Edentulous

Treatment Options for Patients missing all of their teeth in One or Both Dental Arches

Support, Stability and Retention…

Contrary to what many people believe, patients with no teeth remaining in one or both dental arches present a most challenging dental situation. Once teeth are extracted, complete dentures may initially be satisfactory, however, the process of loss of tissue supporting the dentures begins. The initial satisfaction with complete dentures may decrease with time due to shrinking of the supporting tissues. Even with relining or refitting of dentures, satisfactory stability and retention of the prosthesis may not be achieved due to a smaller amount of gum tissue available for dentures to be supported on.
Dental implants which use the process of osseointegration are common and predictable therapy. Implants provide an alternative to conventional dentures. There are advantages and disadvantages to each treatment options for edentulism. Appropriate information concerning treatment allows an informed decision to be made for the most appropriate treatment.

Complete (Conventional) Dentures

A complete denture is a prosthesis made of acrylic and denture teeth. The advantages of this method of treatment are familiarity and cost. The outcome of this treatment is often more problematic than with other treatment choices. Complete dentures are the least stable option for treatment and because of their movement there may be sore tissue, difficulty in function, poor speech and chewing ability. Jaw bone loss continues under dentures and periodic adjustment may be required to maintain comfort.

It is important to note that not all patients experience these problems. Treatment time is short and this procedure has the least treatment expense.

After teeth are extracted, bone in the jaw will continue to be resorbed which decreases the amount of support for conventional dentures. This often limits patient satisfaction with conventional dentures.

Overdentures Supported by Implants

This treatment option is similar to a conventional denture, however, implant overdentures are more stable and retentive than conventional dentures. Between two and six implants are normally placed. Connection to the overdenture is made with individual attachments or a bar which joins the implants. Implant number and attachment type are determined by factors including anatomy and patient desires.

A significant advantage of this technique is improved retention. Studies have shown that patients have increased bite force. Bone loss is slowed or stopped in areas where the implants are placed. People who have advanced jawbone resorption may be best served from a removable denture because the flanges provide support to give appropriate facial contour.

Implant Supported Fixed Dentures

This option requires between 4 to 6 implants. The advantage of this treatment option is that the denture is designed to stay in the patient’s mouth. The patient has greater bite force and there is maximum stability of the prosthesis. The placement of implants has been shown to decrease bone resorption following tooth loss.

A disadvantage of this treatment is that it is more difficult to clean the prosthesis. This treatment also requires more implants than does an overdenture.

How Implant Treatment is Done

Treatment planning is required for treatment success. Planning should begin with the restorative dentist in conjunction with the dentist providing the surgical support. Diagnostic information required may include conventional dental radiographs (X-rays), diagnostic casts and a template to guide the surgery. Occasionally a treatment denture and CT scan may also be required.

When the desired prosthesis design is determined, then the number of implants and their ideal position is selected. Following the surgery in which the implants are placed the existing prosthesis is left out for two or three days to allow soft-tissue healing. The bone and soft tissue heals for a further four to six months. After bone healing, a second surgery may be required to add a connector to the implants. This connector allows the implants to pass through the gums. A second period of soft tissue healing of 2 to 3 weeks is allowed before fabrication of the definitive prosthesis. Minor adjustments over a period of time may be required after initial placement of the prosthesis.

After placement of the final prosthesis, the patient is instructed in required daily maintenance. As with natural teeth, regular evaluation, maintenance and hygiene visits with the restorative dentist and/or the surgical dentist are necessary to maintain optimal dental health of the implants.