What is an implant-supported prosthesis?

An implant is a titanium (or similar biocompatible) screw that replaces the root of a lost tooth. The part you see in your mouth and chew with is the prosthesis made on top of it. The connection between the two is usually provided by an abutment (connector). When most patients say “I’m getting an implant”, they actually mean both of these stages together; yet the treatment plan is usually built backwards — the design of the final prosthesis is decided first.

This is also a principle emphasised in the key textbooks of implant dentistry: the number, position and angle of the implants should be planned according to the intended type of prosthesis. Different prosthetic designs are possible for the same gap, and each has different consequences for maintenance, aesthetics and cost.

What types of fixed implant prostheses are there?

A classification widely used in the clinical literature divides fixed prostheses into three groups, according to how much tissue they replace:

• Prosthesis replacing only the tooth crown: When bone and gum loss is minimal, the crown looks like a natural-sized tooth. This is the goal especially in the front area that shows when you smile.
• Prosthesis that also mimics part of the root area: With moderate bone loss the teeth may look slightly longer. This can be aesthetically acceptable if the lip line is not high.
• Prosthesis replacing both teeth and gum colour: With advanced bone loss a pink (gum-coloured) section is added. Fixed hybrid prostheses in fully edentulous jaws mostly fall into this group.

This distinction matters, because in a patient with significant bone loss, expecting “natural-sized crowns” requires either additional bone/gum procedures or the use of pink porcelain/acrylic.

What is the difference between a screw-retained and a cemented implant crown?

Fixed implant prostheses are secured in two basic ways. In a screw-retained system the prosthesis is fixed directly to the implant or abutment with a small prosthetic screw; the screw access hole is sealed with composite filling. In a cement-retained system the abutment is screwed into the implant and the crown is bonded onto it with a special cement.

Both approaches have their advocates in the reference textbooks. Cemented prostheses are described as having advantages in aesthetics and passive fit, while screw-retained prostheses are valued for how easy they make future repairs, cleaning or re-evaluation. Today, digital design and angled screw-channel options have widened the use of screw-retained prostheses. In particular, the risk of cement remaining under the gum is a point of attention with regard to peri-implant inflammation.

Who is an implant-retained removable denture (overdenture) suitable for?

For fully edentulous patients, an implant-supported removable denture retained on two, three or four implants can be a good option. The denture sits on small attachments fitted to the implants (e.g. ball or low-profile attachments) or on a bar connecting the implants. The patient can take the denture out for cleaning.

• Denture supported by both implants and the palate/gums: Usually made with fewer implants in the lower jaw; chewing load is shared with the tissues.
• Fully implant-supported removable denture: With more implants or a bar, the denture does not move once seated and the load is carried by the implants.

For patients who struggle with conventional complete dentures — especially a lower denture that won’t stay in place — it can bring a marked improvement in comfort. The pink acrylic part also makes it easy to support the lips and cheeks, which is important for patients with advanced bone loss whose face looks “sunken”.

Fixed or removable: how is the decision made?

The decision is never based on a single criterion. During the examination we usually look for answers to these questions:

1. Bone volume and number of implants: A fixed prosthesis generally requires more implants and adequate bone; in some cases bone grafting or angled-implant strategies are planned.
2. Lip and facial support: If bone loss is large, the pink part of a removable denture can support the facial profile more easily.
3. Smile line: In patients whose gums show when smiling, hiding the transition line between prosthesis and tissue must be planned.
4. Cleaning ability: A removable denture is easy to clean once taken out; the underside of a fixed hybrid prosthesis must be cleaned with interdental brushes and a water flosser.
5. Opposing jaw and night-time clenching: Strong chewing forces or bruxism affect the choice of material and the need for a protective night guard.
6. Expectations: Some patients want “teeth I never take out”, while for others fewer surgical procedures are the priority.

Which materials are used?

For single teeth and short bridges, zirconia or porcelain-fused-to-metal is usually preferred. For full-arch fixed prostheses, monolithic or porcelain-layered zirconia, or composite/acrylic teeth on a titanium framework, can be used. In removable dentures, acrylic teeth wear over time and may be renewed at intervals; the plastic inserts in the attachments are also replaced depending on how often they are used. This maintenance need should be explained clearly to the patient from the start.

What does the implant-supported prosthesis process involve?

After the implant is placed, a healing period of usually a few months is allowed for it to fuse with the bone; this varies with the upper or lower jaw, bone quality and whether any additional procedures were performed. During this time a temporary prosthesis can be used in the aesthetic zone. Once healing is complete, the position of the implants is recorded with a conventional impression or an intraoral scan. One or two try-ins may be enough for single crowns, whereas full-arch prostheses need more appointments for tooth arrangement, bite and aesthetic try-ins. In the first weeks after fitting, chewing forces and bite contacts are checked again and minor adjustments are made. Getting used to a new prosthesis for speaking and chewing can take a few weeks. If you are travelling to Istanbul for treatment, we plan these visits together with you in advance.

What are the risks and possible problems?

• Screw loosening or fracture (mostly related to overload or poor fit)
• Porcelain chipping or wear of acrylic teeth
• Gum inflammation caused by excess cement
• Loosening of attachments in removable dentures, food trapping under the denture
• Extra load on implants due to long bridge extensions (cantilevers)

Most of these problems are spotted early at regular check-ups and can be solved with simple interventions. At our clinic, prosthetic planning is carried out jointly by a digital-prosthetic dentist and a specialist in periodontology.

Frequently asked questions

Related pages

Medically reviewed by: Dr. Dt. Mehmet Fuat BozabaSpecialist in periodontology · September 2026

Let’s review your implant-supported prosthesis options together at a consultation in Istanbul. Message us on WhatsApp or call +90 544 289 66 33.

Sources: Misch CE. Contemporary Implant Dentistry, 3rd ed., Mosby Elsevier, 2008; Misch CE. Dental Implant Prosthetics, 1st ed., Mosby, 2005.

This article is for information only; diagnosis and treatment planning can only be determined by a dentist after an examination.