When people consider replacing missing teeth, they often ask about “permanent dentures,” a term that causes confusion. The devices they refer to are fixed dental prosthetics, not traditional dentures. These non-removable replacements are designed to remain securely in the mouth, offering a high degree of stability and function, unlike conventional dentures that must be removed daily. This article clarifies the distinctions between these dental options and explains the circumstances under which a fixed restoration may require professional removal.
Defining Non-Removable Dental Replacements
The phrase “permanent dentures” describes fixed dental restorations, which differ fundamentally from traditional, patient-removable full or partial dentures. Removable dentures rest on the gums, relying on suction or clasps for retention, and must be removed for cleaning and while sleeping. Fixed restorations, by contrast, are secured directly to existing teeth or anchored to dental implants placed within the jawbone.
Individual Implants and Bridges
One type of fixed replacement is the individual dental implant and crown. A titanium post is surgically placed in the jawbone to replace a single tooth root, and a porcelain or zirconia crown is then cemented or screwed onto the implant. This functions much like a natural tooth. Another common fixed option is a cemented fixed bridge, which replaces one or more missing teeth. It is permanently bonded to natural teeth adjacent to the gap, which must be prepared and crowned to serve as anchors for the bridge.
Full-Arch Fixed Solutions
The most comprehensive fixed solution, often called “All-on-4” or a fixed hybrid denture, replaces an entire arch of teeth. It is anchored by a small number of dental implants. This full-arch bridge is typically fabricated from a metal framework covered with acrylic or milled from a durable material like zirconia. Since these restorations are secured with screws or dental cement, the patient cannot remove them without a dentist’s intervention. This secure attachment provides improved chewing function and a stable fit, giving them the “permanent” feel.
When Only a Dentist Can Remove Them
Fixed restorations require professional maintenance and controlled removal; they are not installed and forgotten. For many implant-supported full-arch bridges, the prosthetic is secured to the underlying abutments with small screws. A dentist accesses these screws through tiny openings in the prosthetic, allowing for removal during routine maintenance appointments.
Maintenance and Cleaning
Planned professional removal is necessary for deep cleaning, particularly for screw-retained hybrid designs. Plaque and calculus can accumulate in the space between the prosthetic and the gum tissue. Without periodic deep cleaning, which may be performed annually, bacteria can lead to inflammation and bone loss around the implants, known as peri-implantitis. The dentist also uses this opportunity to inspect the integrity of the internal screws and components, ensuring they are securely tightened.
Damage and Complications
Removal is also required if the restoration sustains damage, such as a fractured or chipped section of the acrylic or porcelain teeth. The fixed prosthetic must be taken out to allow for laboratory repair or adjustment to the underlying metal framework. If a biological complication arises, such as peri-implantitis or the failure of an implant’s abutment, surgical access may be needed to treat the underlying issue. In these clinical scenarios, the fixed restoration is carefully removed using specialized tools.
Daily Care and Long-Term Servicing
Maintaining a fixed dental restoration requires a consistent and specialized daily hygiene routine to ensure its longevity and prevent complications that necessitate professional removal. Traditional brushing is often insufficient because it fails to clean the space between the fixed bridge and the gumline where bacterial plaque accumulates. Patients must focus on disrupting this bacterial biofilm to preserve the health of the underlying implants and gums.
Daily Hygiene Tools
Specialized tools are required to clean beneath the fixed arch. This meticulous cleaning prevents the development of peri-implant mucositis (reversible gum inflammation) and the more serious peri-implantitis. Tools commonly used include:
- Oral irrigators (water flossers), which use a stream of water to flush out food particles and bacteria.
- Threading floss, such as Superfloss.
- Small interdental or proxy brushes, used to mechanically clean the surfaces of the implants and the underside of the bridge.
Professional Monitoring
Regular specialized dental check-ups are a necessary part of long-term servicing, often recommended three to four times a year instead of the standard twice-yearly schedule. During these appointments, the dental professional performs a thorough cleaning using instruments designed not to scratch the implant surfaces. Periodic X-rays are taken to monitor the bone levels around the titanium fixtures, providing an early warning of potential bone loss.
Material Lifespan
The materials used for the final restoration influence the long-term outlook and expected lifespan before refurbishment is needed. Full-arch prosthetics made from acrylic resin over a metal bar may require replacement or significant repair every three to ten years due to wear and tear. Conversely, restorations milled from durable materials like zirconia exhibit superior strength and may last 10 to 15 years or longer. This demonstrates that even fixed restorations have a material lifespan that requires monitoring.