The treatment of the edentulous jaws presents a difficult challenge requiring careful diagnosis and treatment planning to achieve an aesthetic and functional result. These patients, especially the fully edentulous mandible, suffer from poor function and consequently lack of self-confidence, often being termed “dental cripples”. The treatment options for the edentulous jaw are listed in Table 1 and can be either removable or fixed in nature. They range from removable dentures to implant retained dentures and fully fixed implant supported bridgework (Figures 1-6). These are normally retained or supported by multiple implants (typically 2-8 implants). Diagnostic factors Treatment planning encompasses assessment of diagnostic findings, the patient’s symptoms and complaints to meet the patient’s functional and aesthetic expectations. The following factors should be considered (Jivraj et al): Extra-oral factors • Facial and lip support: Lip and facial support is provided by the alveolar ridge shape and cervical crown contours of the anterior teeth. A diagnostic tool can be utilised to make an assessment with/without the maxillary denture in place (Figure 7). This is done to determine if the buccal flange of a removable prosthesis may be required to provide lip/facial support. In cases where there is a need for a flange to be provided, this must be done with a removable prosthesis allowing patients the ability to remove and clean the device, or alternatively, if a fixed prosthesis is requested then the patient would need to undergo extensive grafting procedures. In Figure 8, note the fixed implant bridge that was constructed by the patient’s previous clinician with a large flange that provided lip support, however it had no accessible areas for cleansing with subsequent food trapping under the bridgework.
Post time: Dec-07-2022