Dental Care - Not Without Teeth

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IntroductionMissing the adult teeth, or complete edentulism, is a condition that is not uncommon. Unfortunately, for many different factors, this condition has not been eradicated. Poor oral hygiene, combined with systemic conditions affecting the inflammatory system, play a critical factor in tooth loss. One out of every four individuals aged 65 or more is edentulous. That makes complete dentures a viable restorative option for them. There are other restorative approaches, including dental implants as anchoring / supporting devices. However, the focus of this article will be on complete dentures as an immediate option for patients who are about to lose their remaining teeth...

Immediate Complete DenturesIn order to fabricate a conventional complete denture, the patient needs to be totally edentulous. This represents a problem for patients with multiple broken, loose and non-restorable teeth. These patients have now a dilemma, and often ask themselves: Do I remove all my teeth, wait for healing and then get new dentures or; is it better to keep my teeth as they are now?. The first option would be the better one, given the potential complications of retaining poor teeth, i.e., abscesses, swelling and pain. However, this option is not the most desirable from the cosmetic point of view, given that the patient would have to leave the office toothless. Fortunately, there is an alternative for these patients.
Initial ExamIt is imperative to have a full set of x-rays and a comprehensive oral examination prior to any treatment. During the first appointment, the prosthodontist (or restorative dentist) will interview the patient in order to find out what is know about the treatment. Patient's restorative desires, economics and expectations will be taken into account. After that, the medical history will be reviewed in order to rule out any potential complications. A temporo-mandibular joint (TMJ) evaluation will be done, along with a soft tissue examination. Thorough periodontal (gums) and teeth evaluations will be completed to determine if the patient is indeed a good candidate for dentures.
Pre-Prosthetic SurgeryIn order to fabricate dentures that will fit comfortably, the oral tissues should be firm. The denture bearing areas should be devoid of large bone excesses and undercuts. These would tend to ulcerate the gums, increasing soreness and discomfort. Pre-prosthetic surgery is the treatment indicated to correct these potential problems. In most cases, the Oral and Maxillofacial Surgeon will address those during the extraction appointment.
Impression Taking AppointmentEvery dental requires taking adequate impressions. These are the ones where the lab technician will create your actual dentures from. Impressions by themselves provide only part of information needed. The stone models created from them should be properly related (or mounted) to each other. This is done by taking a bite record. Depending of the amount of teeth left, this process can be accomplished on the same impression appointment. If there are not enough teeth, an additional appointment will be required. This appointment also serves to take notes, measurements and angles of the existing condition. If there are some things we want to, like the size of the front teeth, their color and inclination, we can record it and mimic it on the new dentures.
Try In AppointmentThis appointment is only possible when some of the teeth lost are the front ones. After the models are mounted, a tooth arrangement of the front teeth will be made. Such arrangement will be tried into the patient's mouth for tooth color, inclination and size approval. In this way, some of the estimation is eliminated. Allowing the patient to better know how the front teeth will look like.
Surgical AppointmentBy now, all the pre-surgical steps have been completed. The new dentures are fabricated and are ready to be inserted. The patient has already met the Oral Surgeon and knows exactly what surgical procedures will be performed. The prosthodontist or dentist has provided the surgeon the dentures and a surgical guide (most cases). The only things left are doing the extractions, pre-prosthetic surgery and inserting the new dentures. It is recommended to see the dentist for adjustments, as deemed necessary, the day after the surgical procedure. More than one adjustment appointment is commonly required to have the new dentures fitting and feeling comfortable.
Reline AppointmentsSix months after the teeth are removed; the new dentures will not fit quite as well as in the beginning. This is because the bone has gone through some remodeling processes. It has resorbed (shrunk) as it heals. This is a normal process that gets to a stable stage six months after the extractions. If the patient is fully satisfied with the way the dentures came along, it is recommended to have them relined. The internal part of the denture is resurfaced, allowing it to fit the new gums' shape. The reline process can be done chair side or in a dental laboratory. Because of dental materials compatibility, the second option is more often recommended. This means that the patient will have to leave the dentures with the dentist for approximately two or three days. If scheduled carefully, this should not present major problems for most patients.
ConclusionLoosing the permanent teeth is a traumatic experience. The self-esteem and psychological condition can be really affected if the treatment is not handled properly. A multi-specialty, careful evaluation and treatment planning can prevent these patients from having to walk back home without teeth. Reducing the stress of the procedure and allowing them to have a smile to share with others.
Dr. Luperon is a Prosthodontist and Cosmetic Dentist in Buford, GA. He is passionate about his profession, particularly Cosmetic Dentistry, Implant Dentistry and Full Mouth Rehabilitation. He is happily married and has three beautiful kids. In his spare time, he enjoy watching sports, reading, playing the guitar, computer games and going top church.
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