Dr. Brian Saby's Dental Blog

For the most part, we do some pretty neat things in dentistry today.  We can help people by drastically improving their smiles; we can restore function, and provide the peace of mind that comes with having ideally restored teeth.  This is rather fulfilling for the dentist, but every now and then we treat a patient where we make a dramatic difference and are able to change their lives.  Last week was such a time.

We had been treating a lady in my practice (we will call her Mary) for the last several years.   When we first saw her, her main complaint was her poor fitting upper and lower dentures.  For you to fully understand her problem, we must first go over some things that happen when a person loses their teeth.

Traditionally, when most people lose all their teeth, they initially have a set of dentures made.  These are made of an acrylic base with either porcelain or plastic teeth.  The acrylic base rests on the gums.  The dentures are held in by the suction created by an accurate fit.  The upper dentures, with six times the surface area, suck in well, while the lower denture with less area and a tongue and cheeks to dislodge it, fits adequately. 

Most people can get by with their dentures after sufficient learning and adapting.  Even though the best dentures offer only 25% of the biting ability of natural teeth, the adaptability of people makes this a workable solution to their problem.  However, things get worse.

In the jaws, there are two types of bone, the base bone and the bone that goes around the teeth (basal and alveolar bone for you jargon junkies).  When the teeth are removed, the bone that goes around the teeth immediately begin to dissolve since the stimulus for maintaining the bone, namely the teeth is gone.  Initially, there is usually enough gum-covered bone, to form a ridge.  Over time as the bone shrinks, the dentures fit becomes poorer and poorer.  Every couple of years, a new base needs to be placed on the denture, this is called a reline.  Owing to wear of the teeth and shrinking gums, the dentures need to be replaced every 6 – 8 years.

The amount of bone shrinkage is the biggest problems facing denture wearers.  In most people, the total amount of bone loss is such that they will still be able to function with a denture. In others the bone loss is so great that they have a difficult time with their dentures.  At a certain point, it becomes impossible to construct an adequate denture. Usually, this is seen in the lower jaw since there is no palate to take some of the load.   No one can make a functional, comfortable denture when the foundation has been destroyed due to bone loss. 

Mary was such a person.  She had lost her teeth in her early 20’s.  Over time she had lost almost all the supporting bone in the upper and lower jaws.  Where there is usually a ridge on the lower jaw, she had a ditch.  She  had lost so much lower bone, that the nerve which normally runs in the middle of the jaw, was laying just under the gums causing pain when pressed upon by the denture.  Her upper gums were not anchored to much bone and were loose and flabby.

We initially made a very accurate denture for Mary.  Painstaking attention to detail with regards to fit and the bite ensured that she had the very best denture that could be constructed.  Even with this we had to use a rubbery base on the lower denture to cushion the gums.  This denture served Mary well for about 5 years but was barely adequate.

The solution to Mary’s problem was to place dental implants in her lower jaw.  Ideally we would have constructed fixed lower teeth, but financial considerations did not allow this extensive treatment.  Instead, Mary had two implants placed in lower jaw.  To these we secured a special bar.  Clips in her lower denture allow her to snap her lower denture in place so it is stable. 

The implant placement is a simple procedure that is done under local anesthetic.  The implants are simply screwed into place and left to fuse to the bone.  There is surprisingly little pain following and no pain during placement.

After a three-month period during which Mary was still able to wear her lower denture, we made the bar.  This procedure involves no pain or discomfort for the patient. 

I knew Mary would have considerably more comfort and function with her new dentures, but how much more was not evident until I talked to her sister a few days later.  She mentioned how happy she was and how she was able to eat better with no pain or discomfort.  The most telling indication, however, was when she walked into the kitchen and heard Mary for the first time in 35 years proudly say: “Hey, look at me, I’m eating an apple!”

It is often the simple things in life that we most often take for granted yet miss the most when they are taken away.  If you would like more information about how dental implants may help you improve your life, ask Dr. Saby.

If you are missing one or more teeth and wish to replace them, dental implants are the first treatment choice.  This innovative technique replaces the root of missing teeth with a titanium appliance that actually fuses to your bone and becomes part of your body.  The single tooth or tooth replacement appliance is then screwed to the implant and acts in a manner similar to natural teeth.

Traditionally, missing teeth were replaced by fixed bridgework, where crowns on teeth adjacent to a space support an artificial tooth.  This works very well for short spans such as one missing tooth.  If more than one tooth is missing or if the missing teeth do not have sound teeth on either side, fixed bridgework becomes more complex.  If the spans are too long or all the teeth are missing, removable appliances such as partial or full dentures were constructed to replace the teeth. 

Anyone who has experienced partial dentures or complete dentures knows that there are all sorts of problems associated with these devices. 

Over 30 years ago, an accidental discovery by Dr. Branemark in Sweden led to the modern dental implants.  Dr. Branemark , an orthopedic surgeon, discovered that titanium screws used to hold bone plates in place were extremely difficult to remove.  Study of this phenomenon revealed that the titanium had fused to the bone and become part of the bone.  This process was called osteointegration.  He postulated that osteointegration of titanium could be used to replace missing teeth. (more…)