Some anatomical considerations for implant supported restorations in edentulous patients.

STATEMENT OF PROBLEM: After the loss of the natural teeth, the alveolar process and part of the basal bone remodels, resulting in edentulous residual jaws. In edentulous patients, the residual arches provide the vital tissues on which to place the denture bases and the artificial teeth into their selected positions. The residual arches also furnish the foundation of osseo-integrated implants for the planned restorations. PURPOSE: To examine some characteristics of the edentulous arches, the relations between the occluding jaws and their clinical importance. MATERIAL AND METHODS: 212 stone casts mounted in centric relation, from one hundred and six edentulous patients were examined and surveyed. The measurements included the length, the width of the maxillary and mandibular edentulous arches and the inter jaw distances at anterior and posterior regions. RESULTS: Of the one hundred and six participants, 62.3% were female and 37.7% male subjects. The maximallary arch length and width varied from 36 to 71mm, and between 36 to 58mm, respectively. The mandibular length and width differed from 32 to 55mm, and between 48 to 62mm. Higher width values of maxilla and mandibles were found among males as compared to females (p<0.001). The vertical inter jaw distances varied from 9 to 28mm in both anterior and posterior regions. The horizontal inter jaw distances and relation modes varied widely at both anterior and posterior regions. CONCLUSIONS: There is a large disparity in sizes and shapes of the edentulous arches and varied spatial inter arch characteristics. CLINICAL IMPLICATIONS: Before the placement of osseo integrated implants and rehabilitation of the edentulous patients, it is essential to identify the anatomy and relations of the occluding residual arches to contribute to a successful dental treatment.

The residual edentulous arches--foundation for implants and for removable dentures; some clinical considerations. A review of the literature 1954-2012.

The maxillary and mandibular arches are present before tooth eruption and will develop and mature with tooth activities. Following tooth extraction, the healing wound fills in, partly, the space occupied formerly by the natural tooth. The blood coagulum that occupies the healing wound will be replaced by the residual ridge, a scar tissue, which becomes part of the edentulous arch. After tooth loss, the resulting edentulous arches undergo extensive remodeling changes, but remain indispensable, vital oral structures. The resorptive process of the edentulous jaws is limited. The maxillary and mandibular bodies have never been known to recede completely. Furthermore, physiological spontaneous fracture of the jaws does not occur. One factor that helps preserve the jaws' integrity may be the enveloping muscle girdle attached to the external surfaces of the jawbones. The residual ridge develops after tooth extraction and continues to remodel, during the edentulous life of the individual. The ridge resorption is a chronic, progressive, irreversible process. The residual ridge may even disappear as an anatomic entity following an extended edentulous period, systemic and/or local factors. Resorption of the residual tissues seems to be hastened by, systemic affections, edentulousness time, denture wear, tobacco consumption and other unknown factors. In the edentulous patient, the maxillary ridge migration is centripetal and apical, whereas in the mandible, the remaining ridge shifts centrifugally and apically. Consequently the resulting edentulous maxillary arch is, mostly, internal or at the same vertical level with the facing toothless mandibular arch. The different individual inter arch spatial relations are to be considered for the positioning of the artificial teeth, for optional ridge augmentation procedures and for insertion of dental implants.

Prosthetic care for a mentally ill patient.

A manic-depressive 64 old female arrived to the clinic for prosthetic treatment. She was fully edentulous and wore an old poor set of complete dentures. Her general attitude was apathy, nonattached and almost indifferent to the general environment as well as to the proposed oral care. This behavior can change for the worse at any stage during treatment, especially after the delivery stage, with the possibility of a change from an indifferent to a hostile, non cooperative attitude. The intended care was explained in detail to the patient and her accompanying daughter. After their approval, we were able to perform successfully a new set of complete dentures with improved esthetics and functional capabilities. Flat bony ridges with shallow mucosal coverage precluded vertical mandibular denture extension at the lingual surface. Consequently the resulting prosthesis had reduced lateral lingual flanges with limited support and retation.

The importance of correct diagnosis in complete dentures treatment.

A 68 years edentulous female, wearing unsuccessful complete dentures, was treated by making a new set of dentures. The main initial complains were unaesthetic teeth, excessive gums display, speech impairment and severe difficulties in mastication. With the patient's full collaboration and following sound established prosthodontics principles, a successful set of full dentures was provided. The main changes performed with the new set of dentures were: A. Provision of three millimeters interocclusal rest space between the vertical dimension while in occlusion and the vertical dimension of rest. B. The full anterior and premolars maxillary teeth and the incisal's third of the mandibular anterior teeth were displayed when patient was speaking, smiling and laughing. No artificial gums were displayed during any normal facial or oral activities. C. The occlusal plane was established after the selection of the anterior teeth. The plane was made parallel to the ala tragus (Camper's) line.

Prosthodontic treatment of a patient with Papillon Lefevre syndrome.

Papillon Lefevre Syndrome is an autosomal recessive disorder. One of the most destructive forms is a periodontal disease. A 19 year female with the syndrome, came for dental treatment. Most of her natural dentition was missing. The remaining five natural teeth had extensive carious and periodontal lesions. Two poor dentures replaced the missing teeth. Her main oral complaints were poor esthetics, teeth sensitiveness, and dentures instability. All the remaining natural teeth were removed and the dentures repaired and rebased in one session. Following wound healing and the maturation of the residual ridge, a set of complete dentures was made. Two years after the delivery of the full dentures, an additional set of dentures were provided for social and emotional reasons. 9 years after the last extractions, the patient refuses to undergo bone augmentation and osseointegrated implant procedures, for future preventive and oral rehabilitation care. There is a strong possibility of chronic bone tissue resorption conducive to dentures instability, mandibular nerves exposures and or, perforation of the maxillary sinuses.

The influence of age and denture wear on the size of edentulous structures.

OBJECTIVES: This study was designed to evaluate the influence of age and denture use on the size of arches and residual ridges in edentulous patients. DESIGN: At two nursing homes, maxillary and mandibular stone casts of 302 fully edentulous patients were utilized to measure the size of the arches and residual ridges, according to age and use of complete dentures. Age cohorts were divided into three groups; 60-69, 70-79, and 80-89 years old. Two hundred and forty-nine denture wearers used complete dentures for at least 2 years before examinations. Fifty-three non-denture users had never worn removable prostheses. Chi-square analysis (p<0.05) was used to establish the possible relations between the linear values and the size indexes of the ridges and arches and the two examined parameters: age and denture wear. RESULTS: Young old patients possessed edentulous structures that were not significantly larger than elderly old patients in both the maxilla and the mandible. Non-denture users had significantly bigger arches and ridges in both edentulous jaws than denture users. CONCLUSIONS: Young old, non-denture users tended to have bigger residual edentulous tissues compared to elderly old patients who used complete dentures.

Oral findings in elderly nursing home residents in selected countries: quality of and satisfaction with complete dentures.

A total of 249 complete denture wearers were examined from a geriatric population of 610 patients in seven institutions in four different countries. The evaluation of denture quality was made by the patients' opinions and the examiners rankings with a questionnaire on interocclusal distance, occlusal function, extension, stability, comfort, and esthetics of the dentures. At each of the surveyed institutions, the patients consistently considered their dentures better than did the examiners and the maxillary dentures were rated better that the mandibular dentures by the clinicians and by the patients.

Oral findings in elderly nursing home residents in selected countries: oral hygiene conditions and plaque accumulation on denture surfaces.

Many removable-denture wearers do not keep their prostheses clean. One result of poor hygiene is the accumulation of plaque and/or food debris on the denture surfaces, the oral tissues, the residual ridges, palate, cheeks, and tongue. In the study of the oral conditions of geriatric patients living in institutions, 610 patients were examined in seven old-age homes in four different countries: the United States, Peru, Argentina, and Israel.

Oral findings in elderly nursing home residents in selected countries. 1.

In order to determine the influence of culture, individual idiosyncrasy, social and economic conditions as well as the importance of past and current dental care on oral health, the oral conditions of 610 patients in seven old age homes were evaluated in four countries: USA, Peru, Argentina and Israel. The patients included in this study were examined by clinicians who had undergone training and calibration sessions. The seven institutions surveyed have a large range of physical facilities, economic levels, and a variety of quantity and quality among medical, dental and ancillary staff. There were marked differences as to philosophy of treatment and scope for the dental care of the residents. A subjective impression by the examiners is that old age home administrators do not regard the dental needs of the residents to be among their higher priorities. Dental care is considered expensive and requires special equipment and exclusive physical space on the institutional premises. Of the 610 residents 419 were women and 191 men, with an average age of 80 years. The mean number of years of schooling was six. Sixty-two percent of the examinees were widowed, 21% were married, 1% single, 2% divorced, and 5% of unknown or undeclared status. The main orodontal characteristic of the population surveyed was partial or full eduentulousness. Of the total population (610 examinees) only three patients possessed a full complement of natural, unrestored teeth. Twelve examinees had 28 unit dentition, partly natural teeth and partly restored with plastic fillings, fixed prostheses, crowns or pontics. Three hundred and one patients (49%) of the examined population were totally edentulous, 249 (41%) wore sets of complete dentures and 52 (8%) did not wear any prosthetic restoration or replacement.

Oral findings in elderly nursing home residents in selected countries. 2. Soft tissue lesions and denture wearing habits.

This paper demonstrated that 38% of the 610 examinees at seven institutions in four countries have soft tissue lesions. Seventy to eighty percent of the detected lesions were of the erythematous type. This incidence was found at institutions with and without attending dentists, in denture and non-denture users, in dependent and independent patients. Tissue lesions in denture wearers were four times as many as in non-denture wearers. The percentage of inflammatory lesions in both denture and non-denture wearers was considerably higher at institutions with no attending dental personnel when compared with those with dental care facilities. Where patients depended on the staff and/or their relatives for their personal hygiene, a sharp increase in pathological findings was seen when compared to independent dwellers. The nursing staff and the relatives know very little about the oral problems of the elderly residents. There was no uniform policy about telling patients when to wear their removable dentures and patients did not always follow instructions when they were given. Many patients sleep with their upper denture while the lower one is removed for the night. Patients sometimes sleep in the dentures and sometimes remove one or both dentures for varying periods of time. The high percentage of soft tissue lesions and erratic denture wearing habits point to neglect and insufficient oral care toward the geriatric population studied.

Spatial relationship between anatomic landmarks in edentulous patients: a radiographic study.

In 67 edentulous patients the crests of the residual ridges, the incisive papillae, the maxillary tuberosities, and the mandibular retromolar pads were located and identified with metallic wires inside the acrylic resin denture bases. Occlusal cephalometric radiographs were used to record the spatial relationship between the described anatomic landmarks in the dentures with the mandible in centric relation.