Dental-clearance-and-tooth-replacement-options

Tooth loss affects very many people

There are many reasons why people have to have multiple teeth removed or even all their remaining teeth removed. It should not be a reason for embarrassment for patients as this is one of the areas of patient care in which we deal every day.

Teeth can fail for any number of reasons including decay, gum disease, prolonged dry mouth that can be due to salivary gland disease, immune disease or taking medications that cause a reduction in salivary flow leading to a dry mouth, called xerostomia. Other patients may suffer from various genetic conditions that leave them with damaged teeth from poor quality enamel. Whatever the reason, remember we have seen this many times before and have the experience to help you and support you through the transition from natural teeth to a prosthetic tooth solution of which there are a number of different options ranging from removable dentures to fixed teeth on implants.

Dental clearance – what is it?

Firstly, the removal of all the remaining teeth is best performed with you asleep to avoid anxiety and because the procedure can be a prolonged procedure. This is the kindest way to manage the surgery and allows Dr Colin Priestland to not only remove the teeth, but also ensure that the remaining jaw bone is perfectly shaped and free of sharp edges or uneven surfaces that would lead to difficulty wearing a denture or lead to pain when wearing a denture. The removal of all remaining teeth is referred to as a dental clearance and the re-shaping of the jaw bone is called an alveolectomy. This is most commonly performed at the Mater Day Surgery Unit in Hyde Park with the support of a consultant anaesthetist.  After surgery and a recovery period you can go home the same day.

What is an alveolectomy?

The re-contouring of the jaw bone, called an alveolectomy, is planned carefully in advance of the surgery to allow the prosthetist who provides the prosthetic teeth to make your denture(s) before surgery to allow the surgeon to fit them immediately the surgery is complete. This will help to limit post-operative swelling and ensure the tissues are protected and remain immobile with the multiple stitches in place. Many people are worried about having stitches removed, but there is no need for concern, as Dr Priestland will use dissolving stitches that fall off between days 7 and 21 after surgery.

Patients who have had several teeth removed under day stay general anaesthetic are generally reviewed 7 to 10 days after surgery but should you have any concerns you will have a 24/7 mobile number to call to contact Dr Priestland should you need to. At your review appointment a check is made on your healing to ensure you have no post-operative infection present.

Prosthetic teeth options

There are a number of options available to replace your missing teeth. The first of these options involves the use of dentures. These are acrylic “baseplates” with teeth on that are worn in the mouth over the remaining jawbone and in the upper jaw they cover the palate gaining greater retention and suction helping them stay in place.

Upper conventional complete dentures are generally extremely reliable and successful if they are provided by an experienced and highly trained prosthetist. Mr Bernie Courtney is the prosthetist with whom Dr Priestland works and he has many decades of experience and provides dentures of the highest quality and natural appearance. He is involved in your treatment from the early stages of planning and he and Dr Priestland will discuss your oral anatomy to make sure that after surgery the jaws are left ideally contoured and that there are no bony lumps that may make your denture unstable or uncomfortable.

Lower conventional dentures are frequently more unstable than the upper due to the fact that they are surrounded by mobile soft tissues with moving lips at the front, a tongue on the inside and cheeks on the outside. The result is a denture that can only be successfully worn once the patient learns the muscular control to keep the denture in place. Not all patients are able to master this.

Overdentures

For many patients nowadays who have no remaining lower teeth, dentures can be made to clip onto precision attachments that are screwed onto dental implants that are placed into the lower jaw. These dentures are called over-dentures and have a very high degree of success. They are comfortable, and patients wearing them have the confidence that they don’t move around being attached or anchored to the implants. However, the patient can remove the denture in order to carry out cleaning of the implants and attachments. This is a very positive aspect of this option making home care easier for the patient and the longterm outcome better.

Palate-free upper denture

Implants can be used in the upper jaw to give additional denture retention for those patients who cannot tolerate anything on the palate. Some people feels sick if they have something against the palate and this means that the denture has to be modified and the palatal coverage is cut away leaving the upper denture as a simple horseshoe design like the lower denture but it needs a minimum of 4 implants to keep the denture in place and stable.  This is due to the poorer quality lower density bone found in the upper jaw rather than the high-density higher quality bone found in the lower jaw where either 2 or 3 implants is generally sufficient to stabilise the lower denture.

Fixed teeth on implants

A few patients demand fixed teeth and are unwilling to accept anything that can be removed. In these cases, access to the implants for the removal of plaque is far more difficult and patients often leave plaque and end up with inflammation of the gums around the implants. If this is not treated, the inflammation can progress to become a destructive inflammatory reaction that results in the destruction of the bone around the implants leading to infections, abscesses and implant failure.

For those few patients where nothing but fixed teeth are acceptable, implants can be used to support bridgework involving an entire arch of teeth supported on either metal or ceramic substructures that can be made from various metal alloys or milled Zirconia and then the metal or Zirconia can be layered with high quality porcelain that is shaded to look exactly like natural teeth. Considerable time and effort must be invested by the patient to clean under the structure to prevent plaque build up. Attendance at the dental hygienist must be far more frequent to ensure that the soft tissues around the implants are being maintained in a healthy state.

Stages of implant treatment

Treatment involving the use of implants involves additional stages. The implants may be placed at the time teeth are removed in some circumstances but this is not possible for all patients. If there is infection present then implants cannot be placed until the jaws have healed after the infection has been eliminated following tooth removal.

If implants are placed at the same time as extraction of teeth, then generally the implants are covered and left to integrate into the bone beneath the closed soft tissues. Once this process is complete the implants are uncovered at a second minor surgical procedure that is generally performed under local anaesthetic in the dental surgery, and healing abutments are fitted on the implants. The soft tissues then heal around these over the next 4-6 weeks.

Following soft tissue healing the healing abutments can be removed and replaced with precision attachments. Generally we use “Equator” attachments that are small, easy to fit, and can have the nylon insert changed quickly and easily at minimal cost.

Generally once the Equator has been fitted to the implant, the patient goes to see the Prosthetist who then inserts the denture attachment into the denture and the patient immediately has a denture that clips in and remains in place allowing them to eat normally, smile , laugh and talk with complete confidence.

Contact the friendly team at NQ Surgical Dentistry today on (07) 4725 1656 or call in to see us at 183 Kings Rd, Pimlico QLD 4812