Ara Nazarian DDS, DICOI
In the past, there was a growing number of patients requiring full mouth extractions due to extensive decay, periodontal disease or both combined situations. It used to be that only the Baby Boomers were in need of these extractions and restoration with dentures. However, we are seeing an increased number of younger patients, aged 25-45, who need full mouth edentulation. Unlike the situations that have affected the mature population, this generation of patients usually presents with generalized areas of massive decay and infection due to drug use, poor diet, high amounts of soda intake as well as abnormal wear due to excessive grinding or clenching. Most importantly, these conditions are found in the suburbs of major cities across the United States instead of just the "perceived" inner city.
As dentists, our goal is to always try to save teeth in any way we possibly can, instilling to the best of our ability a great aesthetic and functional outcome that will potentially last for many years. However, when a patient presents with severe decay, wear and infection from the conditions mentioned above, one form of treatment might include extraction of all the remaining teeth followed by some type of prosthetic option such as a denture, overdenture or fixed bridge depending on the needs of the patient as well as what treatment may fit their budget.
When presenting to these patients, I will educate them on the advantages and disadvantages of all possible treatments in addition to the price range for these options. In my explanation, I will include an example using automobiles: "Ms. Smith, as you have just heard in my explanation there are a variety of different types of treatment to restore your smile to proper form and function. You will be able to eat, speak, bite and function with all the various options. However, these options differ with the force you may be able to chew, the size of the prosthetic option and whether or not the prosthesis is removable. In other words, it is a lot like cars where they all will get you from point A-Z, however, you may experience a different kind of drive, level of comfort or feel of luxuries from one car to another."
In most cases, patients want to have the fixed bridges, however, this may be out of their budget. Although full dentures are the lowest in cost, most of these patients have heard of the difficulties in speaking and eating especially with the mandibular denture. Because of this and many more reasons, the most common selection when requiring full mouth edentulation is the overdenture at least in the lower arch.
In this particular case, a patient presented with severe decay and infection due to prior drug use and poor oral hygiene, as well as an unhealthy diet. As seen in the preoperative photo (Figure 1), there is rampant cervical decay extending far below the gum line on most of the teeth. After the proper diagnostic work up, radiographs, CBCT (Carestream Dental) and impressions (Kettenbach USA) were acquired, a clinical examination was performed and various options of treatment discussed with the patient.
After a thorough explanation of the various treatments, the patient decided on having an upper denture opposing a lower overdenture. This would be accomplished by extracting all the remaining teeth, leveling the bone and placement of four dental implants (Engage, OCO Biomedical) in key positions for the lower overdenture. Using Sofreliner Tough® Medium (Tokuyama Dental), both upper and lower immediate dentures were soft relined on the day of surgery. I like using this product because it’s very easy to handle, and also comfortable for the patient. Notice in the Before and After Panoramic X-rays (Figure 2) using the CS 8100 3D (Carestream Dental), how much was accomplished in one surgical visit.
Once 3-4 months passed, the soft reline material was removed and the dentures relined using Rebase II, a chairside hard denture reline material (Tokuyama Dental). When relining dentures or picking up overdenture attachments directly within the mouth, the patient may experience heat generation that is uncomfortable in addition to a bad taste when using methyl methacrylate-based pickup materials. Since Rebase II is methyl methacrylate free, it doesn’t have a strong odor or taste, and it has minimal heat generation, making it a much better experience for the patient. Given this and its high durability and mechanical properties, I use Rebase II for relining dentures and as a pickup material in my implant procedures.
As seen in the postoperative photo (Figure 3), we were able to restore the patient with an aesthetic and functional treatment outcome that fit within her budget that could be further enhanced to fixed by the placement of additional dental implants if desired.