Edentulism is a debilitating and irreversible condition and is described as the “final marker of disease burden for oral health”. Despite advances in preventive dentistry, edentulism is still a major public health problem worldwide. There will be an increase in the overall need for complete dentures, from 53.8 million in 1991 to 61.0 million dentures in 2020.

Edentulism has a series of deleterious consequences for oral and general health. Oral consequences vary from the well-known residual ridge resorption to an impaired masticatory function, an unhealthy diet, social disability, and poor oral health quality of life. Edentulous individuals are also in greater risk for different systemic diseases and an increase in mortality rate.

For some people, the relevance and functionality of teeth can be easily taken for granted, but a closer examination of their considerable significance will demonstrate how they are actually very important. Among other things, teeth serve to:

  • support the lips and cheeks, providing for a fuller, more aesthetically pleasing appearance
  • maintain an individual’s vertical dimension of occlusion
  • along with the tongue and lips, allow for the proper pronunciation of various sounds
  • preserve and maintain the height of the alveolar ridge, cut, grind and chew food.

Replacing missing teeth for Complete Edentulous patient

There are essentially two main ways in which missing teeth can be replaced:

  1. Dentures

Dentures (also known as false teeth) are prosthetic devices constructed to replace missing teeth, and are supported by the surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable and do not feel like real teeth, nor do function like real teeth.

Dentures can help people through:

  • Mastication or chewing ability is improved by replacing edentulous areas with denture teeth.
  • Aesthetics, because the presence of teeth gives a natural appearance to the face, and wearing a denture to replace missing teeth provides support for the lips and cheeks and corrects the collapsed appearance that results from the loss of teeth.
  • Pronunciation, because replacing missing teeth, especially the anteriors, enables patients to speak better. There is especially improvement in pronouncing words containing sibilants for fricatives.
  • Self-esteem, because improved looks and speech boost confidence in the ability to interact socially. 


  • This is the least expensive option for the replacement of teeth
  • The least invasive, no surgery needed (usually).


  • Quite often rely solely on the mucosa for support, do not tend to be as stable as the other options.
  • Very difficult to keep clean and can exacerbate any oral hygiene issues.
  • They are difficult to learn to use. Quite often require complex muscular control to hold them in place.
  • Not as efficient as other options. Foods such as apples and nuts will often have to be avoided.

2. Dental Implants

Implants can be used to restore the complete edentulous patient, therefore no need for removal dentures. Such prosthesis is commonly called All on 4 or Hybrid.

All on 4 or Hybrid Prosthesis materials:

Several dental materials has been used for fabrication of Hybrid prosthesis. Traditionally, metal frame and acrylic teeth has been the material of choice, but new materials with improved properties has been introduced in recent years. The material of choice should be carefully selected in each individual case

a) Metal frame and acrylic teeth

Most common choice of materials for Hybrid prosthesis fabrication due to the long term tradition in dentistry.


  • Well know materials
  • Good esthetics
  • Soft to implants (masticatory forces buffer)


  • Tooth fracture, occurs quite often needing repairs and adjustments
  • Stains over time
  • Wears, therefore need replacement every 5 to 10 years
  • Analogue technique, difficult to re-do or to duplicate if needed

b) Zirconia

Introduced in the dental market a few years ago, hoping that will replace the traditional metal frame and acrylic teeth


  • Esthetics, is questionable depending on prosthesis thickness as well as laboratory technician unique talent
  • Great color stability: due to porcelain and glaze nature it does not stain or fade a way over time
  • Great oral hygiene:
  • No wear or fracture
  • Digital technique: easy to reproduce if needed


  • No long term data
  • Can be hard to implants: material could be too harsh to implants, more data is needed
  • No light transmission: zirconia can bee too opaque, eliminating light transmission making tooth look unreal

c) Nano-Ceramics

Probably one of the latest materials introduced in the market. It is intend to help to over come some of the disadvantages of the zirconia


  • Great esthetics
  • Light transmission: more natural looks
  • Great strength: practicable un-breakable
  • Soft to implants (masticatory forces buffer)
  • Digital technique: easy to reproduce if needed


  • No long term data
  • Wears, therefore need replacement not as soon as conventional metal frame and acrylic
  • Stains over time: will need polish and maintenance

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