Recreating Lost Jawbone
More and more denture wearers are beginning to discover that long term denture use can cause significant amount of bone loss.
Unfortunately many denture wearers who have not had the opportunity to find specialists who offer a wide range of grafting products feel they have no or minimal treatment choices available to them.
The severe loss of jawbone integrity for long term denture wearers is usually manifested in a bony ridge that is ultra thin. This can result in sores, electric jolts, an enlarged tongue and pain.
The height of the bony ridge can also compromised to the extent (in some cases – as with partials) there is no bone at all.
Some patients have the additional problem of the muscles in the bottom of the mouth being “taller” than the bony ridge that can make it impossible to keep the denture in place.
The first photo in this treatment series shows a worn out denture that is discolored and has caused a collapse in vertical height or bite. A collapsing bite can prematurely cause unwanted aging effects and, in severe cases, lower facial wrinkling.
Sores can develop in the corners of the mouth (angular cheilitis), due to yeast accumulation. This condition appears when a patient’s bite has almost totally collapsed (worn out dentures, worn down natural teeth), presenting a “bull dog” effect.
The adjacent second photo reflects considerable loss of bone, especially in the lower arch. Notice how no bone is apparent in the lower, posterior areas (rearmost) of the mandible (lower jaw).
Notice too, on the upper jaw, what appears to be extra gum tissue. This tissue becomes quite loose, creating a flabby ridge and interferes with denture seal and retention.
One of the two remaining lower anchor teeth has broken off at the gum line. Fortunately the upper arch, or maxilla, has sufficient bone quality and quantity to permit the fabrication of a new cosmetic denture.
Fortifying the Bony Ridge
The span of remaining bone in the lower jaw is quite short. It was decided by the patient and Dr. Rick that the best method for reconstructing the longest span possible of new teeth would be a special bridge product that employs a cantilevered design.
Cantilevers in Advanced Prosthodontics
A cantilevered bridge can be fabricated to be longer than the amount of remaining bone.
Strategically placed implants are used to attach the fixed bridge that provides a unique dental function and bite that is nearly identical to a full arch of teeth.
Our third photo, pictured here, shows the removal of the remaining lower teeth while the periodontal tissues are prepared for a Ridge Split Bone Augmentation procedure.
Notice how the exposed ridge of bone seems to be “paper thin.”
Ridge Split Decisions
The adjacent picture shows the use of a ridge spreader that is inserted into locations along the ridge of bone that have been predetermined as necessary for creating a unique configuration of implants that will provide a rock solid foundation for the new bridgework.
The newly “split” areas are prepared for hybrid grafting products along with specific implant devices of differing widths and length that will create the best anchoring advantage along the entire length of the ridge.
New Bone creates New Functionality
Our fifth photo reflects the successful placement of implants (the different colors of each implant driver indicate different characteristics in size and length).
Temporary or provisional implants can also be seen (three very thin implants) that will be used to secure a temporary denture while the traditional implants and bone graft products fully heal over a period of a few months.
Most importantly, the patient will NOT be toothless while the treatment plan progresses.
A few months have passed. In the adjacent photo Dr. Rick is trying-in the new cantilevered bridge frame that will eventually be fabricated into the final porcelain bridge.
During this try-in phase multiple adjustments are made to assure correct bite, occlusion, vertical dimension and properly distributed biting forces on the implant configuration.
Final Porcelain – Final Upper Denture
Temporary tooth replacements, in the form of a temporary upper denture and temporary acrylic lower bridge are used for several weeks by the patient to assure ample time for completing the functional and cosmetic adjustments needed that meet the specifications of Dr. Rick and also of the patient.
When everything is “just right”…. the final restorative products are fabricated for final placement.
The Best of Cantilever Physics and Cosmetic Grade Dentures
Having access to the greatest number of advanced technologies and procedures is a determining factor in what a dentist or specialist can recommend for his/her patient.
Because of the pace of changes within the field of dentistry, remaining abreast of all the changes or what technology is being replaced is difficult to accomplish for any dentist or specialist.
Treatment plans that are developed with 3D imaging (ct scans), access to advanced bone grafting technologies and the widest array of implant choices, cantilevered bridgework is a superb solution for rebuilding an entire arch.
The adjacent x-ray shows how each implant device differs in size and design. They were selected on the basis of tissue characteristics and anchoring values required for the bridge.
Patients should be aware that what one dentist may claim as being impossible may only be an indication of what that particular dentist has access to or knowledge of.
We encourage all patients to get multiple consults from a variety of dentists… just as our featured patient on this page did.
Which Is Which?
The cosmetic quality between our patient’s new cantilevered bridge and her new upper denture are nearly indistinguishable.
In terms of overall dental function, our patient has a new bite and occlusal plane that she hasn’t had since before wearing dentures.
The ability to bite, chew, munch and grind any food to her liking has returned…. without the fear of unwanted movement of her new teeth. As time progresses her ability to smile naturally, as she once did many many years ago…. will return.