Should you have Fake Gums on your All on 4 Teeth and Dental Implants?
If you have done any research into having a full set of dental implants, then you may be wondering if you can have just teeth on your implants, or should you have fake gums?
Many of our patients initially think that its better to just have teeth, and this makes sense, because dental implants are normally used to replace missing teeth.
When we are looking at replacing a full set of teeth, us dentists have 5 categories that we use to describe how we make the final set of teeth. These categories can be slightly confusing to begin with, but bear with us.
You could either have fully fixed teeth, so teeth (and possibly gums) directly screwed into your dental implants.
This option is not removable at home, but is designed to be as cleanable as possible.
There are three types of fixed prosthetics (FP), these are FP1,2, and 3.
FP1 is where you can just have teeth on your dental implants.
As you can see in this photo, the teeth are (kind of) the correct height/ width.
This is important, as in the FP2 version, there is still no gum, but the teeth are made deliberately long, like in these lower teeth.
The FP3 is a typical All on 4, where there is often fake gums, and the fake teeth/gums are fitted into the dental implants.
When you see photos with the lips out of the way, its clear to see the transition of fake to natural.
The key is to hide this transition, so the ‘illusion’ is complete!
As to which of these three options is the best, we need to think about what is possible.
We know that bone is lost as soon as a tooth is removed, and we also know that if we remove multiple teeth, then more bone is likely to be lost.
Also, the gum line will flatten, as you can see in the FP 1 and FP2 photos. We lose the papilla.
So if we are considering, a solution without fake gums, then the position of the natural gums will dictate where the top of the tooth should be.
The bottom of the tooth is dictated by what we call smile design principals. There is a ‘correct’ amount of tooth that should be on show when talking and smiling, so we need to make sure that enough tooth is on show when our patients smile.
This then dictates the bottom edge of the teeth.
The problems come in, if you have lost a lot of bone (from gum disease) or from natural bone loss from removal of teeth, and you choose to have no fake gums, then in order to show the right amount of tooth, the teeth will end up looking very long (FP2).
This is often fine, if the lips don’t move very much, and the long teeth are hidden.
Most of the time, this is not the case, and we are trying to create the best looking smiles that we can, trying to replicate nature.
For this reason 99% of the cases that you see on my website, or on my social media are cases where we have deliberately reduced the bone, so that we have fake gums, because we believe that this looks better, and is easier to clean.
The other options for a full set of teeth on dental implants is to consider removable teeth.
These are referred to as RP4 and RP5.
RP4 have a metal bar on the implants, and the teeth are connected to that, and RP5, the denture is connected to the dental implants directly.
With both of these options, we always have fake gums.
I think a reason that the fake gums are disliked at first is that they are associated with cheap looking dentures.
In the same way that we can create natural and terrible looking veneers, there is a big difference in the qualities of gum available, and the skill of the dental technician matters a lot.
RP-4 refers to a slimline removable set of teeth with fake gum. A metal bar is fixed to the implants and the set of teeth then click onto the metal bar. The biting pressure for the patient goes onto the bar, rather than the patient’s natural gums. Adding a bar adds complexity and cost.
RP-5 is a slimline denture that can be clicked on and off. It is not like a traditional denture, as it does not cover the palate. The natural gum takes some of the pressure when the patient bites, unlike in RP4. This is the option we do most often.
Whether an option with fake gum is chosen will be determined by the factors described previously. In more recent years, the appearance of fake gums has improved considerably to a more natural look. An example of natural looking fake gums can be seen below.
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HI CAN YOU HELP IV HAD 6 UPER INPLANTS FITTED AND I HAVE LOST A LOT OF BONE OVER TIME WITH MY DENTURE MY DENTIST IS GIVING ME LONG TEETH WHICH I DO NOT LIKE AS MY MOUTH HAS GONE SMALL AND IT IS AGEING ME I HAVE ASKED FOR A GUM LINE AND HAVE BEEN TOLD FOR CLEANING THIS IS NOT SUTABLE OPTION AS THE FULL UPER BRIDGE WILL BE PERMENT I AM REALLY CONSERNED AND WOULD LIKE YOUR OPINION THE FINAL TEETH HAVE NOT BEEN FINISHED YET
Hi Susan, its difficult to comment without seeing you in person. I would have thought that if you can have long teeth, then you should be able to have gums put on them to make them look the corrrect height.
Dear doctor, I am about to have two implants on the lower, interior incisor teeth that has suffered bone loss for many years. No doubt my gingival line will drop leading to adjacent “long teeth.” Following bone grafting after excision, might I qualify for these two implants with an attached fake gum or gingival line? Thank you
Yes, (although you are probably getting this reply a little late!) You should be able to have pink porcelain on the crown to disguise the missing gum.
Oh I hope I can make sense and try to explain this .. I am interested in the implants but I have a question about the ones that aren’t fake gums . I have seen on the Internet the implants they look like they come in three sections it looks like they might have three or four individual teeth almost like a bridge they come three individual sets on the top and I believe there’s three sets for the bottom .The implants are using your own gums do you know the name of this type of implants ? Thank you
Hi, they can come in sections, or in a single bridge, it depends on the situation. The implants themselves are not important, I will have preference with one brand, others will use other brands.
Hello maybe a hard question here , I’ve got all on 6 implants top and bottom. Before they were fitted I had temporary ones for 6 months They looked good. After 6 months I got my new ones in , the top ones not the same as when I smile you can’t see as much teeth ,to little I think I’m not sure why this has happened. ,a little question can I change my top ones to make them look bigger similar to the temporary set I had. , I also received sinus lifts
Hi Alan, this is likely because the lab did not copy the temps – I am not sure if they were asked to do this, as its not common practice. The teeth can likely be removed and remade, hopefully your dentist and technicians are understanding in this matter!