Understanding Roadblocks: Why do patients prefer a fixed implant restoration over removable?

Stock photo of a denture patient in the dental operatory with their dentist.
June 18, 2024
Understanding Roadblocks: Why do patients prefer a fixed implant restoration over removable?

When facing edentulism, many patients end up choosing removable implant restorations over fixed restorations due to a lack of awareness, budget, or previous misconceptions. As a skilled clinician, it may be easy for you to see the benefits of a fixed restoration yourself, but knowing how to make that accessible to your patient base can be easier said than done. That’s why it’s important to understand the factors that may lead a patient to favoring one treatment or the other and how you can guide them to choose the solution that will best fit their needs and lifestyle. 

Understanding the Decision-Making Process

Most patients prefer fixed restorations thanks to their many advantages including the sense of security and confidence they provide. With fixed solutions, patients can also enjoy eating what they want again instead of only ordering items on the menu that they know won’t embarrass them in front of others. Additionally, patients don’t have to worry about dropping or losing their dentures with fixed restorations!


Simply telling your patients about these benefits is often not enough. It is important to hone your presentation skills and empathy to effectively teach them about their options.


Normally, It can be challenging to transition a patient from a removable restoration type to a fixed prosthesis because of the substantial costs associated with additional implant placement, as well as the cost of new abutments and the new prostheses. However, with a staged approach to treatment planning, you can slowly work your way to a fixed solution without ever sacrificing your patient’s smile. 


This is where LOCATOR FIXED® comes in. This hybrid fixed solution can easily transition from removable to fixed with the same abutments – there’s no need to swap them out to upgrade your patient! This saves time and money and helps build patients’ trust in your services. You can be their hero and make their smile dreams affordable and within reach. 

Why may patients not be a good fit for a fixed restoration?

Despite all the benefits listed above, there are some instances where a patient might be better suited to receive a removable restoration: 

Poor Oral Hygiene Compliance

The most common reason a patient may be a better candidate for a removable prosthesis is oral hygiene compliance. If your patient is not diligent about their oral hygiene maintenance including their at-home routine as well as visiting for regular cleanings, a fixed prosthesis may do more harm than good. This is because it is easier for food, debris, bacteria, and plaque to build up under the fixed prosthesis.


Cleaning solutions like Regal Hygiene can help alleviate this concern, but it is still absolutely paramount that a good candidate for a fixed prosthesis has diligent oral hygiene habits since they won’t be able to take it out themselves for cleaning. 

History of Bruxism

If you have a patient with a history of bruxism, it may be best to opt for a removable treatment plan to avoid unwanted complications. This is because bruxism causes an excessive amount of force on implants. When you have a fixed appliance (LOCATOR FIXED, All-on-X, screw retained, or otherwise) there is no "give" in the appliance. In turn, this can cause unnecessary stress on the implants in the bone causing failure or a lack of osseointegration. 


The good news is that with removable restorations, there is some give, eliminating the risk of complications associated with bruxism. Plus, your patient will be able to remove it at night so there will be no worry of the appliance wearing down, fracturing, or breaking. It is still recommended, however, for your patient to wear a nightguard to protect their implants and abutments. 

Anatomical Limitations & Available Restorative Space

For proper treatment planning with a fixed implant supported prosthesis, you need more space than is required for a removable restoration. This extra space is needed to allow for a thicker prosthesis. If it is too thin, it will break. There are precautions you can take, such as building your prosthetic with a metal framework, but the question at hand still comes down to whether or not you have enough space to ensure the prosthetic looks natural and facillitate proper phonetics. For example, if you have a patient with a big "gummy" smile, the line of the jaw and the prosthesis may show which would diminish esthetics and cause the patient to lisp.


It also is important to keep in mind that patients with disabilities and movement restrictions may not be able to take a removable appliance in and out of their mouth themselves. In these cases, a fixed restoration may instead be indicated in an effort to help the patient retain a greater sense of autonomy. 

Maintenance and Scheduling Requirements

While both removable and fixed restorations require recall appointments and maintenance, fixed prostheses can take longer to fabricate, which may be a consideration for some patients! 


Most patients don’t want to go without teeth for any period of time; understandably so! This perception of a more immediate gratification is yet another reason many patients choose removable implant-supported dentures. 


One option to overcome this is to place an immediate denture to be used during the healing phase so they never have to go home fully edentulous. This can be a traumatic and embarrassing time for patients, so having the ability to go home with “teeth” – even if it’s just an immediate tissue supported denture to start with – greatly improves the patient’s willingness to proceed with treatment and overall perception of the procedure. This immediate denture can then be relieved, adjusted, and relined to accommodate the abutments and denture housings. 

Financial Limitations

As hinted at earlier, there is usually a considerable difference between removable and traditional fixed solutions. Luckily, LOCATOR FIXED bridges this gap by offering a transitional solution that is both affordable, convenient, flexible, and compatible with both digital and analog workflows. Work the way you want while empowering your patients to do right by their smile and oral health! 

Want more? Download this free eBook! 

If this article raised a couple of eyebrows but you still want more examples of successful cases, be sure to download this free eBook from esteemed clinicians, Dr. Joseph Massad and Dr. David Little. This study follows two clinical cases and details the fabrication of their respective fixed implant-supported prostheses using a simplified procedure using a novel attachment system (LOCATOR FIXED).


Whether you download the eBook or not, we want to hear from you! Have you upgraded a patient from a removable to a fixed prosthesis yet? If you have, how did it go? If you have not, let us know why! We would love for you to join in on this conversation by connecting with us on Instagram, LinkedIn, or Facebook. Or, if you have a question for us, feel free to contact us and a member of our team would be glad to help. We are here to support you in empowering your patients to do right by their smile.  

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