What is an implant-supported prosthesis?

An implant is a titanium or similar biocompatible screw that replaces the root of a lost tooth. The visible part that does the chewing is the prosthesis built on top of it. The connection between the two is usually provided by an abutment (connecting piece). When most patients say “I’m getting an implant”, they actually mean the sum of these two stages; yet the treatment plan is usually built from the end backwards, that is, by first deciding what the prosthesis should look like.

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

What types of fixed implant prostheses are there?

In a classification widely used in the clinical literature, fixed prostheses are divided into three groups according to how much tissue they replace:

• A prosthesis that replaces only the tooth crown: If bone and gum loss is minimal, the crown looks the size of a natural tooth. This is the goal especially in the front region visible when smiling.
• A prosthesis that mimics part of the root area along with the crown: If bone loss is moderate, the teeth may look slightly long. If the lip line is not high, this may be aesthetically acceptable.
• A prosthesis that replaces both tooth and gum colour: In advanced bone loss, a pink (gum-coloured) section is added. Fixed hybrid prostheses in fully edentulous jaws mostly belong to this group.

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

What is the difference between screw-retained and cement-retained implant crowns?

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

Both approaches have their advocates in the reference textbooks. While cement-retained prostheses are described as having advantages in aesthetics and passive fit, screw-retained prostheses are highlighted for the convenience they offer when repair, cleaning or re-evaluation is needed later. Today, digital design and angled screw channel options have broadened the use of screw-retained prostheses. The risk of cement residue remaining under the gum, in particular, is a point of concern with regard to peri-implant inflammation.

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

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

• Denture supported by both implants and the palate/gums: Usually made with fewer implants in the lower jaw; the 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.

It can bring a marked improvement in comfort for patients who struggle with conventional full dentures, especially those whose lower denture will not stay in place. In addition, lip and cheek support is easily achieved thanks to the pink acrylic section; this is important in patients with advanced bone loss whose face looks “collapsed”.

Fixed or removable: how is the decision made?

The decision is not based on a single criterion. During the examination, answers to the following questions are usually sought:

1. Bone volume and number of implants: A fixed prosthesis generally requires more implants and sufficient bone; in some cases bone grafting or angled implant strategies are planned.
2. Lip and facial support: If bone loss is extensive, 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 taken out and cleaned easily; 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 or bruxism affects 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 is the priority.

Which materials are used?

For single teeth and short bridges, zirconia or metal-ceramic (porcelain fused to metal) is mostly preferred. For full-arch fixed prostheses, monolithic or porcelain-layered zirconia, or composite or acrylic teeth on a titanium framework may be used. In removable dentures, acrylic teeth wear over time and can be renewed at intervals; the plastic components in the retention attachments are also replaced depending on frequency of use. This maintenance need should be clearly explained to the patient at the outset.

How does the implant-supported prosthesis process proceed?

After the implant is placed, a healing period of usually several months is allowed for it to fuse with the bone; this period varies with the upper or lower jaw, bone quality and whether additional procedures were performed. A temporary prosthesis can be used in the aesthetic zone during this time. Once healing is complete, the position of the implants is recorded with a conventional impression or an intraoral scan. For single-tooth crowns, one or two try-ins may be enough, while full-arch prostheses require more appointments for tooth arrangement, bite and aesthetic try-ins. In the first weeks after the prosthesis is fitted, chewing forces and bite contacts are rechecked; minor adjustments are made during this period. It can take a few weeks for the patient to adapt to the new prosthesis in terms of speech and chewing. For international patients, the stages can be grouped into two or three visits to Istanbul, planned with the clinic in advance.

What are the risks and possible problems?

• Screw loosening or fracture (mostly related to overload or a poor fit)
• Porcelain fracture or acrylic tooth wear
• Gum inflammation due to cement residue
• Loosening of the retention component in removable dentures, food accumulation under the denture
• Extra load on the implants due to long bridge extensions (cantilevers)

Most of these problems are detected early during regular check-ups and can be resolved with simple interventions. In our clinic, prosthesis planning is carried out through a joint assessment by the digital-prosthetic dentist and the specialist in periodontology.

Frequently asked questions

Related pages

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

Let us assess your implant-supported prosthesis options together at a consultation. Message us on WhatsApp or call 0544 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 purposes only; diagnosis and treatment planning are determined solely by the dentist after an examination.