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Fixed Dental Implant Bridge vs. Implant Denture – What is the REAL Difference?

There is a common mistake that I hear from patients on a regular basis.

Often times, I see patients for second opinions for dental implants to replace all of their teeth. They tell me they are having all their teeth removed and having a “bridge.”

When I dig deeper or reference their paperwork, they are actually getting an overdenture!

Whoa! Yikes! Wait a second!

There is a HUGE difference between a “fixed bridge” and “overdenture” which some falsely call a “removable bridge”

Look at these pictures:

Upper denture
Note the size of the two.

An overdenture is just that…a denture that goes over implants and it is removable. It must be taken out at night and cleaned underneath.

Don’t get me wrong, overdentures are fantastic for the right situation. Nine times out of ten, the right situation is a person that has had dentures for years and needs extra hold and security with their dentures. They can be made to look great.  They are especially beneficial for the lower jaw.

Fixed bridges are cemented or screwed to the implants and cannot be removed by you. Unlike dentures that have pink acrylic and plastic teeth, fixed bridges are porcelain fused to metal or monolithic zirconia such as the Prettau dental implant bridge.

You will not have anything touching the roof of your mouth going over your gums with a fixed bridge. The teeth “emerge” from the gums and are not plastic like dentures.

Overdentures can be made with porcelain teeth, but that only makes the dentures look better.  It does not make them smaller or feel more natural.

Some fixed bridges have a gold substructure underneath them. Hence the name “porcelain fused to metal.” Because they have gold they are very strong compared to their overdenture counterpart.  More recent advances allow fixed Bridges to be made out of solid zirconia such as a Prettau style dental implant bridge.

If you are missing a little bit of gum, I usually make pink ceramic porcelain near your natural gum line. This will make it so the teeth don’t look too long and square. Having that little triangle of gum between the teeth makes all the difference when you smile.  If you are missing a lot of gum and bone than more pink ceramic will need to be added to give you proper facial lip support.

These are fixed porcelain bridges that I made for the whole upper jaw.  These patients lost all of their upper teeth:

Prettau Dental Implants-BeforePrettau Dental Implants-After


The cost of dental implants and a fixed bridge is more than an overdenture.  The process of restoring multiple dental implants into a fixed bridge is a highly complicated procedure with a very high laboratory cost.  It takes many more appointments to make a fixed bridge that it does an overdenture.  There is little to no room for error in a fixed bridge.  An experienced  implant dentist will spend an extraordinary amount of time to make everything right so that you do not experience failure of the bridge.  Replacing a full upper jaw with fixed dental implants is considered the single most difficult thing to do in dentistry.

This is a picture of a patient of mine without his overdenture in place.  The implants are connected to a bar that the removable teeth snap onto.


The inside of the denture looks like this.  It has clips that attach to the bar and make it snap in.


The implants also need to be much more precisely placed, whereas an overdenture has some leeway.

Bone volume for samples
Over dentures are far better for the lower jaw that they are for the upper jaw. I do not commonly recommended over dentures for the upper unless there is extreme circumstances usually related to facial skin support.

What is right for you? It really depends on what you want, your budget, and how much bone you have.

The position of your lips and how much space you have between your top ad bottom teeth is CRITICAL. This is often overlooked by your average dentist. Your face and lips can end up looking too bulky or caved in if this is not determined in the photographic assessment before anything is done.

You typically need more bone and more implants to make a solid fixed bridge than an overdenture. Depending on your situation, bone grafting or bone leveling may be necessary. These are things I can only determine by evaluating you in person.

If you are missing all of your teeth, a CT scan is almost always necessary to have a safe surgery.

The fixed bridge is the best long term solution and requires very little maintenance. An overdenture may be upgraded in the future to a fixed bridge.

Bottom line… A fixed bridge is the best and an overdenture is meant for people that already have dentures.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow of the American Academy of Implant Dentistry
Burbank, California

238 thoughts on “Fixed Dental Implant Bridge vs. Implant Denture – What is the REAL Difference?

  1. I need an all on 4/6 implant on the top and bottom.
    I have 5 natural healthy teeth left on the bottom and the rest of my mouth is failing caps, bridges and “thin” bone in my mouth. I am only 43 and have the $ for only one arch and a little extra $ for an implant or snap in dentures. I am going to do the upper arch 1st. My dentist suggested leaving my bottom teeth in for now. And maybe adding a few implants?? I’m leaning towards the upper arch implant and snap in dentures in the bottom, I’m positive my 5 remaining teeth will go bad sooner than later lol.. I just don’t have enough money to do the top and bottom fixed bridges at this time.. what are your thoughts? And thank you for this forum and answering our questions.

    1. This is a great question. Regardless of what you decide to do it is most important to make sure that you have what we referred to as a level occlusal plane. This means that the bite plane is straight. Typically if somebody had to choose a full upper or full lower I would suggest an upper standard non-implant denture for the top and fixed implants for the bottom. This is only if all teeth have to go and there is budgetary concerns.

      this patient in this video had a nonlevel bite that you can really notice on one side.

      If the bite does not level then the new permanent work will never look right and the only way to correct it would be to replace it.

      I recently treated a 37-year-old female for full restoration including having to use a zygomatic implant.

      I’m assuming you’re a nonsmoker.

      aanother option would be to do temporary full arch dental implant teeth on both the top and bottom and use the temporaries longer until you can afford to convert to the final.

      1. Dear Dr. Ramsey,
        I think I have really messed up. I went to a local dentist who told me he could do implants much cheaper than a well known dentist in Va. would do. I was wanting the all on 4 implants. First he extracted all my teeth, with only local anesthetic & then did the upper implants. He also had to do bone graphs on practically every implant & also did a sinus lift. For some reason my mouth would not stay numb more than 20 minutes, so I was crying in agony & had to come back for the lower implants with the same issue occurring. The first (upper)was about 5.5 hrs. & the lower about 3.5 hrs. Then I was given dentures that didn’t even fit my mouth. I was never able to get the upper & lower dentures in together. I didn’t actually have another appt. for about 5 months when he did the abutments. When I would call to see him , he would see me in the office, (like where he has his desk & paper work).He didnt get any kind of scan, but when he went to put in the abutments there was so much bone overgrowth he had to remove bone to find the implants. Then it was another 2 months after calling him numerous times he finally did the 30 minute wax try ins & said they were perfect, although they didn’t feel perfect & 8 told him they didn’t feel right. Just last week he put in my temporary teeth. They are all bulky & big. The gum part covers about about a fourth or fifth of the upper palette & comes all the way up where my gum & upper lip meet. The bottoms are not quite so large, but do come back way far behind the teeth & the front gum again is at the lip & gum line. I paid upfront for the zirconia teeth, which he insisted I pay everything up front. I hate these teeth because they are lots bigger than the dentures even & makes my upper lip look as if I had fillers put in. He keeps telling me they have to be that way to to keep from breaking. I thought zirconia was impossible to break. This dentist has been nothing but problems for me & won’t listen to anything I tell him. He is young around 36 & apparently doesn’t know what he he is doing. My first mistake was paying cash upfront. It has been almost 8 months & all I have so far is an over sized denture screwed onto my gums. What should I do? Also, everytime I eat a bite of food, I have to spend about 30 minutes just trying to get the food out from under this “whatever it is” with a water pic. It still won’t get all the food out. I can feel food up under it, but the way the gum line is done it’s impossible to clean it all out. Also, my teeth dont touch anywhere except the very back. It’s harder to eat with these than the dentures. I can’t even bite an apple cause the teeth dont come together in front. I would appreciate any suggestions as to what I should do. I paid for all on 4 in Zirconia. I refuse to settle for these dentures that are so huge, but not sure how to make him listen. I have already mentioned calling the dental board, but he doesnt seem to care.

        1. Oh gosh. What a mess. Why not just go back to the original guy? I’m sure they will give you an honest assessment and perhaps take over the case.

  2. Hi Dr Ramsey-

    Thank you for the great post. I have some questions regarding my implants and hopefully you could give me some advice here.

    My 5 upper front teeth(#6 to #10) were extracted and placed with three implants and a bridge over the missing teeth. I struggled with this procedure as it failed several times with my dentist back then. And the implant finally succeeded after getting referred to and done by another oral surgeon. The bridge was done by another dentist after evaluation of the oral surgeon that the bone integration was solid enough to proceed. The whole thing was completed about 2.5 years ago and the implants/bridge is working fine. It is, however, visually a lot shorter than my real teeth in the past which makes my smile really weird ever since. I’d like to know whether there any possibility to make the bridge longer without redoing the whole thing.

    Any comment/suggestion would be very much appreciated.

    Thank you!

  3. Dear Doctor Ramsey.
    I lost the four front upper teeth when I was about 10 years old and wore a partial denture since age 15, then in 1998 a dentist extracted the rest of my upper teeth and then I started wearing a full removable denture. I am 62 now.
    About 5 years ago I got tired of having loose dentures and speech problems (lisp because of the denture, and on top English is my second language what made the situation more frustrating). I started researching about implants to see if there were any options that could help me, I went to check some dentists that did implants close to my area (North Orange County, CA) and since I was not convinced, I asked my general dentist and he recommended an oral surgeon in Garden Grove. I was given very good information about implants that made sense with my research, was told that because I had been wearing a denture for so many years I had very little bone mass and needed bone graph and 6 to 8 implants, and at the end I decided to go for the over denture instead of the fixed bridge because I was concerned of food trapped in the flange piece of the fixed bridge.
    I had bone graph surgery done in Feb/2014, he also put a surgical mesh, and it took one month before I could wear my denture because of redness in one section of my gum, I am fortunate that I was able to work from home all that time. Then the surgical mesh was removed in August 2014 and six implants placed in October. My general dentist took the impressions for the metal bar and for the over denture and sent the work to an external lab, finally in January of 2015 I had the work done. The denture had the teeth smaller than my original denture, and matched the size of my lower teeth but when I smiled did not looked good and even though the palate is smaller, I feel like is in the way when I speak, speaking and enunciating words has become more difficult, no need to say a total disappointment and I realized that my dentist did not know much of cosmetic dentistry even when he tried hard. I went back 2 days later giving him all my concerns and he decided to bring the lab technician to his office and the technician looked at my profile and checked my speech and noticed that the bite had to be opened and that I had not enough space in my mouth to speak, took the over denture back to the lab, changed the front teeth, made them bigger and opened the bite. It is better than before as far as the look but it is not what I had envisioned at the end of the treatment; the feeling of having my own tooth, in addition more food is trapped in the palate now than before.
    I spent close to $40K in total and feel that it was a big disappointment – maybe the implants were done correctly but not the denture, and definitely and over denture was not a good option for me. I wanted to consult if I can still have a fixed denture with the way the way the implants were placed, and how much the consultation is, also I can ask my oral surgeon and my general dentist to give me any xrays, etc that I can bring to help expedite the diagnosis. Regards
    Olga G.

  4. I am 82 y.o male, due to tooth decay all my upper teeth were removed, but the lower teeth are in place and oral health is pretty good.
    I have upper removable dentures, they do not fit well and uncomfortable.
    They told me that I need bone grafting at some place at the back. My general health is good for 82 y.o I have one kidney but it is working 100%.
    I am looking to restore my upper teeth with non removable bridge vs implants.
    I need your experienced opinon concidering my advanced age and quality of life after that.
    What is the price difference on avarage between implants vs non removable bridge?

    Thank you

      1. Hi, I’m confused to hear about fixed teeth in 24 hours. If implants are not zygomatic, is it true that implants should not get a crown before 6 months to give the implant time to integrate w the bone?

  5. Thank you for this great information. I’m getting ready to get dental implants, I wanted to consult with 3 different Providers who specialize in this. Im looking at 2 different methods, one is the usual “all on 4” using 1 arch for top & one for bottom on 4 implants each. The other is “3 on 6” 3 separate bridges for each arch (top & bottom) on 2 implants each bridge. this methode doesnt have artificial gums, much like individual tooth implants dont. Im 58 years old & need to do this and want to make the right decision. My question is, why is the all on 4, better than the 3 on 6? from 1 piece vs 3 pieces, do you think one is better than the other? or will they both give me the same results? I appreciate your opinions!

    1. Didn’t I answer this already?? Did you not get the reply?
      If not please repost your question.

      In general one piece is better for the upper jaw whenever possible. Additional implants for the upper jaw are always helpful. Both options are good but your unique situation and the space between your top and bottom jaw are critical to know in advance. Also, if your smile is very “gummy” that will be an important determinant. For me, delivering immediate teeth on the day of extraction and implants is another important factor.
      Ultimately you need to figure out the rationale that each dentist is using for treatment… Then make your decision.

  6. I am 32 years old and had all of my teeth pulled last April. Since then I have been wearing immediate dentures. I am scheduled to go in this month and get two implants on my lower jaw and have my immediate denture that I wear now retrofitted to those two implants for a better hold on my lower. Do you think that this is the best way for me to go? Or should I go with the bridge insert thing that you’re talking about?

    1. Oh gosh…I am so sorry. At age 32 your bone will shrink tremendously over time to the point that you may not even be able to wear dentures. Although 2 implants are better than 0 implants they only provide a little bit of hold just to keep the lower from popping out of your mouth. Ideally fixed Bridges would help you keep your face musculature and slow down bone loss over time.

      Often times the patient that I treat with zygomatic implants is the one that lost their upper back teeth or all of their upper teeth along time ago and have almost no bone.

      1. Hello Dr. I’m extremely happy that I came across your site. Thank you so much for taking the time to inform those of us who are in need of a knowledgeable dentist such as yourself! About 8 years ago, I got an upper partial, but one of my teeth that it attached to had to be extracted. It’s been downhill since. I now have 2 1/2, yes, 2 1/2 teeth in the top! Soon, I will have them extracted and I’ve been researching a more permanent replacement. I have 7 lower teeth, but one on the side needs to be extracted and I want to get a lower partial. How well will an upper bridge work with a lower partial?
        Thanking you in advance and again, thank you for the service you are providing us…a wealth of information!

  7. Hi,

    I’m 27 years old and I have been diagnosed with juvenile periodontitis. My doctor says since I have a lot of bone loss and my gums are infected they will have to extract all teeth and do a fixed bridge implants.
    Anyone here knows as young as me diagnosed with such severe periodontal condition?I’m very scared and confused as to which doctor to consult and how to proceed further.
    Would the bridges last forever if taken care properly? I want something that will last and look natural.

    1. Hi Sandy,
      Why are you so certain that you are going to lose all of your teeth? I would have a second opinion. Speak to them about using diluted hypochlorite which is household bleach to help treat this aggressive form of gum disease. There are other options! If all of your teeth are super loose already then prognosis is not good. If that is the case, consider finding the best implant dentist to can find to build a planned for long-term stability since you are so young. I treat people in their 30s all the time. In fact last week I had a 30-year-old that even needed zygomatic implants. Best of luck

    2. Please get a second opinion I was told same thing did not need to have teeth taken out wait if a tooth falls replace with a im p plant and have your gums treated

    3. Just wanted to let you know, I lost all my teeth when I was 30.. I don’t think it’s that uncommon anymore. I wasn’t diagnosed with anything

  8. Interested in the price for the top implants? I have
    already been checked by another dentists and i was told I was a good candidate, I’m shopping around for pricing. I only had my top dental for 4/ month. I’m looking to have it done as soon as possible.

  9. Hi, My Doctor told me I need a bone graft for my upper jaw and need 4 screws on the upper jaw. I don’t have ant teeth left in my mouth upper and lower. My teeth do not stay without glue. Should I go for surgery?

    1. Hi – I just had upper and lower hybrid implants done. The temporary implants were in for about 18 months due to a couple of complications. I just received the permanent hybrid. The lower is very uncomfortable. It gets food caught in it all the time and looks very unnatural.
      My question is would it have been better to have all implants on the bottom? Seems like food would not get stuck underneath and chewing would be easier.
      At this point can I still do implants all across the bottom and have the hybrid denture across the top?

  10. I just wanted to comment to thank you for this page, and for being active with the commenters on it. My husband wants to resolve the issues he’s having with his teeth and his current ill-fitting “partials.” We visited a chain that does full all-on-4 implants – my husband was excited at the prospect right up until we got the price quote ($52K!). We cannot afford that, unless we never want to retire. I had been trying to clarify, for ourselves, the difference between the implants offered and “snap in dentures,” and this page has helped in that regard.

    Now I’m left wishing we lived closer to you. If we ARE, somehow (lottery?) going to undertake this procedure for my husband — I wish we were near you. It’s very hard to trust someone to do this, and do it correctly.

      1. That *is* the cost for both full upper & lower. I know it’s a lot of work, but that’s just prohibitive for many people!

        1. The cost can be far greater than what you have mentioned. Typically speaking that cost range will get you a lower end bridge/implants. The bridge may be plastic rather than authentic Prettau zirconia and implants may be all on 4 rather than a more ideal number of implants. Very respectfully, I am saying that it is on the low and for a double arch full reconstruction design that is supposed to last years and years. I do an inordinate amount of redo full mouth cases and it always ends up costing the patient more this way then to have done at the right way from the beginning.

  11. I know exactly what an over denture is, I wear one every day, but the dam thing doesn’t fit right, it hurts, it comes loose when I eat, and I hate it, but the alternative is to pay $35,000.00 more than the $12,00.00 I already have paid, and I just don’t have that much money. I am also unsure who the right Dentist is, if they know enough, or am I going into another dark room? The last Dentist said he knew how to do this, but obviously he or the lab he sent it to didn’t, because I am in pain every day and can’t wait until after dinner when I can remove them for the rest of the day.

    1. Oh gosh. Sorry about your situation. As a patient I suggest you be very selective about who does this. Making the teeth is equal in importance to the actual surgery. Many patients and even doctors think this is really easy.

      On the other hand sometimes and overdenture is not proper treatment and it is important that the doctor tell you this.

      I don’t even make upper overdentures because they do not meet expectations for many patients they surely don’t meet mine. I don’t know if you have an upper or lower but it would be nice for you to reply to let the group know.

      1. The overdenture I have is a full upper, it’s cut out so I don’t have plastic on the roof of my mouth so I can taste my food. The denture is held in the back of my upper jaw by four (two on each side) posts that were installed about 3-4 years ago, (nothing in the front) and they coincide or line up with the holes (metal caps) in the overdenture that attempts to hold it in place, but it rocks side to side, and digs into the roof of my mouth in the front. I use a paste to hold it down in the front, that helps a little to hold it from dropping, (very embarrassing) but that doesn’t stop the pain in the front of my mouth.
        The last dentist that gave me the 35 thousand dollar price to do the upper teeth correct said he would have to go into the sinus cavity, & that gives me pause, but he also said the previous dentist did that in the back, I had no idea. I guess I’m lucky I didn’t get an infection although they did give me lots of anti-infection pills to take after the surgery.
        I was also told by a previous dentist ( the dentist that installed the four posts) that because the bone in my upper jaw is very low and was told that cadaver bone would have to be used on the exterior of the upper jaw bone, how would that work, or would it work at all?
        I do have lots of reservations or concerns.

        1. As I mentioned before, I do not think that upper overdentures achieve much for a patient perspective. Having only for implants is not enough to truly convert you into something solid and fixed similar to crown and bridge work which looks and feels like your own teeth.

          The mechanics of your overdenture were either designed incorrectly or there is a technique error. Typically you would have a bar connecting them for stability and not remove the palate unless the implants were connected with a bar.

          Four disconnected implants is really not enough stability for an upper overdenture.

  12. I have full top dentures now. I hate them I have to glue them everyday ando sometimes twice a day. And taking them out hurts. Is there something that stays in the mouth without glue. I can’t afford implants

  13. Hi I’m a 50yr old woman who has a partial front denture, who has recently been told that I need to lose all my teeth. I’m so scared. I have decided to go with permanent dentures, and my 1st consult coming up this week. I’ve been trying to do as much research as I can when I found your site. I know without you seeing me personally what my best options would be but any advise would be helpful.
    I’ve been advised that I have serve periodontal disease, when I got my partial over 20yrs ago I was never advised that it was temp and even after follow appts. Long story short, I do have a proper one now (last 5yrs) but the teeth around have loosened and ready to fall out.
    What would be my best option? Thank you in advance for your time and guidance.

    1. I don’t like the word “permanent dentures.” It is really vague and I suggest you’re going to clarify exactly what this means. Nothing is permanent especially hybrid acrylic dentures.

      Without seeing you it might be the best option to remove all teeth and do a prettau dental implant bridge.

      If done properly, and with enough implants, this may be the last time you ever need any dentistry done!

      1. Yes Doctor, when I see someone on TV for instance like actors or actress would have the funds early in their life’s to have their real teeth removed, and have implants installed.
        In that way they are finished with dentistry (maybe a cleaning once in a while) and they have beautiful looking teeth all the time.
        I wish I had the funds early in my life to do that, because I wouldn’t have waited back then, but on the other hand the technology for getting implants of this quality wasn’t available yet, over 50 years ago.

        1. Pulling all teeth is only done if needed. Unfortunately Dentistry is never finished it is only maintained over time. This includes dental implants.

          1. I need two implants upper jaw the teeth have been pulled I lost my partial I couldn’t wear it hardly anyways looking for mini upper right teeth It’s a facial matter my Lips And jaw look Sunk in just from these missing I don’t want a bridge I want to be able to go out eat And not remove them

  14. I want the permanent bridges upper and lower-have had false teeth for about a year and literally hate them as I can’t even wear lower ones and yes they have tried to fix with no success. My problem is that I live in Miss near Memphis,Tenn. and was wondering if there is anyway you could give me some names in either state that does the same procedure that you do? I appreciate your help!

    1. Every doctor has a unique skill set. I don’t know of someone in your area that does it the same way. Sorry.

  15. Hello Doctor
    I have just received my brand new over dentures attached with 4 zygomatic implants. I have been a denture wearer for over 40 years and will say the new dentures feel great, look great and I am happy with them except for one issue. In the past I have a full palate covering but no longer. When I remove the teeth at night there is a nasty build up of food and nastiness. We have been trying unsuccessfully to prevent this situation but have not had any luck. Is this just something I just need to live with or do I need to have the dentures remade?

    1. I guess the question is why I have an overdenture made with zygomatic implants? ALL of the zygomatic dental implants that I do get fixed, nonremovable Prettau zirconia Bridges. When made correctly there is really no reason for an overdenture that you have to remove nightly. The denture will also require replacement every few years.

      You can remake the teeth like I show in this video. Let me know your thoughts. If you would also describe your experience with zygomatic implants that would be beneficial for others to read. They are an excellent implant for patients with very severe bone loss. I use them for the most severe of cases.

      Converting to a fixed bridge from an overdenture can be done!

  16. Hi Dr Amin, When treating perimplantitis (bone loss and painful infection that comes and goes for 4 yrs in a barely visible molar), how do you feel about use of lasers to remove infection?

    I love your site so much, thanks!, nan

  17. Hi
    I have a permanent fix lower bridge porcelain no pink acrylic, its just the teeth. the teeth are not flush against the gums one of them I can see a bit of the implant. shouldn’t this type of permanent implant be flush against the gums with no space or gaps. Food will get under it and its not removable.

    1. It is possible that you are having a bit of bone loss and or recession. Or it could be just that the bridge was made this way. All teeth and implants will undergo slight recession and bone loss over time as we get older but as long as it is not peri-implantitis then you are fine.


  19. i have 6 implants upper jaw before we start the treatment the plan was to put three fixed bridges now seems the dentist change his mine and saying we have to put one bridge with 10 teeth connect i saw the bridge but don’t like it don’t seems the shape be right and not looking like my own teeth i like to know if my three part bridge can be my option in my case

  20. I am in the process of reconstruction of the uppers, a total replacement of all teeth. The periodontist will be putting in 6 implants in total. He recommends that I get a fixed denture appliance made from acrylic. It would have to be removed and cleaned every 2-3 years.

    My dentist who is doing the dentures and installation suggests instead he prefers placing a series of porcelain crowns to the 6 implants, either a whole set or a series of 3 depending on the implant placement. He states the crowns he feels are better because they never have to be removed to clean, thus they are more sanitary.

    So the Periodontist is recommending the fixed denture appliance attached to the implants. His thoughts are that if it a tooth chips or breaks breaks it can be repaired inexpensively and quickly. He said the porcelain crowns would be more costly etc.

    My Dentist says he has dome them both ways but if it was his mouth he prefers the crowns, and said they rarely if ever break and likes them because they can be kept clean and more sanitary.

    Confused as to which is the best option?

    1. Porcelain is almost always the better option. Acrylic is terrible. It breaks, chips and stains after just a few years.

  21. Hi. I have a full arch PFM bridge in the upper jaw cemented to 6 implant direct sybron dental implants.
    Is it possible to have a conversion on the bridge/ implants to a screw retained bridge – for better hygiene,
    or would i need to change all.

    1. I don’t think switching from cement retained to screw retained is going to have any benefit unless the design of your bridge is incorrect. Watch this video on 3-D full arch tooth design

      I think it will give you some good background for discussion and thought. I hope it helps. You’re welcome to leave a comment there.

  22. Hi Doctor,

    I would be grateful for you expert opinion. It is now a year since I had 2 zygomatic implants and 3 implants in the front, in my upper jaw. I was fitted with a temporary bridge and was told that I would have the permanent bridge in 6 months’ time. There has been no follow up consultation, however, I feel rather comfortable with the temporary bridge. For some unknown reason that dentist is reluctant to finish the job. I have two questions – (1) Could the final bridge be fitted by any dentist? (2) Would I be able to live with this temporary bridge permanently without further damage?

    1. You have to get teh real bride done. Zygomatic implants are great in certain circumstances. They exist the palate at a sharp angle. You need to see a very high level dentist to take over to make the teeth. Probably 0.1% of dentists have any experience with it. I am very familiar and use these myself.

  23. Hi,
    I’m a 100% disabled veteran and I’m eligible for free dental. Due to past seizures I broke all of my teeth. The va made a set of dentures but they never fit me right. They want to use screws and make my dentures permanent.
    Unfortunely I had 2 heart caths each requiring a stent now I’m on Berlinta for the rest of my life. They are in holding right now.
    What do you recommend and how much would it cost me?

    1. BRILINTA is used to lower your chance of having another heart attack or dying from a heart attack or stroke, but BRILINTA (and similar drugs) can cause bleeding that can be serious and sometimes lead to death. Instances of serious bleeding, such as internal bleeding, may require blood transfusions or surgery. While you take BRILINTA, you may bruise and bleed more easily and be more likely to have nosebleeds. Bleeding will also take longer than usual to stop.

      It is better to just stay on it during the dental implant procedure. You will just need to deal with bleeding. With an experienced implant surgeon, hopefully they can suture you up enough to where the bleeding is not so bad afterwards. Some patients do end up in the hospital to stop bleeding though.

  24. I am 75. I’ve had dentures for about 50 years. I hate having to take my top dentures out when I go for outpatient or in patient hospital visits. My Mom is gone now but my last memory of her is with no teeth. So sad. My question is about my bone and gum loss after all those years. Is it still possible for me to have permanent dental implant?

    1. Yes. I do this very routinely. You will likely have an advanced case of bone loss but could easily have upper lower fixed bridges. Do your research!!

  25. With implant bridge on the top arch do you have to have all the pink acrylic gum that sits over the front of the gum. I think I’d find this uncomfortable/claustrophobic? Is there any way to avoid that? Would it be better for the bridge to be placed beneath the gum rather than part over the front of it. I’m not a denture wearer and have no gum problems. Just trauma to my teeth that will eventually fail.

    Also would it not look and be better to maintain for the long term to replace each tooth individually with separate implant and crowns. If costs aren’t too much of a problem?

  26. With the state of the art, best fixed bridge(w the little bit of pink porcelain for gum triangles),
    is metal(gold) used? or is it all zirconium?

    for mandibular 6 tooth fixed permanent bridge)

  27. my name is Happiness Khabola, living in South Africa, I really don’t know when last did I smile for a photo nor laughing out loud because of no teeth…

    what I noticed about me was that I’m dental phobic.


  28. Hi Doc,I have 4 implants, after bone grafts, ready for a 6 tooth bridge. With a state of the art FIXED zirconium/gold w pink porcelain bridge, HOW many years can it be expected to remain stable and healthy? I worry about cleaning under the pink porcelain(and trapped food causing infections that can cause perimplantitis and loss).
    How often have you seen that happen?
    Much appreciation for all your info!

    1. How long this will last is dependent on many factors. Having thick gum and bone around the implants is critical. There are a multitude of other things such as your bite, your skeletal relationship, or a hygiene, Prosthetic design that will all play factors into how long everything will last.
      Cleaning should be designed into the bridge so that you have access for all areas. In my office all bridges and crowns are designed on a 3-D software program so we can see everything before it is even started.

  29. Fixed bridge sounds great, but how expensive for a full top and bottom set fitted to a man with no teeth or dentures fitted, can’t have dentures as don’t get on with them, gagging all the time and can’t eat with them, would love fixed bridges but at what cost.

    1. Yes, replacing body parts with fixed prosthetic devices dental implants can become costly for sure. Also keep in mind longevity with whatever procedure you choose. And overdenture will typically be replaced after 10 years while a fixed bridge that is well engineered will go much longer.

      1. Hi!
        I am confused. I was told that over dentures will never need to be replaced. That the titanium as the core of the structure should last as long as fixed implants. It was mentioned that the only part on an over denture that would possibly need replacement could be the teeth and that the most it would cost is $1,000. I really want the fixed zirconia porceline bridge and I am so upset that my prosthodontist for some reason thinks the over denture with acrylic teeth is the best product. This is so stressful. Any thoughts to help clarify this? Thanks so much

        1. Some implant overdenture’s that are very well-made have an internal metal core. If yours is made this way it will last much longer than 90% of them that I see. The metal core can be re–based and new teeth can be put on but if there is no metal core the entire overdenture would need to be replaced.

          The metal should show throughout the entire denture not just under the attachments. Hope this helps.

  30. Hello,
    I am a 55 year old who is not at all interested in an overdenture or removable prosthesis.
    I have 4 zygomatic implants and 4 regular implants on the bottom. I am interested in getting a fixed bridge with porcelain teeth for both my upper and lower prosthesis. I really am impressed with your work.
    Would you be able to design a fixed bridge connected to the zygomatic implants? What options do I have?
    Thank you so much for your time.

      1. Hello Dr.,
        I was wondering if I could trouble you to help me understand the issues considered when determining if an individual is a good candidate for the fixed zirconia porcaline bridge. I have been told I cannot have a fixed prosthesis given I need lip support from the prosthesis to compensate for bone loss. Allegedly, I would be unable to clean under a fixed prosthesis given the height of it needed for support. It have never heard any restrictions like that before. I am confused as to whether this rests in the skill of the provider in designing the prostheses or if this is truly an issue?

        1. This is a good question. It often relies on the experience of the provider in reconstructing facial support and designing cleansability at the same time….no easy task. Some of us have made it our passion and are privileged to help people attain excellent dental health and aesthetics using fixed solid zirconia porcelain implant Bridges. It is possible in almost every situation. It sounds like your case is complex so be sure to work with someone who has done this many times. There are a lot of really great dentist out there.
          The challenge is balancing biology with aesthetics. There are many that do not understand more modern methods of reconstructing full arches…..I am constantly teaching classes on this topic!!! The restrictions you mention are things I even thought were true 15 years ago.
          good luck!

      2. Dear Dr.
        I have 4 zygomatic implants and I would like you to make me a fixed zirconia porcelain bridge. Can you facilitate this without the need for further implants? The surgeon that placed the zygomatic implants said he did not have enough room to place a regular implant in the front.
        I have had nothing but trouble with the design of the overdenture I received and my prostodontist claims I am not a candidate for a fixed bridge.
        It is time for me to come from Portland, OR to have you assess my situation but I was wondering if you thought you could proceed without additional implants.
        Additionally, I understand each case is individual but do you have any idea how much this may cost me?
        Thank you so much for your time.
        Joanie Allman

  31. Whoa! Yikes! Wait a second! There is a HUGE difference in a fixed bridge and an overdenture.
    I wish I had found you before my dentist gave me implants @ # 6-7-8-10-11-12 and I told him I wanted a fixed bridge and I ended up with a fixed overdenture!
    But now, here I sit with a $26,000.00 piece of plastic over my gums that I can’t stand. It feels like a plain old denture, except no pallet covering. It works, but feels like a new pair of shoes you can’t take off.
    I am far away from your location, but am so impressed with your internet site and your knowledge, especially the Prettau bridge, I may try to get to your location if it were possible to utilize my existing implant posts for the Prettau. But being financially wounded now, what it cost has become a factor.
    There are dentist locally that show up on internet searches that mention the Prettau, but then they just don’t seem to relate their experience with the process. I kinda feel like I would be going down the same old road as I did before .
    Thanks Dr. Amin, I just wish I were a little closer to Burbank!

    1. Same thing happened to me, He put both upper and lower implants in. 6 on the upper and 4 on the bottom. Would it be possible to have the bridge instead of these overdentures? And how much more would it cost?

      1. I just treated a patient like this recently. It depends on the position and spacing of the implants. Sometimes there is not enough or too much room for the material that is chosen. The guy I treated had 10 implants that were not deep enough for an overdenture. I had to add seven more implants to make it work. Your situation is not unique but what can be done is always unique.

        Better planning always helps avoid this costly mistake.

    2. It seems to me that dental patents with no insight in finding a good dentist that he or she can afford, must become a victim before that patient learns what he or she did wrong after sitting in the dentist chair, i.e. they believed what they were told. Once burned, twice shy.

      I am one of those who is twice shy, the dentist I selected was sure in his presentation to me that he could build a device just like my lower bridge, I thought it would be just like the Prettau, but when he was finished, I realized then it was just an over denture, and was done so poorly, he had to do it all over again at his own expense.

      1. ugh…read this post….yes there is tremendous variability in training, skill and experience within implant dentists just as there are with heart surgeons and pediatricians.

  32. I have all on four upper and lower. I hate my bridges. I have the implants,abutments etc. I just need someone to make me new acrylic bridges. What is the cost of replacement? Thank you

    1. I can never answer cost with any degree of accuracy without seeing you. Often times the implants themsleves need to be replaced or more implants are needed to convert your bridges to solid zirconia instead. The All on four has issues long term mostly in the upper jaw. How is your upper?

  33. I can understand how individual implants/crown will be parked in the bone and the gums will grow around it.
    But I am confused about complete fixed bridge that is not removable? The removable snap on and off bridge gives the gums a rest overnight. BUT fixed complete bridges look like they are screwed down ON TOP of the gums with no rest at nightime?! Please explain how it works.
    Is it not actually on top of gums but rather a surgical gum flap is opened up to the bone under the entire fixed bridge and the gums hug/heal next to the bridge? So the fixed bridge is not on top of the gums but is sitting directly on top of the bone and not on top of the gums?

    I have no upper teeth any more.
    You say if I had the complete upper zirconia Prettau bridge, it would not be an over denture, over the gums. But I heard that the zirconia prettau bridge is NOT screwed in directly to the bone below the gums but rather just above the gums so there is still a small thin space between the denture and the gums. How is that different than over dentures?

    1. Hello Steven,

      I wish I had time to answer every single question but keep in mind I still need to see live patients and have a family. Most questions that are posted have been answered in previous questions already, but let me see if I can help you understand. Ideally you should be seen by somebody in person so that they can “show” you the difference.

      The bridge is simply butted up against the gum in the areas where there are not any implants and emerges through the gums in areas where there are implants. The gums do not need to rest with a fixed solid zirconia Prettau style dental implant bridge. There is no reason to cut the gum and try to fit underneath as that would not work biologically. A fixed solid zirconia dental implant bridge is not removable and is screwed in directly to the implants which are inserted in the bone. An overdenture is a huge piece of acrylic which sits on top of not only wear the teeth used to be but all over the palate and all over the outer wall into your cheek pouches.

      The best thing for you to do would be to hold in see one in your own hands. I hope this helps.


      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  34. Your videos on this website is very informative. I really like the fixed bridge implant video. I need more info on a fixed bridge implant for upper with 6 or less implants in the front and 5 or less on the lower jaw using maybe a regular bridge. I’m,of course, self diagnosing my needs. But I wanted to give a picture, somewhat of a picture, of my issues.

  35. I have the temporary upper arch bridge and am disappointed that my gums are still covered as with the overdenture that was replaced. Necessary due to so much bone loss. But I am thrilled with the appearance.

  36. I am inquiring for my wife she’s a diabetic and we went to a dentist in Seattle about a year ago now all her posts came out do you have a solution???

    1. Need much more detail to answer your question. The more the better. Blood sugar numbers? Does she have other teeth? How long after they were in did they fail, etc…. As much info as possible.

  37. I’ll tell you Jodi Reeves
    If I had to do it over again I wouldn’t. It cost me about 12 thousand for 4 implants in the upper jaw which holds the upper denture in place and many times it comes out of the implants.
    To me there is no difference between a full upper denture and these implants.
    I had surgery to channel out two ditches in the bone (the only way I know how to describe how it was done) so they can fill it with cadaver bone which is like a paste, and four implants (two on each side) then he sews the gum tissue over it.
    One year later when it’s all healed they screw the gold posts into the implants which are embedded into the cadaver bone. The new denture is the same as one without the gold posts except they have four holes that line up with the implants, and the denture is cut out so most of the pallet is exposed so you can taste your food better, however you still have this huge piece of plastic in your mouth.
    This is the less expensive way of doing it, but the only thing you save is the fixodent or sea bond to hold the denture in if you were using a full denture without these implants. You still take it out at night a give it a chemical bath, but believe me it’s not worth the cost or the pain just to save some sea bonds that cost about 6 bucks a month.
    If your considering this way of doing it,
    The more expensive way is 32 thousand dollars, and only if you have good bone for the implants, if they have to put in cadaver bone, then it’s more, much more, but they look and work the best, they don’t come out unless your dentist takes them out.
    If your considering this way, do your research, and ask ask ask, friends, neighbors, or anyone who had full implants done, make sure they like the implant job that was done and the DENTIST that did it, that is sooooo important.

    Good Luck

    1. Well said… I don’t suggest ****UPPER*** implant overdentures …for about the last 12 years I have not made one and have exclusively done fixed bridges only. They end up costing too much and don’t provide
      Thank you for your detailed comment. Happy New Year!!
      Dr. Amin

  38. I have been advised that I have enough bone for a fixed bridges both top and bottom. My top teeth are very ‘patched up’. Consisting of four crowns and a bridge, leaving about seven natural teeth. I have had a bottom denture for about four years. The prices I have been quoted vary enormously from £18.000 to £30.000. From on line research and personal consultation it seems this is down to the materials used. Also if on line information is correct the surgeon performing the £18.000 surgery has far more experience, probably due to the cost. Apart from the saving I feel experience is a very important factor. I should mention I am sixty seven and natural looking implants are more important to me than durability.

  39. My husband has been wearing a full upper denture (and partial lower). The upper in particular bothers him because it feels like too large a piece of hardware in his mouth and he can no longer chew normally or taste the way he used to (who knew there were significant taste buds in the roof of one’s mouth?). I would like to get a GENERAL idea about the cost of four upper implants and an upper fixed bridge. Can you provide such an estimate? We understand that actual prices might vary significanty, but we would like a general idea so we can decide if it’s even a remote possibility or not. Thank you!

    Jodi Reeves

    1. Cost can vary tremendously on the upper jaw. It is highly complex. For a fixed bridge it may be as little as $25,000 or may be as much as $60,000. The average is somewhere in the middle.

      There is a tremendous variation of skill level and expertise when replacing a full upper jaw. There are so many different techniques and materials to do this procedure and unfortunately many of them are extremely under-engineered ans are “fads.” A full upper fixed bridge is the most difficult of all dental implant procedures.
      Having only four dental implants on the upper jaw is a very weak design. If even one of them fails, the entire bridge in all the money in time you spent will be gone. You have to look at long-term things such as peri-implantitis and bone loss that can and does occur.

      The “all on 4” dental procedure is overly marketed. I see at least one of these cases a week that are failing. The upper jaw has such soft bone that 4 implants replacing 14 teeth just doesn’t make a lot of sense. Yes it is cheaper than adding more implants but you really need to consider the long-term. That long-term starts at the three to five-year mark.

      I would suggest something like to Prettau dental implant bridge made on 6-10 implants for the upper jaw.


      Ramsey Amin DDS

    1. Cost can vary tremendously on the upper jaw. It is highly complex. For a fixed bridge it may be as little as $25,000 or may be as much as $60,000 PER JAW. The average is somewhere in the middle.

      There is a tremendous variation of skill level and expertise when replacing a full upper jaw. There are so many different techniques and materials to do this procedure and unfortunately many of them are extremely under-engineered ans are “fads.” A full upper fixed bridge is the most difficult of all dental implant procedures.
      Having only four dental implants on the upper jaw is a very weak design. If even one of them fails, the entire bridge in all the money in time you spent will be gone. You have to look at long-term things such as peri-implantitis and bone loss that can and does occur.

      I would suggest something like to Prettau dental implant bridge made on 6-10 implants for the upper jaw.

      The lower jaw can often be restored with 5 implants because the bone is much stronger. This makes the lower jaw less costly in general than the upper jaw. Oftentimes bone grafting is not needed on the lower jaw at all while it is much more common on the upper jaw


      Ramsey Amin DDS

  40. I need Upper and lower full dental fixed Implant,How much they will cost and is there any grant available? I am a very low income and I am in Canada ontario Mississauga.

    1. I wish there was. Perhaps in Canada the medical insurance will cover this???

      Medical insurance does not cover this in the United States.

  41. I am 74, lost four upper molars [3rd and 4th from each end i.e. from LH & RH sides and the remaining twelve teeth are so far intact]. My gums are receded, I was told implantation is not advisable due to my receding gums problem. I do not have bad breath, I’m not a diabetic, nor do I suffer from gum swelling [my dentist told me I don’t have periodontal or as I understand any gum disease]. I need those four missing molars replaced, as I lost food biting capacity. Please let me know what would be the best option left for me in your opinion? I’m of Indian origin, but live in England [UK] for the past 50 years. Thank you.

  42. hi i have one question as there is so many implants can you please tell me is a implant retained denture same as fixed or is it like overdentures that are removable

  43. I was wondering which was better, a lower arch removable implant denture or a permanent lower arch implant denture?

    My question has to do with cleaning. If you have a permanent lower arch titanium bridge denture can a water pick remove all the food particles and liquids from underneath so bacterial does not grow and cause gum issues?

    1. ” permanent lower arch implant denture” is always better. Yes it will be more difficult to clean but oftentimes within WaterPik and toothbrush will do the trick as long as it is designed well.

  44. I have had a bottom denture for four years. My top jaw has four crowns and a bridge. with about seven remaining teeth. My top gum is very receded. However, I have been told there is enough bone there for implants. Also implants have been recommended for the bottom jaw. Initially I thought I was more suitable for denture implants as opposed to a bridge. I have done quite a bit of research on this and I do know the difference. I just don’t know what to do. I should mention I am 67yrs

    1. Hi Lynne,

      A fixed bridge is ALWAYS better than a removable overdenture. For the most part, it ends up coming down to finances. The fixed bridge is always going to be more costly but keep in mind a requires far less maintenance over the years than an overdenture.

      Consult with a very experienced implant dentist if you’re considering upper and lower fixed Bridges such as the Prettau dental implant bridge or having individual dental implants or small segmented Bridges. They are much more difficult technically than an overdenture.

      Good luck with everything

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  45. My wife has bone loss and she very small. 4’11”
    She is in need of full upper and lower.
    Maybe has teeth size of a 13 to 15 year old.
    My teeyh aswell had the domino effect once my whizz dome can out the next 2 in front came out with in a few years. 9 teeth on top but need 3 more need pulling. The bottom I have 14 teeth but need 4 pulled. Cant eat meat anymore. Its bugging me.

    1. If you would like more information than what is available on my website or blog, please call my office to schedule an appointment.

      On the homepage you will see a button for the prettau dental implant bridge

    1. A fixed hybrid denture is a combination of denture teeth fused onto a metal base. The metal base screws to the implants in the teeth are made of plastic/acrylic denture teeth.

      Although more inexpensive, they still degrade like dentures in a short period of time. They tend to break frequently unless they are really thick. I would suggest having porcelain fused to metal or some sort of monolithic zirconia restoration. Both of these restorations will last much longer but are far more costly and require a high level of technical skill to perform.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      1. I have paid 11.250.00 Dollars for fixed bridge with poecelain, tatanium gold base metal. this was after full exam and CT scan and consulting with the DR Jhon Ross who had put six implant for me. after he got all the money he told me he is giving me fixed hybrid upper bridge. I can’t get him to explain what is hybrid fixed bridge.his name is Dr Michale p. Folck DDS.it has been over three months and I have not even seen the temp for tryout. please help me understand how to talk to him about my concern. I am in VA, beach VA. othre vise i would have come to see you.thanks.

        1. Hmmm… I just suggest you have an open conversation so that expectations are met. Dental implant full mouth Bridges are highly complex and there are so many different variations of them such as porcelain fused to metal, monolithic zirconia and/or hybrid Bridges. There is a tremendous cost difference between these also. Most of the full mouth cases I do are done with the Prettau dental implant bridge which is monolithic zirconia. Keep in mind the surgical implant placement had to have been originally planned this way to accept which type of bridge you’re going to have. You can always change in the middle of it.

          Very respectfully,

          Ramsey A. Amin, D.D.S.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry

    1. I am sorry but I do not have enough information to help you. You need to see a dentist and have a clinical exam and x-rays.

      Ramsey Amin DDS

  46. I have dental implants and an overdenture on my bottom jaw I have 4 implants on the bottom and 6 on the top. I just recently replaced my upper overdenture with a fixed bridge with 10 teeth they are cemented to my top implants… Its’ ending up costing $8,500. Just for the top. How much do you think it would cost to get a set of bottom fixed dentures? Is there away to possibly use my existing overdenture and attach them like the fixed uppers are attached or will they be like my new upper bridge with no plastic, gum looking stuff like normal dentures have? I’m 36 and would love to get your option on this matter and see what your thought and or suggestions might be??? Thanks for your help and your time.

    1. It is great that you have been able to convert your existing dental implant from an overdenture into a fixed bridge. This is a nice thing about having a two-piece implant with a removable abutment that is well placed. It allows you flexibility.

      Oftentimes the pink gum porcelain or acrylic is necessary to prevent the teeth from looking overly long. Your most likely missing teeth, bone and gum… Not just teeth alone. When this is the case it is best to have a pink replacement which is more ideally porcelain on a fixed bridge such as a Prettau or porcelain fused to metal as opposed to a hybrid that has plastic acrylic.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  47. I was wonder I have denture and my upper gum is extra skin so my dentist wants that remove and then maybe new denture if I get one would it be better for implant denture and how much would it be

  48. I have a bridge that has fallen due to rotting teeth i guess dentist says will due a 8teeth upper with 3 post bull up crown lengthening on 6 8 and 9 maybe thers other holding this new bridge with pins so what do you think do it ?

  49. Dentures don’t fell good they fall out,they told me that drill holes in dentures then put studs in my gums would hold denture better,it’s better to put implants then having dentures right do you take payments.reply sending

    1. Many patients have an extremely difficult time adapting to dentures. They are large and bulky and are mouths were never designed to be filled with plastic acrylic.

      It sounds like you’re talking about an implant snap on overdenture utilizing locator abutments. If you are just looking for stability, adding dental implants underneath your existing dentures will help. If you’re looking at eliminating your dentures altogether then you need to consider something like to a Prettau dental implant bridge.

      If you’re local and considering seeing me personally, please call the office at 818-846-3203 and speak to one of my staff members to schedule an appointment. I would be happy to help you.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

    1. Hi James,

      Three implants is not enough. You have to engineer implants in a similar fashion to how God designed your natural teeth. We have may more than three roots per arch.

      If you don’t design strength, you will not have longevity. This is not an area to skimp on, unless you are looking for problems.

      If you are talking about a snap on over denture that you remove then that is a different story.

    1. hi Saad,

      this is one of the most difficult things to do because gums are alive with blood in them and have a translucent appearance. Please see the link below to see real world examples of cases that I have done. Of course not all of them can be perfect, but we have to always remember what shows when the patient smiles is much more important than what shows when you’re lips are pulled back for dental photograph.

      fake in real gum transitions using the Prettau dental implant bridge

      Smile Gallery

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  50. Hi Dr. Amin,

    First of all, I want to say thank you for all of the amazing information you’ve provided on your website. I have had too many dental issues to list in one post, but sufficed to say, they are legion. I am a 38 yr old mother of 5 beautiful children, and although I’d never trade being a mom, the havoc those pregnancies wreaked on my dental status has been astronomical. I have had work done to every, single tooth left in my mouth and have already lost half of my teeth. The rest are in terrible shape, and need to be pulled. I’m certain I have bone loss, although I’m unsure of the extent.

    I believe I lost my papillae approximately 4-6 years ago (between my 3rd and 4th child). To be honest, I didn’t even realize that was what was causing that gap at my gum line until I read it here, as I didn’t realize you could actually “lose” them. Thus far, the dental care I’ve received here in Kansas has been a nightmare to say the least. I truly wish I lived closer to Burbank so I could come in for a consultation with you. Do you know of any reputable dentists that specialize in fixed bridge implants closer to my location? I really want to do this right the first time. I have been so traumatized by bad dentists, that I have a sincere phobia about sitting in that chair now. 🙁

    ~Robin K.

    1. Hi Robin,

      The entire time that you are losing papilla was because you had underlying periodontal disease that was going untreated. Attached is a link to find a dentist qualified in your area. You really needed expert since you are so young.

      American Board of Oral Implantology / Implant Dentistry is an excellent resource to find a great dentist for this type of procedure

      I would suggest that you have a Prettau dental implant bridge or something extremely similar to it. Avoid the all on 4 procedure or a hybrid type of fixed denture.

      Prettau dental implant bridge
      How to Choose an Implant Dentist

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  51. thank you for clarifying so much information. I’m considering having this procedure done and will be contacting your office. I am local to you. You actually treated a friend of mine many years ago and he says it was a great and things are still perfect. Looking forward to meeting you in person soon.

    William C.

    1. Hi Will,

      I look forward to meeting. Make sure to let my front office know who referred you so we know your connection to that patient.
      See you soon!

      Dr. Ramsey Amin DDS

  52. Hi Dr Amin,

    I am in the process of having all of my teeth extracted. I have 17 left. I am interested in getting dentures and have been seeing hybridge dentures advertised. Can you give me advice on what I need to look for and ask local dentists in my area as I don’t have money to spend on procedures that isn’t needed.

    1. Hi Jimmy,

      Hybrid Bridges break all the time. I would not suggest you have one of these unless you’re okay with having a lot of repairs done. I would suggest you have a Prettau bridge if you’re considering a fixed dental implant solution. Prettau bridge is made of monolithic zirconia and is extremely strong. It does not chip and will not break if it is designed properly. The design is the most important aspect. The implants have to be placed at a very precise depth in order for the Prettau bridge to work.

      I would suggest you find a total solution provider dentist that can handle your difficult situation from start to finish with a single provider. Attached is a link on how to choose an implant dentist and also some more information on the Prettau dental implant bridge

      Related links for you:
      Prettau Dental Implant Full Mouth Bridge
      The Process of “Permanent” Fixed Dental Implant Teeth -5 Steps to Replacing All Your Teeth
      fixed versus removable from maintenance standpoint

      Good luck,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  53. thank you for your wonderful article. The work you show is very nice. I also saw the you have a lot of examples in the smile Gallery section of your website. Thank you for your understanding and devotion to your patients

    1. Hello Elmaati,

      The cost to replace a complete upper arch or lower arch with dental implants can be variable. This depends on bone density and bone volume primarily. I strongly suggest you see a very skilled implant dentist for this. Replacing all teeth with dental implants is the most difficult procedure dentistry has to offer. Your body parts are priceless!

      Cost can vary from $20,000-$50,000 per arch.

      Very Respectfully,

      Ramsey Amin, DDS
      Diplomate of the American Board of Oral Implantology/Implant Dentistry
      Fellow of the American Academy of Implant Dentistry
      Burbank, California

  54. I need help about 1yr 1/2 ago I went to the dentist I was missing one tooth in the front top of my mouth which I have since 14 yrs of age I been wearing a flip all my life so I wanted to fix that problem and get something permanent ok about time I left they shaved down 5 teeth in the top saying I need a bridge cause trying to do one tooth want work due to one tooth was loose I’m not understanding but figured they know best they then covered all the tooth with a plastic fake teeth looking thing shortly one week after called me in to show me the teeth they were gonna place in my mouth which looked like they robbed them from a skeletons mouth I said no and walked out then shortly after that I got pregnant so now no dentist so baby is here now turned 2 and this plastic over the top of my mouth is detorating slowly I need help asap please I dont know what I need or who to trust but I do know I need my mouth fixed asap

    1. Hello Crystal,

      It sounds like you had 5 teeth ground down for a bridge and still have acrylic/plastic temporaries in place. The real porcelain teeth still need to be delivered. Typically in the front of the mouth I will perform a prototype or “wax up” in order for you to see what the teeth look like before you get the final ones. It sounds like there was some errors in communication.

      Regardless you cannot just leave your teeth in temporaries because they leak. If the teeth are left in temporaries for too long you will develop cavities at the edges are what we call margins of the temporary crowns were you cannot see them. This could lead to loss of all 5 of those teeth and/or root canals. I would suggest you go back to the same dentist to work out your differences and then determine what to do from there. It doesn’t sound like you need dental implants or bone grafting at this point but it does sound like you need to finish your dentistry.

      Good luck. Take great care of your teeth your whole life. Prevention is the key to avoiding the need for dental implants and-or bone reconstruction.

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

  55. Yes, fixed dental implant bridge is really better than implant denture because it can’t be remove and it is like a real teeth. It is stronger than just a plain implant denture because its structure acts like the root of a natural tooth, anchoring the replacement into the jaw bone.

  56. hello Dr. Amin
    i couldn’t get a word of your reply. can you reply me by email please, my email address is xxxxxxx thanks for your time in advance

    1. please re-post your question. I answer 100s of comments on this blog. Please try again as the problem is likely with your computer settings or software.

      I’m happy to help you if you can post your question

      Dr. Amin

  57. Hi! I’m 48 and never had any problem with my teeth until last year in July. I felt some swelling in my front left upper tooth gum. When I touched it started to pus, very small amount of pus. After that I had to go to rinse my mouth in every 5 minutes cause there’s a bad taste in my mouth. I have no dental insurance, but a friend dentist saw me and told me that I have serious gum disease and only a periodontist can fix my problem. Because of severe financial problem I couldn’t go to a periodontist, now my tooth is loose and pus still comes. Front left upper tooth is getting longer and those two teeth are getting so much space in between them. I don’t know what to do or where to go, can you suggest anything please. Thank you!

    1. Hi! I’m 48 and never had any problem with my teeth until last year in July. I felt some swelling in my front left upper tooth gum. When I touched it started to pus, very small amount of pus. After that I had to go to rinse my mouth in every 5 minutes cause there’s a bad taste in my mouth. I have no dental insurance, but a friend dentist saw me and told me that I have serious gum disease and only a periodontist can fix my problem. Because of severe financial problem I couldn’t go to a periodontist, now my tooth is loose and pus still comes. Front left upper tooth is getting longer and those two teeth are getting so much space in between them. I don’t know what to do or where to go, can you suggest anything please. Thank you!

      1. Hello M,

        It sounds like you have long-standing, undiagnosed periodontal disease which has caused bone loss. If you are smoker, this is far more aggressive. If the teeth are loose, oftentimes this is going to lead to extractions.
        A periodontist may be a good start but is not necessarily a requirement. You need to have a great dentist as your main quarterback, and the periodontist as backup. Your case will likely require tooth replacement and restoration with either dental implants, partial dentures or even full dentures. Some dentists are trained in all types of specialty procedures and are true “total solution providers.” You may be best seeking an opinion of a total solution provider who can then steer you to a proper specialist if needed. Many of the best dentist in the world are general dentists who are trained in all types of specialty procedures such as endodontics, periodontics, implant dentistry, oral surgery, prosthodontics and others. I find that these providers have the best solutions both long and short-term.

        Regardless of who you see, you need to see somebody very soon.

        How to Choose an Implant Dentist

        Signs and Symptoms of Periodontal Disease

        Ramsey Amin DDS

        1. Thank you Dr. Ramsey Amin for the fast reply! I want to ask you a question… I never smoked in my life, I drink soda once in months, don’t have sweets more often, I floss every day since last 25 years, I can’t even sleep if I don’t floss, I clean my toung regularly and there are people I know who are much older than me and they don’t even floss then what are the reasons I got gum disease? I am just wondering if people have gum disease because of some deficiencies. Thanks!

          1. hi M,

            I would have to see you to help you with this. There are some types of gum disease that present themselves without any pain or problem to the patient at all. The key is to see a dentist twice a year and to catch these things very early…sorry


  58. Dear Doctor Amin,
    Just wanted to let you know I did have a DEXA scan and all was fine. I have a slight case of ostepenia. I do not have diabetes and I never have been on Fosomax. I think my problem was that I had lost several teeth as a young girl and my bone disintegrated. The oral surgeon doing the implants felt my bone was okay until he began the surgery.
    All in all I am doing okay with the snap in denture.
    Thanks for your reply, Kay

  59. Hello. I had all my teeth pulled I was supposed to get full bridge implants the dentist took our full 401k pulled all my teeth and then lost his license cause he killed a patient using meds to sedate and wasn’t licensed to. I lost a lot of bone I’m sure I will need bone grafts. What kind of cost am I looking at at worst case scenerio? If I come there to do it how long will I need to be there?

    1. Yikes Teresa!

      What a horrible story. I feel so badly for all parties involved here.
      IV sedation in a dental office is extremely safe when the provider is well-trained, experienced and does this on a daily basis. Do not assume that all dentists are trained alike.
      Sleep Dentistry

      I am assuming this is one of these dental implant super centers which advertises on the radio extremely low rates and a factory, clinic-like atmosphere? I routinely see patients from these Walmart style centers which come to me with poorly placed dental implants, lots of complications and broken teeth.

      There was a place in Orange County Southern California that this occurred. Were you treated in this location?

      Without seeing you in person, there is no way for me to know how long he would need to be here. Where do live?

      Very respectfully,
      Ramsey Amin DDS

  60. Dear Dr Amin,
    Thank you for your website and the photos of both fixed upper jaw implants and the photos of the removable over dentures. Almost 3 years ago I had the few remaining upper teeth I had removed. I did this rather then trying to save these 6 teeth. I had several dentist recommend implants rather then trying to restore the 6 teeth which all were crowned and 2 with root canals.
    I had 5 implants placed in the day I had the 6 teeth removed. 4 months later I went in and 3 implants were removed due to not adhering to the bone. I did have 2 CAT scans which indicated I had enough bone. The dentist did extensive bone grafts several times and placed several more implants. I have lost tract of how many implants were placed. Eventually I had to have a sinus lift and then another bone graft. As a result I finally have 4 good implants. I took calcium suppliments during this whole process. I was in my 70’s when this process began and now I am 80 years old.
    This past week after about 4 months of planning by the dentist creating my snap in over denture I finally got some permanent teeth. I would have prefered the fixed implants but am grateful for the snap ins. I was not sure I liked all this metal in my mouth with the bars but I guess I will get used to it all. I can snap the over denture okay and snap it in in the morning. My dentist charged me up front and never asked for another penny for all the extra work he did. I had one dentist doing the implants and another doing the denture, they both worked closely together. All in all I am grateful to have a new set of teeth at age 80 years. I just worry if I get old and feeble will someone else be able to get the denture out and in.
    Thanks for the photos, they look just like what I have. Kay

    1. Hi Kay,

      Thank you for sharing your story. It is definitely an unusual one. If these types of complications happened on a regular basis, nobody would be having dental implants or bone grafting done.

      Fortunately dental implants and dental implant bone grafting is a highly predictable procedure for the vast majority. I’m so sorry you had such issues along the way.

      You should be tested for osteoporosis/osteopenia and know your T score by taking a DEXA scan with your physician. I am guessing you may have had some sort of underlying disease such as diabetes mellitus, osteoporosis or have possibly been on long-term Fosamax or Boniva which could’ve resulted in failure.

      Regardless I’m happy that you’re doing well now. Again thank you for sharing your story. There are several thousand people that read this blog on a regular basis.

      Do you take Fosamax, Actonel or Boniva? What You Need To Know Before Having Dental Implants

      Periodontal Disease and Diabetes

      Good luck,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  61. Oh wow. You are an incredible dentist. Thank you for responding to everyone’s inquiries.
    I’m 33 years old and had an implant supported denture placed on my upper jaw a year ago.
    My dentist assured me I would be very happy with it.
    Wow, I was most disappointed. He didn’t have an exact model of upper dentures, he only showed me lowers, which I don’t need. They seemed ideal because they would not cover my palette like the temporary denture I had for a year prior to that.
    When I got it I was shocked how bulky it was. I make sure not to open my mouth too wide because though it doesn’t cover my palette, it’s extremely noticeable. The metal on the back that sits on my frontal palette makes it really obvious.
    I had to transfer right after I got them overseas the following week.
    They always have rocked and so I still have to use adhesive. One of the main things I had looked forward to was not having to use that stuff.
    Since they are acrylic, after a year they worn out to the point they have begun to crack and a piece of acrylic fell right under one of the abutments.
    I’m coming up on my yearly dental visit. I’m in the military, it’s all been done via the military. I am very grateful overall. I am no longer in pain and my smile is pretty.
    However, I am considering asking to get a permanent implant supported bridge. I want to be as informed as possible. I read numerous posts here and all the complications and room for error from dentist that are either not competent or misinformed.
    Also, all the possibilities for complications very particular to each individual.
    I’m definitely bookmarking this page. Most likely I won’t get this new dental work done till I return to the states over a year from now. If the military won’t do it, I will definitely pay for it myself.
    There is one thing that turns me off from bridges. The look of it at the gumline seems unnatural from images I have seen. Also, I have a partial bridge in my bottom jaw and there is a slight gap between my gums and the bridge. It’s no big deal in the bottom. I just have to brush really well down there to remove all food particles that get stuck.
    I do hear that there is that gap between the bridge and the gums that requires individuals to use a water pik to really get in there and clean. The idea of having food stuck in between my gums and bridge and not being able to remove it adequately does worry me. I have been pain free with healthy gums for 2 years now, I don’t want to risk gum disease again.
    So can implant supported bridges look as pretty and natural as a well made denture?
    Is my worry for gum disease really a concern? Or is it something easily preventable simply by brushing well with an electric toothbrush and the use of a water pik?
    Also I believe I have 8 implants supporting my denture, if not 8 then 6. Will these most likely be used if I go for an implant supported bridge? I’m guessing so. They seem well placed in my gums.
    Thank you!

    1. Hello Ana,

      Thank you for your very kind words. Yes it takes a lot of extra time to respond to 100s of inquiries and run my private practice in Burbank, and balance family at the same time. It is definitely a juggling act…LOL
      It sounds like you have had quite the disappointment in having a dental implant over denture. I do not suggest this type of treatment for a 33-year-old that has not had dentures before for many years. Over dentures are far better for people who have had dentures for many years and are just looking for better support.

      There are definitely really bulky but typically did not rock at all. And yes you are correct, because they’re acrylic they wear out and break all the time especially if the space between your implant in your teeth is minimal. We call this interarch space.

      We all have to remember that what is created by nature and what is created by man are always going to be different. Just like a prosthetic leg looks and feels different than a natural leg, a dental implant tooth has similar disadvantages because it is man-made. The most important thing about making the gumline look natural is to make sure that this transition between pink porcelain occurs under the lip. We do not want to see the transition zone between pink porcelain or pink acrylic when you smile. It is very difficult to mask this because natural tissue has blood within it.

      When done properly, a full mouth dental implant bridge such as the Prettau full contour zirconia bridge can be done in a very pretty smile. Please see the link below and see some real patients that have had this treatment. This needs to be handled by someone who is very skilled and very experienced with full mouth restoration with dental implants. Gum disease and peri-implantitis is always a concern. Make sure your nonsmoker and have excellent oral hygiene with routine hygiene visits at least every 6 months.

      Generally 6-8 implants will support a fixed bridge such as a Prettau bridge or porcelain fused to metal bridge with pink-colored ceramic. Keep in mind that some dentists are far better with re-creating pink ceramics than others. Some labs are just far more experience with this.

      Prettau Dental Implant Full Mouth Bridge

      What is Peri-implantitis and What Do I Do About It? – Bone Loss Around Dental Implants ~Burbank Dentist, Ramsey Amin Reviews

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  62. I now have the final thing in my month which should have been a titanium bar fitted on 7 implants. Not sure why at the very last minute this dentist decided not to give me a titanium bar. This was not the plan at all and only to find out as the teeth was going into my month. I don’t think I have any bar at all. Does this make any sense? will I end up with issues down the road. I think I have this fixed bridges porcelain but not fused to metal bar only implants.
    This dentist didn’t place my implants and picked up from someone else mess.
    I am seeing my dentist this week and don’t know what questions to ask him. Please help me. I need to be reassured he did not cheap out on the last minute. I think the bar was sent back and some screw up happened at the last minute this is why i now have no bar. He said it was difficult to make the bar with titanium so he use chrome brushed. I am so confused. I can’t afford to do this again for the third time. I am now over $50,000 and still questioning the quality. My trust is so not there and I wish it was. Please help

    1. Sorry I forgot to mention it is the all upper teeth. fixed bridge is what I have in now. I can not clean it because have no space. Also my bottom teeth is like a roller coaster (meaning a slight dip. Thank you again. Please reply within a couple days. I am meeting with the dentist this Thursday.

      1. The bottom teeth should be leveled out. This ideally is done before the upper is made! I see now that you are having an upper fixed dental implant bridge made! see my other comments please

        Dr. Amin

    2. Hello Debbie,

      I am not completely clear where your seven implants are but I’m guessing they are in your upper jaw. It sounds like you are having a CAD milled titanium bar to support a hybrid fixed bridge. This means that the titanium bar is fabricated by computer-aided design and computer-aided milling…. These are really good and quite accurate. They allow the implants to be joined strongly but passively.

      It sounds like you are on the way to a fixed dental implant bridge, but it sounds like a hybrid. Most dentists make hybrid bridges. This means the teeth are plastic denture teeth on top of a metal substructure. Regardless of the material that’s used, a slight space needs to be developed for you to be able to get underneath with special floss threaders and tiny brushes. The space needs to be very small if it is on your upper jaw so that your speech is not affected.

      So the bar is likely just a substructure for the fixed bridge. He has to try this piece in to make sure it fits. You should be very clear on whether you’re getting in over denture or a fixed dental implant bridge.

      My preference is a Prettau dental implant fixed bridge which is made of monolithic zirconia.
      The implants had to have been placed purposely for this particular restoration prior to surgery. Not all implant positions will be able to have this superior bridge.

      Good luck with everything… I’m sure it will turn out well! 😉

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      1. We were clear we were doing a bar, fixed dental implant bridge.
        He took a ct scan to clarified this was capable of doing.
        I now have this finial in my month.
        This is what I have.
        -No space for getting underneath with special floss threaders and tiny brushes.
        -seven implants screwed in type should have been a bar. But Dentist decided not to without tell me at the very last minute.
        – I can not clean underneath nor can I take this plate off.
        -He said I should never have to take it out every. I said I would cleaning this was the plan.
        -It is the screw in type just no bar
        -one screw not plugged at all because no space for plug
        Do see me having issues down the road?
        -Just screws on porcelain but not fused to metal bar only implants.
        Quality? How long will this last? I am scared I am going to be back to start over in five years or sooner. I can’t afford it

        1. Sorry, I meant the other dentist and I were very clear on the bar. He did the scan and he plugged off one of the eight implants. Everything was a go with the bar. Something changed at the last minute. This just not right .

        2. Debbie,

          I would have to see you in person to answer these questions. I know you and I have had quite the long discussions.

          A fixed bridge is always better than a bar overdenture if that is what you have. Usually a bar means it is removable

          Ramsey Amin DDS

  63. In Feb 2014 I went in to get permanent fixed dentures. I had 8 implants placed on my upper arch and 6 placed on my lower and am in the process of getting fixed permanent bridges. My bridges were made and placed in June of this year. The day they were placed I went to eat pasta and the bottoms broke loose. I went back to my dentist and he said the cement didn’t hold and he tried 3 different cements without success. I was given back my old bottom denture plate until a different bridge is made.He is now going to place a metal bar to attach the bridge to and says they will be non removable. Well tonight after work my upper bridge came loose on one side. Will I loose the upper bridge over the weekend . I can’t get ahold of my dentist, I can’t go with out any upper teeth until Monday. I don’t have my old upper plate it was left with my dentist. What can I do if all of my teeth fall out. I was told the abutments are screwed to the implants and the bridge is cemented to the abutments. The cement is not holding! I’m concerned now because the new bridges he is having made are acrylic and not porcelain like the ones he first made, which is what is loose today, and we are having trouble keeping them in my mouth. They are suppose to be fixed?? And these were just put in 1 month ago. He says I will be happier with the acrylic because I complained about the clicking noise when I talk, you can see the abutment posts along my gum line and he said the gum line can’t be built up on the porcelain bridge, and I wanted longer teeth in the front because now the teeth are straight across and my smile doesn’t follow the smile line of my lower lip. All of this is just to try and give you a little info on my case. My big concern right now is that I’m going to loose my teeth over the weekend and don’t know what to do. Thanks in advance if you can give me any guidance.
    Why am I having so much trouble with these porcelain bridges?

    1. Hello Diane B!

      Wow, this is quite a story. I apologize in replying nine days after your original post. I was out of town and my entire office was on vacation.

      Something sounds very wrong here. Cement does not hold bridges in place. It merely just fills gaps. There is no reason for the bridge to rely on the cement for to hold in. It sounds like something is strange with the design of this bridge. A dental implant bridge that is cemented can often hold with just Vaseline and not even need cements because it has built in retention by the shape and length of the abutments. This means they have a very tiny gap in the cement simply provides friction in the seal.

      Yes your teeth are supposed to be fixed and not come out. Clicking noises can also be a sign that the teeth are too tall in your mouth. We call this vertical dimension of occlusion. In my own dental implant practice in Burbank California, I take patients through temporaries in order to test their speech, phonetics, facial support, bite and of course aesthetics. Typically all this is worked out in temporary stage.

      I use acrylic only for temporaries or another material called pmma. Regardless, it sounds like your dentist is going to make this right. I’m sure he has no ill intentions.
      If for some reason your teeth fall out at an inopportune time, recement them with a store-bought dental temporary cement.

      Sorry for the trouble you are having. This is very unusual. On a side note, most of the bridges that I make on dental implants are either retained with screws or have CADCAM milled custom abutments. These are two things that will help prevent the teeth from falling out. This is all by design by a very skilled dental laboratory guided by the dentist.

      links that will help you



      Very respectfully,
      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

  64. Hi,
    I have a 4 tooth bridge on the right side of my mouth and a 10 tooth bridge on the left side. Tooth #15 (anchor tooth) had a root canal done on it in 2011. It now has a small amount of decay. My dentist suggested getting an eval for a re-do on the root canal. My quote was over $2,000 over the phone . If I decide to get the tooth pulled instead, would I need an implant to replace the extracted tooth and a new 10 tooth bridge? If a root canal can be done to save the tooth, what is the success rate of a root canal being done again on the same tooth.

    Thanks for your time!

    1. Hello Helen,

      Every time you root canal tooth, it gets weaker. It sounds like this one tooth is very important for your 10 tooth bridge. You should really consider the possibility of a fixed implant replacement such as a monolithic zirconia Prettau dental implant bridge. This would involve extraction of most or possibly all of the teeth on that arch and replacement of those teeth with a dental implant fixed bridge.

      Of course I have not seen you, or your situation, but one tooth supporting 10 teeth is a recipe for long-term failure. A new 10 tooth bridge is not likely to last few more than 3-5 years if it involves back teeth on the molars. Some front Bridges on teeth that do not have root canals can last many years without problems.

      Each situation is unique. Keep in mind that Bridges flex in the Center if they are made of porcelain fused to metal. Recurrent decay around the edges of your crowns and Bridges are very common. Be sure you exercise perfect oral hygiene.

      I have included a link for the Prettau dental implant bridge so that you can know your options should this come to fruition.


      Good luck and keep me posted.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      1. I went to the school of dentstry in NYC to have a perminate bridge and and a lower partial put in. Because I am on Medicaid my dentures that are partials move and slide and my upper tooth that was screwed in broke off and is hanging and I cant eat at all. Only soup do you know of a very good Medicaid dentist in my zip code of 10011 NYC signed desperate and fit to be tied.

        1. I am so sorry..I do not know of somebody in that network. I practice across the country in Southern California.

          Good luck,

          Ramsey Amin DDS

  65. i was really curious about how much it would cost to get a none corosive and none conductive metal to have either placed over my canines or implanted as my canines. yes they will be sharp. i tend to be looking at these all the time but, the metals i have found are so expensive like platinum or rhodium. the “noble” metals. what i was looking for is something that is durable as well as the current factors ive listed before. is there any other metals that have these properties that aren’t as expensive per ounce? also how much would dental work cost me for both teeth?

    1. Hello Andrew,

      Dental implants made of titanium have been around since the mid-1960s. There is a ton of research and data to support the use and safety of titanium alloys. Metal has to be biocompatible to be able to be placed into your body. The cost per ounce of titanium is negligible. Manufacturing of a medical device that is safe to be implanted into patients is priceless.

      I wouldn’t try to reinvent any type of alternative material without long-term studies prior to its release.

      The cost of most dental implant procedures are generally related to the training, judgment, and experience of your dental implant surgeon. Anybody can put a screw in, but placing it precisely into the human body to replace a body part is of critical importance. Oftentimes the bone needs to be rebuilt in order to even have a dental implant.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  66. I just returned from the periodontist , who did a cat sac , and a panoramic can on my teeth. He said I have internal resorption ,and an implant would not work. He said it would take years and many bone grafts. I am 56 yrs old. He suggested a fixed bridge using 5 upper teeth. The tooth is #19 that had a root canal 32 years ago. I had had trauma to the tooth as a child.

    He also said he could do gum tissue support on my canine tooth which needed it. He would make small incisions in my pallet, and then make a splint to cover the pallet so my tongue would mess with it. He said it would take 2/3 months to heal.

    My question. What will support my fixed bridge, will I have to have 4 implants? He never mentioned implants on the other teeth. Just gum tissue surgery.

    1. Hello Stephanie,

      Having an abscess over a previously bone grafted area for a dental implant is not that common. The bone may or may not work its way out on its own. The antibiotics will likely help tone things down for a while and buy you some time until your regular dental implant dentist can see you.
      Without seeing you and your x-rays, it is difficult for me to tell you otherwise. Most bone grafts are articulated materials that have the size of small granola. If one of these tiny pieces comes out it means that it was never integrated in the first place. This does not mean that the entire bone graft is going to fail because of one particle that did not integrate.
      Have faith that things will go okay. Thank you for your very kind words. I wish you the best.
      Ramsey Amin DDS
      Burbank, California

  67. Dr Amin, your site is great!

    1. Could snap ins be better than permanent screw in types in regards to a solid zirconia bridge? It seems it might be easier to clean around the posts daily. Do certain foods cause snaps-ins to snap out?

    3. What is the difference between an overdenture and a solid zirconia bridge? Despite reading and seeing the pictures here it appears my “acrylic permanents” look more like an over denture and they are extremely hard to clean! They are screwed in.

    4. What is the cost difference between an over denture and a solid zirconia bridge? Do any insurances cover any part of this?

    So far I have broken an upper and lower tooth on my titanium bridge. I have flattened a few teeth in the 4 years I have had them. I do wear a night guard. Also, it is so offset from the actual gum that chewing seems to cause stress/irritation around the posts (at least, that is my thoughts). No screws are in a tooth structure. The over hangs make it very difficult to clean underneath despite my using a Water-Pik device.

    Thanks for any help you can offer. You have a stellar website. Very sadly though, I am a “by-product” of the VA bureaucracy (Given all that, the rotating student left healing posts off for 30 minutes). Eh, he is my doc. No smiles there.
    Regretfully, I am in Bama… (ouch)

    1. Hi Philip,
      I’m going to try to answer each one of your questions! My answers are marked by*****

      1. Could snap ins be better than permanent screw in types in regards to a solid zirconia bridge? It seems it might be easier to clean around the posts daily. Do certain foods cause snaps-ins to snap out?

      *********** it is extremely rare that removable snap in dentures would be better than a solid zirconia dental implant Prettau bridge. Removable teeth are made out of acrylic and are essentially dentures that snap onto titanium dental implants. They will require much more maintenance and complete replacement in a few years. It is solid zirconia Prettau dental implant bridge is nonremovable and does not chip, break or need to be replaced as frequently as a snap in denture****

      2. What is the difference between an overdenture and a solid zirconia bridge? Despite reading and seeing the pictures here it appears my “acrylic permanents” look more like an over denture and they are extremely hard to clean! They are screwed in.

      ****** even though they are screwed in, I design certain features in order to be able to clean them. It is really important to me that my patients understand how to keep their dental implants clean and plaque free to avoid the potential for bone loss around the actual dental implants. An interdental brush, rubber tip, WaterPik, floss and electric toothbrush are all necessary adjuncts to keep fixed dental implant Bridges clean. All patients should see a dental hygienist at least 2-3 times a year and have routine x-rays every 1-3 years to evaluate crestal bone loss***

      3. What is the cost difference between an over denture and a solid zirconia bridge? Do any insurances cover any part of this?

      ******* a solid zirconia bridge probably costs one third more than an overdenture… In the long-term an overdenture will be replaced several times while a fixed solid zirconia bridge is very unlikely to be replaced if it is designed correctly and executed by an expert dental implant provider…. You do get what you pay for. When he comes to your body parts, go for the best. insurance hardly covers anything at all unfortunately***

      So far I have broken an upper and lower tooth on my titanium bridge. I have flattened a few teeth in the 4 years I have had them. I do wear a night guard. Also, it is so offset from the actual gum that chewing seems to cause stress/irritation around the posts (at least, that is my thoughts). No screws are in a tooth structure. The over hangs make it very difficult to clean underneath despite my using a Water-Pik device.

      ****Sounds like you have a acrylic fused to metal bridge on dental implants. You have a flange designed that does not lend itself to proper cleaning. The design of the bridge and the position of the implants in the bone are critical to being able to have a bridge it does not break and is easy to clean. My recommendation would be to replace your acrylic dental implant bridge with a Prettau solid zirconia bridge if you have enough from the edges of your teeth to the tops of your implants**

      Thanks for any help you can offer. You have a stellar website. Very sadly though, I am a “by-product” of the VA bureaucracy (Given all that, the rotating student left healing posts off for 30 minutes). Eh, he is my doc. No smiles there.
      Regretfully, I am in Bama… (ouch)

      *****Thank you for your very kind words. Thank you for serving our country***
      Ramsey Amin DDS

  68. I have had implants and am ready for my fixed denture. However, one of the screws came out of my implant, is this normal and should I be concerned. My biggest fear is that my temperature denture, which cost over $1600 has fitted so poorly and will not stay in and it makes me look 10 years older. Should I be concerned that my permanent denture/implant will not look any better. How can I make sure my permanent implant fits and looks more natural. I have all my savings riding on this and can not afford to have it redone.

    I live on the east coast. Thanks for your time in answering my questions.

  69. Hello sir,
    i am 18 year old
    i chipped my front right tooth when i was 16 and at first it was operated upon and fixed with dental cement as the chip was really minor, later my dentist suggested capping and i went for it, but it is opaque ( i think because of metal acrylic) and does not look natural, over time has even moved upwards making gap between my teeth, i want to replace it as it looks really bad.
    please suggest what material will be the best and most natural looking but not very very expensive!?

    1. Hi Radhika,

      Your teeth are priceless! A month after having a great result, you will be happy that you spent the money to do it right!

      Each situation is different but you can use E.Max Press, Lava or felspathic

      good luck!

      Dr. Amin

  70. Hi,
    I have a dental implant that I have done a 5 months ago. It was done in my country.
    My dentist there advise me that because the time I spend there was too short. It could become loose, and I should go to a dentist here to tight it up. Could you please do this?


    1. Hi Maria,

      I don’t really understand your question. Your implant is unlikely to become loose!
      I can help if you need!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  71. An overdenture helps fill in the bone loss on the upper teeth. The pink acrylic can be used to add bulk. If I choose a fixed full upper implant supported bridge is there any way they can still add to the gumline for bulk and to restore lip fullness? I have to make a decision thanks

    1. Hi Lisa,

      A fixed implant solution can still support your lips. Your bone loss and skeletal relationship has to be pretty severe under my care to have an overdenture due this reason. Most of the time that choice is made to save money.

      It is very routine in my Burbank office to create full lip support using non-removable dental implant teeth.

      There are VERY special contours that need to be built into the teeth to support your lips the right way.

      I suggest you seek out an ABOI credentialed dentist in your area.

      Good luck!

      Dr. Amin.

  72. Q1: Sir…you state that a fixed bridge is the best option. Do you mean it’s the best option between the two methods discussed here (overdenture vs fixed bridge) or best option compared to any restoration? I’m thinking of having my awful and too far gone upper teeth removed and a implant and crown placed for each individual tooth. Is that the best option short of having own natural teeth? Or would you still recommend fixed bridge?

    Q2: re: fixed bridges….what is your opinion on a fixed bridge that is in two or four segments? I know one dentist that likes to use a PFM bridge in two pieces, one left and one right side of upper on 8 implants. Another dentist suggested 8 implants supporting 4 segments of a bridge. I guess the advantage of this is not having to remove/repair/replace the whole full arch if something goes wrong but is there also maybe an advantage as far as bite force being spread out over the bridge differently?

    Q3: Is PFM being dropped by a lot of dentist in favor of other options in order to metal free? Like using zirconia instead or e.max? Or is PFM still a great choice?

    Q4: I have been researching hours upon hours, days upon days trying to find out what the best option is for my case. In your opinion can you list what the absolute best 3 or 4 options (in order of bestness*) are for someone who needs to have all uppers extracted?

    *I like to make up my own words 😉

    1. Hi Rod,

      thank you for your organized questions!

      q1: The ‘best option’ is different for each person. Just like a minivan maybe a better option than a Ferrari. Your unique situation, desires and anatomy will determine this if money is no object. There are many times when I do replace every single tooth with an implant. Often times, every back tooth is a single tooth implant while the front benefits from some spacing between implants and skipping sites for cosmetic reasons.

      q2: Segmented bridges are great when using traditional technique materials such as PFM. CAD/CAM technology reduces some of the fit problems that leads implant dentists to break up into segments.

      q3: Yes to zirconia — https://www.burbankdentalimplants.com/prettau-dental-implant-full-mouth-bridge/
      Emax is great for esthetics too. PFM’s are good but they do chip!

      q4: Very difficult to answer without seeing you. Fixed, cemented or screw retained CAD/CAM bridges or single unit implants are the best **IF** your bone, bite and facial esthetics will allow. An overdenture or traditional non-implant upper denture would be the less optimal choice.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  73. Hi Dr. Amin,
    I’m 66, female, have 5 implants to bottom jaw. I am going to get a removable snap-on denture, but would like to have fixed denture that only can be removed by a dentist. Is 5 implants enough for the fixed denture and how much more to get fixed over snap-on denture?

    1. Hi Silver,

      Yes, five implants are enough…if they are in the right spot.

      I use five lower implants routinely to support full fixed porcelain bridges for the last fourteen years.

      I would suggest porcelain instead such as the prettau fixed dental implant bridge. It is super strong and looks great and has low to no maintenance. Fixed hybrid dentures break all the time and start looking bad after only 1-2 years because they are plastic dentures.

      I have many samples in this link;


      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  74. Dr Amin, how nice of you to answer all these questions. I am in WV and have had dental problems as long as I can remember. While in grade school, one of my front teeth was partially broken off and became abcessed(sp?) The dentist said that because my front teeth weren’t straight he had to pull all four front permanent teeth to place a partial. The wires on the partial ruined the rest of my top teeth and I had a full upper denture in high school. Fourteen years ago at the age of 43 yrs., I had five dental implants with an over denture. One year ago, one of the implants broke between the bone and the gum(I think). The surgeon removed the implant and placed cadaver bone around the remaining four implants. A few days ago, I removed the denture and felt pain and noticed the abuttment was loose. I panicked and inserted the denture. When I tried to remove it, it felt like the implant was pulling out. I called my dentist, who is on vacation, and was told to not remove the denture and just clean it as well as possible since he can’t see me for ten more days. My dentist had advised against the permanent bridge, saying my teeth would look very long. I noticed you use pink gum and wonder if my dentist could possibly do this since I will probably, once again, need another surgery.

    1. Hi Paula,

      I’m sorry to hear about your dental situation. Some overdentures cause more stress on implants than fixed bridges.

      Most of my patients that I treat elect to have fixed upper porcelain dental implant bridges instead of snap on dentures. You are likely to be missing bone, so pink porcelain will be needed and is recommended. You will likely need at least 6 implants. Your four sound a bit too weak for this.

      Look at this page for some examples;


      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      1. Thank you for your prompt reply, Dr Amin. I will try to find a surgeon in WV that can do this for me. Hopefully, I will finally have no dental worries.


  75. Hi Dr.Ramsey
    Im a 34 year old woman that needs major help……I have missing teeth, a few cavities and 5 days ago my gold crown fell out along with my tooth…im afraid of dentist due to the fact that was hurt very badly while getting a tooth pulled….I really want implants but I cant afford it…any suggestions?? is there any insurance that would cover implants??

    1. Hi Katrice,

      I understand your fear of dentistry and dental implants. You can sleep through most of it using IV sedation. This way you can get the dental work that you need done in a comfortable manner. It is really awesome. I use IV sedation 1-3 times daily.

      Here is a link;


      All procedures can be done safely while you are sedated.


      Dr. Amin.

  76. Hello Doctor,
    I recently had oral surgery removing several bad teeth. 3 weeks later we were supposed to add Acrylic temps until I could decide whether to go with implants or bridges for the final solution. I paid $12,000.00 for the temporary work with temps not including the $5000.00 for the oral surgeon who removed the bad teeth and a metal l bracket from a 20 year old broken jaw injury which was causing an infection so 3200 was the actual price for the teeth removal. I have 8 teeth saved on top and 8 teeth saved on the bottom. When the Temps were put in they cracked twice in for days. When I went back for the second repair and started questioning the durability of the acrylic was when I was told by the dentist he never put in the acrylic and I had the resin based temps in and now he will be putting the acrylic teeth in this week. First of all he led me to believe that the acrylics were in already which now has taken the trust away I had in him. Was there a big difference in cost from the resin based temps and the Acrylic temps? For 12000 I assured I was getting great temps which would buy me 1 year to save for the permanent teeth. The permanent work he has estimated at $30,000. Which now Iam started to question also. Any advice would be greatly appreciated…

    1. Hi Michael,

      It sounds like there have been some
      miscommunications. Don’t let them get you down. You will be so happy that you had the implants when this is all done.

      In complex situations like you have, I prefer to control all the dentistry from start to finish. This means that one implant dentist is responsible for the surgery and making the teeth. This also helps reduce cost.

      Temporaries do break. Materials are one factor but your bite design and your compliance is usually more important than the material. You should only be chewing very soft foods like pasta until the real teeth are put on.


      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  77. High I’ve wore top denture from age 16 hate it so much lost my teeth thru bad asthma hw much would it cost me get fixed denture

  78. I am a 75 year old 10 years out from a heart transplant. I have a full upper denture and a bridge with only 6 teeth on the lower. i have had quite a bit of bone loss on the upper jaw but am considering implants. My dentist had CAT and MRIs done and determined I could support an upper full im plant devise with 4 posts if the outer two were installed radially. My question is should i consider a removable or fixed device? the difference in cost is $22000 vs $15000. Are the fixed devices really worth the difference in price? I do not like the full pallet dentures i now have.
    Thank you

    1. Hi John,

      Fixed implants are MUCH better than removable. Just make sure the bridge is porcelain not acrylic plastic.

      Four implants is too few for a fixed bridge. If one fails, there is no back up and you will lose everything.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  79. Hello Dr. Amin!
    In the past 6-7 months, my remaining lower teeth have broken and 3 of the 7 teeth that I have are at varying heights of “nub.” I have gumline cavities to all 7 that remain. These are front teeth as I have lost back/jaw teeth at various times d/t extractions. I realize that you would need to see me for an accurate price on the removal of these and the cost of either a “fixed” or an “overdenture.” However, I am hoping you can give me a rough estimate on the cost of either procedure/appliance. I would definitely prefer the fixed but my finances are, of the course, the issue. I do not have insurance, so all costs are out of pocket. I am a nurse and my smile is very important to me as well as my patients. I feel as if I look like a “crackhead” or “meth user.” I would hate to have someone that looked like a drug user caring for me or my loved one! Therefore, I am not smiling like I used to! I know my teeth are visible when I speak, so I look down or away when conversing. I was very impressed when I saw that you answered people’s questions, so I am hoping you can answer mine & n afford someone with your expertise to make me smile again!!

  80. Hello Dr. Ramsey, I am a 28 year old female, and my mouth needs a lot of work. I have been to several dentist for consultation, but was not satisfied, on what they told me. My front two teeth are discolored, and one has an infection, and is longer than the other. I also have some missing teeth on each side of my jaw. I have a build up of calcus as well. I was told that it would take 2 years to fix my teeth. Why so long? I am interested in a impant bridge. Do you think I will be paying a lot for an implant bridge for the top of my jaw. I do not want to spend a fortune, but I want something that will last and look natural.

    1. Hi Kimberly,

      It sounds like you need a fairly substantial reconstruction of your mouth. Depending on the extent of bone grafting and making teeth, sometimes it can take 1-2 years to complete. Bone by nature heals slower than other parts of our body.

      As far as cost goes, dental reconstructions can vary depending on your needs. I have done rehabilitations from as little as $1500 to as much as $90,000. You really need to have a diagnosis and treatment plan that is well thought out and phased properly.

      I hope this helps.


      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  81. I am a 59 yr. old female. In the last year, all of my teeth were pulled. I had a set of dentures made that cost more than a thousand dollars. My gums would not support them. Then I had surgery to have four implants in the top of my mouth and two in the bottom. Because a couple of the top ones did not graft due to my not having enough bone, they were redone using cadaver bone. Then I was referred to a dentist to have dentures made. He initially told me that my bottom dentures could be adjusted to fit over the implants, but that I would need “hybrid” dentures made for the top. A couple weeks later he sends me a copy of his “plan” for me. Now he says I need six abutments at the cost of $470.00 each, and new dentures upper and lower. He says that the estimated cost will be around $5,700.00. (I have already had to pay for than $11,000.00 for the extractions, dentures, and implants.) Why do I need implants and abutments? I am throughly confused and broke.

    1. Hi Margaret,

      The most important thing about your treatment is the plan that is developed before you ever start. A diagnosis is made, then the treatment is executed to follow the diagnosis. Sometimes, immediate dentures need to be replaced and can not be used for the final teeth. In my office, I control all these factors by doing the surgery and making the teeth myself in most cases. This controls cost and leads to great results. Have a discussion with your dentist about what your options are at this point.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  82. Hi Sara,
    In order to quote you accurately, I would need to see you.
    It will depend on your bone structure, and the area of the missing teeth. If I am able to use a one-piece implant, that can save you some money.
    Keep in mind that if you decide to do a regular bridge, you will be replacing it in 5-7 years. An implant bridge is usually done only once!
    Ramsey A. Amin, D.D.S.
    Diplomate of the American Board of Oral Implantology /Implant Dentistry
    Fellow of the American Academy of Implant Dentistry
    Burbank, California

  83. What is the cost of a fixed bridge compared to teeth implants. I need only a small bridge about 3 missing teeth Approx. cost

  84. Hi Bob,
    Since you live so close, why don’t you come in for free evaluation?
    I am here until Wednesday, then wont be back until 2011.
    Please bring a current panoramic x-ray or fmx AFTER all the implants have healed more than 4 months.
    If you do not have that x-ray, it can be taken for a nominal fee.
    It will also be helpful, to have the name and sizes of implants that you have.
    Please speak to Angie or Sophia when you call.
    Looking forward to meeting you!
    Dr. Ramsey Amin

  85. In answer to your questions:
    1. Were the implants placed in such a way to accept a “screw-retained” bridge or a cemented bridge?
    They should have been done I believe for a “screw-retained” bridge but I am not sure.
    2. Do you have enough lip support with your current temporary?
    Do not have a current temporary.
    3. Are the final abutments in place or do you just have healing abutments?
    Healing abutments.
    4. Do you want acrylic teeth or porcelain?
    5. Would you be available to come in for me to look at you if you are local?
    We are in San Gabriel. I am asking about
    my wife and will need to see if she approves.

  86. Hi Bob,
    A few question so I can answer you more accurately.
    1. Were the implants placed in such a way to accept a “screw-retained” bridge or a cemented bridge?
    2. Do you have enough lip support with your current temporary?
    3. Are the final abutments in place or do you just have healing abutments?
    4. Do you want acrylic teeth or porcelain?
    5. Would you be available to come in for me to look at you if you are local?
    Dr. Amin

  87. Please provide a ball park estimate for making and installing an upper and a lower fixed bridge. 16 implants are already in place and ready to go. Thank you for your assistance.

  88. Hi Mike Wilson,
    Yes…that price range sounds fairly normal.
    Does this include standard or custom abutments? Does this include or exclude the implants, bone grafting, and extractions?
    Consider the long-term costs of definite repairs if you go with the acrylic style. Tooth fracture is very common if it fixed with plastic denture teeth.
    Does this help you?
    Dr. Ramsey Amin

  89. with a set of fixed bridge dentures, what should the cost difference be between acrylic and porcelain – I was told that fixed acrylic would run about 16000 vs 25000 for porcelain.
    Is this price spread accurate?

  90. You will need more implants for a fixed bridge than an overdenture. Typically 6 -10 implants are ideal for a fixed bridge.
    The main cost difference is not the surgery, but rather the teeth. There is extensive lab expense involved.
    A fixed bridge can cost double the cost of an overdenture. A fixed bridge is the best of the best.

  91. I would like to know what is the different in cost (approximate) between the overdenture and the fix bridge. Are the number of implants the same for both procedures

  92. Thanks for clarifying this. I wish I had you do my surgery. The doctor I saw is not considered to be an expert like you are. I may travel to come see you!

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About Ramsey Amin, DDS

Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.