Oral health remains one of the most overlooked components of overall health, particularly among underserved and medically complex populations. In community health center settings, clinicians frequently encounter patients who have struggled for years with edentulism, ill-fitting dentures, and the cascading effects these conditions have on nutrition, systemic health, and overall quality of life.
While implant-supported mandibular dentures have been shown to significantly improve stability and patient satisfaction, access to this form of treatment remains limited for those who may benefit from it the most.
Dr. Shilpi Joshi.
In high-volume safety-net dental clinics, the standard of care is often shaped not only by clinical need but also by financial constraints, insurance limitations, and systemic barriers. Traditional mandibular dentures, though widely used, may fail to provide adequate retention and function, particularly in patients with advanced ridge resorption and in spite of considering alternate impression techniques.
This shortcoming often results in compromised chewing ability, discomfort, and reduced patient confidence. For medically compromised older adults, these challenges are further compounded by multiple morbidities such as diabetes, cardiovascular disease, and nutritional deficiencies.
Implant-retained overdentures offer a transformative solution. Even the placement of adequately sized implants in the mandible can significantly improve denture stability, enhance masticatory function, and elevate overall patient satisfaction.
In our community health setting, we have implemented and evaluated care models that expand access to implant-supported overdentures for underserved patients, with a focus on improving both functional outcomes and quality of life, and we are currently evaluating and analyzing these models via research efforts.
Dr. Kadambari Rawal.
One promising approach was the development of a structured implant access program through an academic–community partnership. The department of oral and maxillofacial surgery at Boston Medical Center provided two implants for mandibular edentulous patients as well as the prosthetic component (retention rings).
The placement of the implants was free of charge for the patient while the referring dentist at NeighborHealth center was responsible for the prosthetic phase of the treatment. The program was funded by the Massachusetts Dental Society. This shared-care model distributed both financial and clinical responsibilities, making advanced treatment more feasible within community health settings.
Patient selection was critical to ensure both safety and predictable outcomes. Eligible patients typically demonstrated financial need and were often enrolled in public insurance programs such as MassHealth or the Health Safety Net.
Candidates presented with complete mandibular edentulism and an inability to tolerate conventional lower dentures due to poor retention. Patients requiring extensive bone grafting were generally excluded, as the program prioritized cases where predictable implant placement could be achieved without complex surgical intervention.
Through an academic–community partnership, selected patients received an implant-supported mandibular denture. Boston Medical Center provided the two abutments and retention rings while the referring dentist performed the prosthetic treatment phase.Images courtesy of Drs. Joshi and Rawal.
Reasonably sound and managed overall health was another essential consideration. Patients had to be suitable for implant placement under local anesthesia, as sedation and general anesthesia were not routinely included.
Histories of radiation therapy or use of antiresorptive or antiangiogenic medications were evaluated on a case-by-case basis. Continuity of care remained fundamental, as patients needed to have a restorative dentist to complete the prosthetic phase and ensure functional rehabilitation.
The program was intentionally streamlined, typically involving three visits: an initial evaluation to determine candidacy, implant placement, and then a subsequent follow-up appointment. This simplified structure helped reduce logistical barriers for patients who often faced challenges related to transportation, employment, or caregiving responsibilities.
There were several criteria that selected patients had to meet to receive the mandibular overdenture.
From a clinical perspective, early observations in our patient population demonstrated consistently higher satisfaction among those receiving implant-retained overdentures compared to conventional dentures. Patients reported improved chewing ability, enhanced stability, and greater confidence in social interactions. These improvements extend beyond oral function. Better mastication can support improved nutrition, which is particularly important for older adults managing chronic systemic conditions.
The implant-supported mandibular overdenture post-installation. Besides benefits such as improved chewing ability and stability, patients reported greater confidence.
This model demonstrated how collaboration between organized dentistry, academic institutions, and community clinics can effectively expand access to advanced care for underserved populations. It also creates meaningful educational opportunities for dental students and trainees, who gain exposure to implant dentistry within real-world public health settings. Such experiences are critical in shaping future providers who are both clinically competent and socially responsive.
While this model is based in the U.S., similar barriers to accessing advanced dental care exist globally. The need for scalable, community-based solutions to expand access to implant-supported treatment is increasingly relevant across diverse healthcare systems.
Within long-term care (LTC) communities, geriatric dentists treating medically compromised older adults and end-of-life patients have observed that patients admitted to LTC with implant-retained lower dentures age well with a better quality of life compared to their counterparts.
The rates of lost dentures (an unfortunate issue that plagues most nursing homes) are lower for implant-retained dentures compared to non-implant-retained dentures. The ability to chew food, speak, sing, talk, and socialize remain consistent during the LTC stay for these individuals and contributes to a better quality of life during a very vulnerable time in their lives.
Often, patients who cannot tolerate their existing mandibular dentures during the end stages of life simply stop wearing them. At this point, based on their medical history and frailty, patients may not be suitable candidates for implants. It is therefore of exceeding importance that eligible patients receive timely implant placements, keeping in mind that bone resorption is common among edentulous patients and can affect denture fit later in life.
Despite these advancements, systemic challenges persist: Reimbursement structures have not kept pace with clinical evidence, and many public insurance programs continue to exclude implant therapy from coverage. Addressing these gaps requires ongoing advocacy, policy reform, and innovative care delivery models that prioritize patient-centered outcomes.
Ultimately, expanding access to implant-supported dentures is not simply about adopting new technology, it is about redefining what constitutes essential care. For patients who have long struggled with the limitations of conventional dentures, implant-supported solutions can restore not only function but also dignity, confidence, and quality of life.
As oral health continues to be recognized as an integral component of overall health, expanding access to implant-supported solutions should no longer be viewed as optional but as an essential step toward achieving equitable and comprehensive healthcare.
Editor’s note: References available upon request.
Dr. Shilpi Joshi is a community health dentist, educator, and researcher based in Boston. She serves as an adjunct faculty member at the Boston University Henry M. Goldman School of Dental Medicine and practices in a high-volume safety-net setting, providing care to medically complex and underserved populations. Her work focuses on advancing access to care through innovative community-based models, including collaborative implant-supported prosthetic programs for vulnerable and aging adults.
Dr. Kadambari Rawal, MSD, is a geriatric and public health dentist and serves as a clinical associate professor at the Boston University Henry M. Goldman School of Dental Medicine. She practices at long-term care communities in Boston and Greater Boston, providing comprehensive dental care to medically compromised patients, end-of-life populations, adults with special healthcare needs, and treats centenarians almost daily. The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
