Patients call my office frequently and ask my office manager if I do hybrid bridges. She immediately tells them that I do in fact place implant hybrid bridges. The next question is, “how much is that”? This prompts Rose, my manager, to ask “a Procera 12 unit CAD-CAM or an acrylic denture toth hybrid bridge?” The patient then states, “Whats the difference”? There is a big difference in both price and longevity of service.
If you do a Google word search on hybrid bridges, a huge group of hits come up. As you study the different You Tube videos and information, two major categories exist. These are Procera CAD-CAM bridges and the second group is acrylic denture tooth hybrid bridges.
Lets start with the Procera CAD-CAM bridge which I place at my Manalapan, NJ office. These bridges are usually supported by five through eight implants and have a titanium milled understructure (cut from one piece). The term CAD-CAM is a acronym for computer assisted design and computer assisted manufacturing. This substructure is screw retained on the implants and has individual ceramic crowns on top of the one piece titanium frame. Gingiva or gum colored composite resin is baked on to simulate the patients gum. This hybrid bridge is the strongest and the most natural looking and allows for the best chewing efficiency for the patient. These of course are the most costly to place.
The other hybrid acrylic bridges have a metal internal sutstructure but have acrylic denture teeth with baked on acrylic gum. It is essentially a regular denture with a metal framework internal to it. These are as well, screw retained.
With the CAD-CAM Procera bridge, an ideal mock up of the final tooth set up is tried in prior to construction. The perfect size, position and shade of the teeth is determined. Support of the patient’s lips and speech sounds are assessed. Once all of this is assessed in location to the implants, the computer scans the set up and records the position to fractions of millimeters. The computer is then able to cut the framework or “skeleton” to support the crowns in the exact position that is required. The computer also mills the crowns in the exact size from the predetermined set up. The final hybrid bridge mimics the try-in bridge in both space and shape perfectly. There are no surprises in shape, position or shade.
With a denture tooth hybrid bridge, only the mesh framework or to speak in layman’s term “reinforcement bar” are designed by the computer. The denture teeth and the resin gum colored body are baked over the imbeded framework.
So which one is right for you? That depends on a lot of factors. Placement of the implants with the acrylic denture tooth hybrid bridge is very critical. Since the screw holes for the implants should be hidden, nothing is worse than having an access screw hole coming right out of the middle of an upper front denture tooth. No matter how you try to cover it, it is a problem and it looks like a patch. Patients need to be informed and aware of compromises like these before implant placement and the start of treatment. I unfortunately have many patients arrive from other offices with unforeseen compaints like this. Most times I do not believe the patients were intentionally misled and probably even the dentist themselves were unaware of the compromise until construction of the final work. It is too late then for both parties. Careful and meticulous design and implant placement prior would have avoided these issues. Since this dentist places his own implants, I have no one else to blame.
With a denture hybrid bridge, the teeth on the prosthesis are acrylic resin denture teeth which certainly wear faster than a ceramic crown. They also occasionally pop off the bridge and need to be repaired. Patients also need to be aware that the denture tooth hybrid bridge will need to be replaced or refurbrished, kind of like a worn tire needs to be recapped. This clinician has found that some patients need the hybrid denture tooth bridge removed yearly to be cleaned outside of the mouth. The acrylic is much harder to keep clean. With some people, a huge amount of tartar grows on and underneath the acrylic bridge work. This does not happen with the same frequency with a Procera CAD-CAM bridge since the plastic gum on these is a composite resin and not pure acrylic. This dentist will always look at a patient’s existing prosthesis to see how clean it looks, certainly if the patients cannot keep it clean when they can remove it the hygiene situation is going to be worse when it is not removable by them.
So which hybrid bridge is right for you? And that goes back to my first answer. That depends. My consults ARE ALWAYS FREE. And as my staff will tell you, I like to talk. So all you have to lose is a little time and maybe a little hearing. Well, maybe not the hearing.
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