- When a person loses natural teeth due to aging or trauma, the bone undergoes a remodeling process. The cortical plates holding the root of the teeth collapses and the alveolar bone height decreases, therefore the overall height of the bone to reduces.
- The conventional solution for an edentulous patient is a complete denture which includes two acrylic plates for upper and lower jaw with teeth attached onto them. These are removable appliances and need good bone support for retention.
- When there is excessive bone loss/atrophy/resorption, the denture plates may lose the retention causing the patient difficulty in eating and speaking.
- For patients who don’t want a removable complete denture with poor retention and are looking for a fixed prosthesis for their condition may go for implant supported denture which gives excellent retention and good aesthetics.
- One more way to improve retention is implant supported-bars and bar-supported complete removable denture which will provide retention where there is severe loss of bone and excessive inter-arch space making non-removable approach impossible.
- When there is less bone for implant insertion, bone grafting procedure is carried out to provide good support for the implant to integrate with jaw for proper function and implant-bone integration.
- If there is significant upper jaw anterior resorption, the implants with bars should be kept distal to the upper lateral incisors in order to not interfere with tooth placement and phonetics.
- Complete edentulous patient’s proper evaluation of the jaw and the model survey is very important for the dentist to properly assess the bone condition of the patient and deliver an accurate and predictable result to the patient.
While planning a treatment plan for an edentulous patient, a dentist must evaluate the 10 important landmark points which will guide and help in deciding the best result for the patient. These are:-
- TMJ Diagnosis: It should be determined to get an adapted centric posture of the denture.
- Vertical Dimension: Distance between upper and lower teeth at rest should be 2mm.
- Lower Incisal Edge: To guide the phonetics
- Upper Incisal Edge: To guide the phonetics
- Centric Stops: A technique using the patient’s centric stop as an index to relate the working casts of a fixed restorative unit is described. This technique reduces the possibility of dimensional changes and inaccurate cast relationships often observed with conventional materials
- Anterior Guidance: It is determined by the upper and lower incisal edge position and their vertical and horizontal distance to guide the overload and get a balanced occlusion.
- Curve Of Spee: It is defined as the curvature of the mandibular occlusal plane beginning at the tip of the lower incisors and following the buccal cusps of the posterior teeth, continuing to the terminal molar.
- Curve Of Wilson: It is the curve that connects the buccal and lingual cusp tips of the mandibular molars. It is generally inclined inwardly.
- Cusp Or Fossa Angle: It is usually determined to guide the teeth to modify the plane of occlusion setting so the forces on molars are equal in every direction.
- Aesthetic Plane: Verification of the aesthetic plane with the facial profile in order to fabricate a denture in harmony with the facial contour of the patient.
