, the picture is reversed. The teeth are screwed not onto the palate but onto implants placed in the jawbone; the implants, not a plate, do the carrying, and the upper palate stays uncovered. Taste and the sense of temperature stay where they are, the tongue finds its old reference point, and because there is no back edge, the gag reflex is never triggered. Denture adhesive drops off the agenda. The force of chewing goes down into the bone. The teeth are not taken out of the mouth; they do not spend the night in a glass of water.

The reason we can do this in three clinical days is the type of implant we use. A conventional implant takes its anchorage in the softer spongy bone inside the jaw, and months are spent waiting for that bone to fuse with the implant surface; if there is not enough bone, volume is added first with a graft. A strategic implant, by contrast, locks mechanically into the hard layer wrapped around the outside of the jaw, the cortical bone. What provides the anchorage is not waiting but that locking, which is there from the first day. This is why bone grafting and months of waiting do not come into it, and why the fixed teeth are fitted in three clinical days.

The two lists below become clear after the examination and the CBCT scan. Seeing yourself in the second list does not mean the door is closed; some of the points mean 'let us sort this out first' rather than 'no'.

This sequence is not treatment but decision making. At the end of it you know what is possible in your mouth and what that is based on.

1. 1

   Send us your X-ray

   If you already have a panoramic X-ray or a CBCT scan, send it through the form. The image is read by the dentist who would carry out the treatment; the first reply is written by the dentist, not by an assistant. You do not need to come in, and we get back to you within one working day.

2. 2

   Tell us about your current denture

   How many years you have used it, how many times it has been relined or replaced and how much adhesive it needs each day tell us directly how far the ridge of your bone has flattened. Bring your denture with you to the examination.

3. 3

   A three-dimensional CBCT scan

   A panoramic X-ray is two-dimensional; it gives an idea of the height of the bone, but not of its thickness or the state of the hard outer layer. The decision in this method rests directly on where the cortical layer is, how thick it is and how sound it is; we do not make promises without seeing a CBCT scan.

4. 4

   General health and medicines

   We want to see your systemic conditions, the medicines you take regularly and your most recent test results. We ask for the full list of the medicines you take at the first consultation; giving us incomplete information works against you.

5. 5

   You get the plan in writing

   How many implants, in which jaw, with what bridgework and whether a graft is needed are all shared in writing. If it is not suitable for you, we write that down just as plainly.

6. 6

   Three clinical days

   Once we have agreed on the plan, the surgery and the fitting of the fixed teeth are spread over three clinical days. You do not leave the clinic without teeth. You know what will be done on each day before you arrive.

There are four routes, and what separates them is not comfort but what the teeth rest on. Which one is right for you is decided by the state of your own jaw.

We write these down not to frighten you but so that you can ask the right questions at whichever clinic you go to.

The course below applies to patients treated with strategic implants. In a plan that includes a graft, healing takes longer.

1. Three clinical days

   Day 1 begins, before surgery, with a three-dimensional CBCT scan and a review of your plan; the implants are placed that same day and your first try-in teeth are made. On day 2, try-ins settle the bite and the appearance, and on day 3 the final fixed teeth are fitted and treatment is complete. You leave the clinic with your final fixed teeth. Some swelling and tenderness during these days is normal.

2. The first week

   The swelling goes down. We ask you to eat soft food, to keep away from hard and hot food and to brush the area gently. Because your palate is uncovered, you sense temperature with your palate again; bear that in mind with hot drinks in the first few days.

3. The first few weeks

   Speech settles within a few days. We increase the chewing load step by step; food with a hard crust and habits such as chewing ice are put off during this period. The gum settles into its new shape over these weeks.

4. Check-ups and the long term

   We give you the check-up schedule and the care of the bridgework in writing. An interdental brush and a water flosser are part of your daily routine from now on, not a denture brush and a glass at the bedside.

We give no figures on this page, because the right figure can only be given once a CBCT scan has been seen. What you should look at when you compare is not the amount you pay on the first day but the total over the years ahead: on the denture side, relining, replacement and adhesive are items that keep coming back, while on the fixed teeth side the payment is made once and what follows is maintenance. Send us your image and we will share the scope with you in writing, item by item. These are the items that determine the amount:

Number of implants and which jaw

One jaw or both, how many implants are planned and which areas they will be placed in determine the total directly.

Preparing the mouth

If there are teeth that have to be taken out, gum disease that has to be treated or roots that have to be removed, these are added to the plan and affect the timetable too.

Bridgework

The material and the laboratory work for the fixed teeth have a direct effect on the amount. We tell you in writing at the outset which brand of material we use.

The time dimension

The cost of a denture that covers the palate does not end when it is delivered; as the bone gets lower, relining, replacement at intervals and a constant need for adhesive come into play. With fixed teeth these repeating items do not exist; their place is taken by regular check-ups and cleaning.