Tye: Hello. I want to thank everyone for tuning in today. My name is Tye Binuyo with the Top-Rated Dentist podcast. We are the show that introduces you to excellent dentists and dental professionals from around the country as well as the services they offer. Today I have a very special guest joining me, Dr. Susan Maxwell.

Dr. Maxwell is a dentist at Carolina Oaks Dental Care and has been serving the Greenville residents for the last six years and is here today to talk to us about fixed hybrid dentures. Thank you for joining us, Dr. Maxwell.

Dr. Maxwell: Thank you for having me here to talk about this.

Tye: No problem. To get started, could you give us some background information about your practice as well as your journey in dentistry?

Dr. Maxwell: Sure. The practice is here in Greenville South Carolina. The original practice has been around over 30 plus years. It took on the name Carolina Oaks Dental Care about 10 years ago and I came on board about six years ago.

That was after I finished dental school at Medical University in South Carolina. I then did a one-year general practice residency at Carolina's Medical Center in Charlotte just to get a little more medical and surgical training before I started private practice as a general dentist.

Tye: Awesome. Now let's jump right into it. Fixed hybrid dentures. In lay terms but from a doctor's perspective, could you tell us exactly what they are?

Dr. Maxwell: Sure. Fixed hybrid dentures are when a patient is denture less. They don't have any teeth or are losing all their teeth and they have several implants strategically placed in their jaw. The dentist comes back and can convert either their existing complete denture or they have a new denture made that is attached, screwed into the implant the same day of surgery.

That allows patients to have an immediate fixed-in-place-option at the time of implant placement. I know you've probably seen commercials about teeth-in-a-day. That's kind of what this is, and the conversion is not the final product.

You must heal for several months with the “interim” dentures in place and then you return to your dentist and they'll make you a final denture. The conversion just means that the traditional style denture, which is removable, can be adjusted to complement the housing component of the implant for the final fixed hybrid dentures.

Tye: So are the implants the root of the tooth? Could you talk more about exactly what the implants are?

Dr. Maxwell: Sure. Dental implants are titanium screws that are screwed into the jawbone, they have little micro pores and the bone will grow into the micro pores and lock the implant into the jaw.

So basically, they are kind of a prosthetic replica of your actual root of your tooth. Some people that just lose a single tooth will have an individual implant placed to replace that missing tooth. In this case you're having somewhere between four and six implants placed across the jaw to support the dentures.

Tye: Interesting. So that serves as the support for the actual denture which is then attached to the implant. Is that correct?

Dr. Maxwell: Yes. They're basically the anchor.

Tye: Now, what are the differences? Could you tell us the differences between traditional dentures and the fixed hybrid dentures?

Dr. Maxwell: Sure. So traditional dentures typically are acrylic-based plates with artificial teeth and they come in and out so they're removable. There's nothing holding them in.

Most people complain about traditional dentures because they're bulky and uncomfortable and they're not attached to anything, so they come in and out and flop around. Your upper dentures cover the roof of your mouth. It can affect your sense of taste and so a lot of people that have complete upper dentures will complain more so about it altering their sense of taste and therefore their enjoyment of eating.

You do get a little bit of a seal, kind of like a suction-cup-effect on the top one. It's called your posterior palate seal. It's where your hard palate meets your soft palate at the roof of your mouth that you get that suction cup effect. They're tolerated a little bit better.

Now the ones for the bottom jaw have no suction cup effect and they just really flop around. People do not find them very comfortable at all because you need to use a lot of adhesive. You just don't get the replicated chewing like you would with a fixed hybrid denture because they move around when you chew. They're just sitting on top of your jaws.

Tye: It can pop out while eating?

Dr. Maxwell: Yeah. Everybody's mouth structure is different so sometimes they just don't stay in unless you're using a lot of adhesive. There was a patient that had her dentures come out when she was singing in the choir and she was mortified. We started talking about converting them into fixed hybrid dentures. Because they're so bulky and they are in the roof of your mouth, that can affect your speech. Some people get a whistle or almost like a lisp because their tongue can't get used to having something in their mouth.

When people have these complaints that's when I start talking to them about fixed hybrid dentures where we can convert your traditional dentures, or you can have new ones made depending on the patient situation is. They also have a more aesthetic design which is pectin based. It's a little bit shiny and more natural-looking and then you can cement an individual porcelain crown or ceramic crown. You can have a lot more characterization and they just look a lot more natural than your typical acrylic denture.

Tye: It sounds like the fixed hybrid dentures solve a lot of the problems that come with traditional dentures like the comfortability, the smell, speech? I guess that's safe to say?

Dr. Maxwell: Yes 100 percent.

Tye: Now can you talk more on the process? What's involved from day one? How does the whole process of getting fixed hybrid dentures go?

Dr. Maxwell: Sure. It’s a collaborative effort. I'm involved from the initial consultation of speaking with patients. I have a working relationship with an oral surgeon and a prosthodontist. A lab technician will create the denture. I will have the patient go have a consult with the oral surgeon and the prosthodontist. After the visit, typically they will have some 3D imaging done at the surgeon's office and that's so that we can begin the design process.

The prosthodontist or I will take several impressions so that we can make molds. This is so that we can get together to design the fixed hybrid dentures.

There's a lot that happens behind the scenes to get that ideal-looking denture. We must look at how the implants need to be angled so that you can have the immediate denture placed. We must design surgical guide at the time of surgery, that guides the implant into the right angle and location that we want to be successful.

Sometimes we need to reduce the bone after the teeth are removed to allow for the thickness of the denture. We must also make guides for that conversion.

We will have the initial dentures created and then on the day of surgery we'll use those guides to mark where the actual implants are in the jaw, so that we can make the adaptations to the denture that houses the complementing components.

Tye: Sounds like quite a lot involved, but it also sounds like it's done to make sure the fixed hybrid dentures function just like natural teeth?

Dr. Maxwell: Right. So, after all the planning and we go over medical history and make sure that the patient can handle general anesthesia and that their bone is healthy so that the implant will incorporate, once all that has been decided we'll schedule the surgery. Every case is different but typically we're taking the teeth out, adjusting the bone, placing implants and delivering the denture on that same day.

It's a long day but it's the shortest procedure or process of the whole thing. Once the surgery occurs we'll either do like a 24 or 48-hour post-op to adjust the denture and make sure they're not hitting too hard because it's vital in the first six weeks of healing. Even though you have the teeth, they're not functional just yet.

You're on a strict diet. You're cutting things up like a toddler, you're eating mashed potatoes and mac and cheese. And that's so that the bone will heal. If you break your leg, and then you try and walk on it after it's been reset, it's going to keep it from healing. It's the same concept. Even though you have teeth there, they are pretty much just for aesthetics initially.

It's a huge difference from other options where you don't have something fixed immediately. You have to let that healing process occur and that can take up to six months. We'll follow along to see how it's healing and adjust if we need to, but it's just kind of a waiting game.

After the healing takes place we'll get you back in to make the final denture. That's your chance to make any changes to the one (dentures) that you've temporarily been in. So, if you don't like the shape of the teeth, if you don't like the color, if you want to upgrade from the acrylic to the pectin base, then that's your chance to make any changes. We'll take those impressions, and have denture made and then in a few weeks you come back and we'll deliver the final product.

Tye: Let me make sure I understand you. When I get started we're on the dentures, which I guess we can call temporary. During that time, I'm kind of just eating softer foods until the healing is complete. I then move into permanent or more permanent dentures where I can consume a wide variety of food. Is that correct?

Dr. Maxwell: Yeah. Once we put those final dentures in, you're back to eating corn on the cob and biting into apples. They're functioning just like your natural teeth. Up until that healing, you're cutting off the corn on the cob, you're cutting up your apples. And then you have that strict diet the first six weeks, but it's all to set you up for success. If we didn't do that, then the implants would fail, and it would be a nightmare, so six weeks in comparison to having your natural teeth replaced is nothing.

Tye: I'm guessing they can be removed for maintenance? Is it like permanent or semi-permanent? What's the deal once they're in my mouth? The final conversion or the final dentures?

Dr. Maxwell: Typically, patients will come back every six months or once a year for maintenance. We will unscrew and remove the denture and that way I can look at the tissue underneath there and make sure everything's healthy.

We can take x-rays of the implant and make sure they're healthy. If screws get worn out, we can replace them. If you do something and the denture gets damaged and we need to repair it, we're able to take it out for repairs.

If over time they get dingy or worn down or if there's something about it you don't like that you want to change. We can make new ones. They can last as long as they're functional and in good shape. Everybody is a little bit different in how rough they are. Yes, they can come out. We can remove them. But when they're in, they're in. They're fixed.

Tye: Now how long would you say they last? How long can I get out of the dentures? I'm guessing the implants are the root so they are permanent, I’m taking those with me. But the dentures, 10 years? 20 years? How long?

Dr. Maxwell: Yeah. I think only time will tell. People are different in what they eat and how they chew and that kind of stuff. I mean in an ideal world I'd love them to last 10, 20, 30 and 40 years. And they certainly can if you take care of them and you come back for regular maintenance and things like that. But things happen, and we'll cross those bridges when we get there. But ideally, yeah. I'd say at least 10 plus years.

Tye: Now how would you compare the cost of fixed hybrid dentures to the per tooth type of implant? From what I understand, fixed hybrid dentures is the whole upper mouth, the whole upper arch and the bottom--kind of all in one. How does the cost compare if I was having each tooth implanted into my mouth?

Dr. Maxwell: Yes, so kind of the breakdown would be if you're replacing an entire arch of teeth with individual implants, you're not going to literally put one implant per tooth; you'll bridge them. Two implants would replace three to four teeth depending on where in the arch it is.

Then you come back and put crowns on them. The cost is either very close or more to do the bridges, which are made from porcelain versus the fixed hybrid dentures. But the difference is you have a lot more flexibility with implant placement and design when you do this fixed hybrid versus the bridgework.

Angulation must be ideal to get the ones... There's a lot of details but it comes down to the flexibility. You have a lot more room to work with angulation and implant placement when you do a fixed hybrid than you do with an actual crown/bridge type of restoration. And then also with repair. It's way easier to repair a fixed hybrid denture than it is the crowns and bridges.

Tye: Are fixed hybrid dentures covered by my average PPO insurance plan? What's the deal in terms of the insurance?

Dr. Maxwell: Right now, they are not covered by insurance. Hopefully as these become more and more popular procedures that are done, insurance will start picking up coverage. But right now, they are not.

Tye: What about our payment options. Are there any payment plans that are available?

Dr. Maxwell: Yeah. So typically, it's upfront payment. But there are things out there like CareCredit that you prequalified for a no interest payment plan. It can be six months to three years for you to pay interest-free. We offer CareCredit to our patients as an option to be able to spread out the cost. But most of the time it's cash, check, credit card upfront.

Tye: Got it. Dr. Maxwell, this has been awesome. Do you have any final words for anyone that might be considering fixed hybrid dentures or even regular implants?

Dr. Maxwell: Yeah. I would be happy to sit down for a consult with anyone who just wants to discuss their options or treatment because there are many ways that you can go about it. One of the things I pride myself in is offering patients multiple choices so that they can custom fit it to their personality. Our office is here in Greenville, South Carolina. You can give us a call at 864-235-3949 and I'd be happy to discuss your treatment options.

Tye: Thank you so much again for joining us I found this very informative and I'm sure our listeners will get a lot out of it as well.

Dr. Maxwell: Yeah. Thank You.