Treatment options for edentulismUncategorised
Posted by: The Probe 21st April 2020
Faced with an aging population, dental professionals are encountering many more patients with missing teeth. Both partial and complete edentulism can cause numerous difficulties for those who suffer from the condition. Although a single missing tooth may not result in functional issues that are immediately noticeable, eventually the surrounding teeth may shift to fill the space left behind. This can give rise to occlusal problems that can make it difficult for patients to maintain effective oral hygiene. In addition, the unsightly gap of a missing tooth, especially in the anterior region, can negatively impact the patient’s appearance.
Those with several missing teeth are even more at risk of complications, as the loss of dentition can quickly lead to bone resorption in affected areas.[i] This can not only adversely affect nutrition intake – with far-reaching consequences on general health – but can also alter the patient’s facial structure, making them appear older.[ii], [iii], [iv] These effects can have a detrimental impact on a patient’s overall quality of life. As such, it is important that practitioners explore the different options that are available for treating missing teeth, and consider which of these would be most beneficial to the afflicted individual.
In cases where a patient has a missing tooth or is partially edentate, a dental bridge can offer a permanent restorative solution that looks and feels like a natural tooth. The main drawback of a bridge is that it typically requires preparation of the abutment teeth on either side of the gap to support the restoration. This is a somewhat invasive process that results in the reduction of natural, healthy tooth structure, which many clinicians find uncomfortable performing. As a dental bridge is a fixed solution, it can also be more difficult for patients to maintain. If oral disease develops in or around the abutment teeth, then the bridge – as well as the supporting dentition – may be lost. Dental caries is the most common cause of conventional dental bridge failure.[v]
Advances in dental technology and materials have ensured that dentures are more functional and comfortable than ever before, and can be indiscernible from natural teeth. They are also an inexpensive treatment option, which may explain why an estimated 15 million people in the UK wear a partial or complete denture.[vi] However, there are some negative side effects associated with dentures. As it can be removable, a denture does not necessarily combat the bone resorption that occurs as a result of tooth loss – in fact, some experts suggest that this effect can be accelerated with denture use.[vii] In addition, meticulous care can extend the life of a well-made denture, but eventually it will need to be replaced, particularly if it becomes loose and shows signs of significant wear.
Although they require surgery and are more costly than other treatment options, single-unit dental implants can be particularly beneficial for edentate patients. As well as providing a permanent, fixed solution, they can prevent subsequent bone resorption from the loss of a tooth. Peri-implantitis is still a common complication associated with implants that can speed up bone loss and lead to implant failure if left untreated.[viii], [ix] However, implants remain a highly popular restorative solution as they can provide long-term function and aesthetics that are superior to that achieved with dentures. Full-arch implant rehabilitation, in particular, can completely transform the smile of a patient who has no natural teeth.
During such procedures, it is common practise for practitioners to remove a significant amount of bone and gingiva in order to accommodate an immediately loaded fixed prosthesis. Although this approach is applicable in some cases, it is not necessarily indicated for all. There is another option that enables clinicians to provide minimally invasive treatment, whereby the hard and soft tissue are preserved so that patients benefit from a highly aesthetic and functional restoration.
Practitioners can learn to do this predictably through The FP1 Course, which is led by renowned implant dentists, Drs Nikhil Sisodia, Martin Wanendeya and Paulo Carvalho. This innovative new programme is taught over two days and explores a muco-gingival approach to full-arch dentistry that incorporates both digital and analogue processes. Delegates can expand on their implant expertise in order to achieve natural-looking results with high quality dental implants and porcelain prosthetics.
There are various treatment options available to effectively combat tooth loss. However, patients must be treated on a case-by-case basis – a solution that works for one person might not necessarily work for another. It is important to remember that each treatment has advantages and disadvantages that need to be presented carefully to patients, who will have their own reasons for preferring one solution over another. These include treatment expectations and financial constraints that must be taken into consideration too. As with any aspect of dentistry, it is essential to tailor treatment according to the individual needs and preferences of each patient.
For more information, visit The FP1 Course Facebook page.
[i] Bodic, F., Hamel, L., Lerouxel, E., Baslé, M. F. and Chappard, D. (2005) Bone loss and teeth. Joint Bone Spine. 72(3):215–221. DOI: 10.1016/j.jbspin.2004.03.007.
[ii] Geissler, C. A. and Bates, J. F. (1984) The nutritional effects of tooth loss. Am J Clin Nutr. 39(3): 478-489. DOI: 10.1093/ajcn/39.3.478.
[iii] Allen, P. F. and McMillan, A. S. (2003) A review of the functional and psychosocial outcomes of edentulousness treated with complete replacement dentures. Journal of the Canadian Dental Association. 69(10): 662-662e.
[iv] Emami, E., de Souza, R. F., Kabawat, M. and Feine, J. S. (2013) The impact of edentulism on oral and general health. International Journal of Dentistry. 2013. 498305. DOI: 10.1155/2013/498305. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664508/. [Last accessed: 17.10.19].
[v] Briggs, P., Ray-Chaudhuri, A and Shah, K. (2012) Avoiding and Managing the Failure of Conventional Crowns and Bridges. Dental Update. 39(2): 78-80, 82-84. DOI: 10.12968/denu.2012.39.2.78.
[vi] Wheeler, G. (2019) Dentures: a guide to types of false teeth & their costs. ElectricTeeth. Link: https://www.electricteeth.co.uk/false-teeth-dentures/. [Last accessed: 17.10.19].
[vii] Mittal, Y., Jindal, G. and Garg, S. (2016) Bone manipulation procedures in dental implants. Indian Journal of Dentistry. 7(2): 86–94. DOI: 10.4103/0975-962X.184650. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934094/. [Last accessed: 17.10.19].
[viii] Mahato, N., Wu, X. and Wang, L. (2016) Management of peri-implantitis: a systematic review, 2010-2015. SpringerPlus. 5: 105. DOI: 10.1186/s40064-016-1735-2. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4735040/. [Last accessed: 17.10.19].
[ix] Mengel, R., Heim, T. and Thöne-Mühling, M. (2017) Mucositis, peri-implantitis, and survival and success rates of oxide-coated implants in patients treated for periodontitis 3- to 6-year results of a case-series study. International Journal of Implant Dentistry. 3(1): 48. DOI: 10.1186/s40729-017-0110-6. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704031/. [Last accessed: 17.10.19].
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