What is an implant-supported prosthesis?

An implant is a titanium (or similarly biocompatible) screw that replaces the root of a lost tooth. The part you see in the mouth and chew with is the prosthesis made on top of it. The connection between the two is usually provided by an abutment (connector piece). When most patients say “I’m getting an implant”, they actually mean the sum of these two stages; yet the treatment plan is often built backwards – first deciding what the final prosthesis will look like.

This is 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 prosthesis type. 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: If bone and gum loss is minimal, the crown looks like a natural-sized tooth. This is the goal especially in the front area visible when smiling.
• Prosthesis that also mimics part of the root area: With moderate bone loss, the teeth may look slightly longer. If the lip line is not high, this can be aesthetically acceptable.
• Prosthesis replacing both teeth and gum colour: In 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: in a patient with significant bone loss, the expectation of “natural-sized crowns” requires either additional bone/gum procedures or the use of pink porcelain/acrylic.

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

Fixed implant prostheses are secured in two main 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 onto the implant and the crown is bonded onto it with a special cement.

Both approaches have advocates in the reference textbooks. Cemented prostheses are described as having advantages in aesthetics and passive fit, while screw-retained prostheses are valued for the ease they offer when repair, cleaning or re-evaluation is needed later. Today, digital design and angled screw-channel options have widened the use of screw-retained prostheses. In particular, the risk of excess cement remaining under the gum is an important consideration with regard to peri-implant inflammation.

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

For fully edentulous patients, an implant-supported removable denture clipping onto 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 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.

For patients who struggle with a conventional complete denture – especially a lower denture that won’t stay in place – it can bring a marked increase in comfort. Lip and cheek support is also easily provided by the pink acrylic section, 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. At the examination, we usually look for answers to these questions:

1. Bone volume and number of implants: A fixed prosthesis generally needs 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 who show gum when smiling, the transition line between prosthesis and tissue must be planned so that it is hidden.
4. Cleaning ability: A removable denture is easy to clean when taken out; underneath 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 material choice and the need for a protective night guard.
6. Expectations: Some patients want “teeth I never take out”; for others, fewer surgical procedures is the priority.

Which materials are used?

For single teeth and short bridges, zirconia or porcelain-fused-to-metal is mostly 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 the acrylic teeth wear over time and may be renewed at intervals; the plastic inserts in the attachments are also replaced depending on how often the denture is used. This maintenance need should be explained clearly to the patient from the start.

How does the implant prosthesis process work?

After the implant is placed, a healing period of usually a few months is allowed for it to fuse with the bone; this varies depending on the upper or lower jaw, bone quality and whether additional procedures were performed. During this period a temporary prosthesis may be used in the aesthetic zone. Once healing is complete, the implant positions are recorded with a conventional impression or an intraoral scan. One or two try-ins may be enough for a single crown, while full-arch prostheses require more appointments for tooth setup, bite and aesthetic try-ins. For international patients visiting Istanbul, we plan these appointments in advance so the stages fit your travel schedule. After the prosthesis is fitted, chewing forces and bite contacts are checked again in the first weeks, and small adjustments are made during this period. Getting used to the new prosthesis for speaking and chewing may take a few weeks.

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 due to excess cement
• Loosening of attachments in removable dentures, food trapping under the denture
• Extra load on the implants from long bridge extensions (cantilevers)

Most of these problems are noticed early during 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 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 are determined by the dentist after an examination.