Treating edentulism: what are the options? Jonathan Fleet Nobel BiocareFeatured Products Promotional Features
Posted by: The Probe 17th February 2019
Edentulism remains a significant problem for dental professionals to overcome. This is partly due to the number of edentulous patients. After all, although our collective oral health is arguably getting better and therefore cases of edentulism should be decreasing, we are also faced with an aging population in many countries across the world.[i]
As it is generally the elderly who suffer most from edentulism,[ii]it therefore means that many dentists are being presented with more edentulous patients walking through their doors. As such, it’s important that professionals explore the different options available for treating edentulous patients and consider which of these will be most beneficial to the afflicted individuals.
Why must we tackle edentulism?
Both partial and complete edentulism can cause a number of significant problems for those who suffer from them. Though a single missing tooth may not cause noticeable functional problems at first, it is entirely likely that the surrounding teeth may drift to fill the space left behind, possibly resulting in occlusal issues.[iii]
Fully edentulous patients, or those missing many teeth are at even more risk, as the loss of teeth quickly leads to bone loss in the affected areas.[iv]This can rapidly alter facial aesthetics. Furthermore, the loss of many teeth has been found to hamper people’s abilities to chew properly and therefore could lead to malnutrition if people are unable to eat nourishing food.[v]
Interestingly, edentulism has also been linked with a number of significant general health conditions. These include an increased risk of diabetes, a higher chance of developing chronic kidney disease and even a number of possibly fatal heart conditions.[vi]Therefore, in order to keep patients safe it’s important to be able to provide quick, effective treatment that will prevent their tooth loss from causing lasting problems.
The majority of patients will likely be suffering from partial edentulism and may only be missing a single or small number of teeth spread out throughout their oral cavity. Due to the localized nature of partial edentulism the most effective treatment options for these patients are dental implants, partial dentures, dental bridges or even a combination of treatments depending on the pattern of edentulism present.
When discussing these options with your patients it’s important to remember that all treatments have positives and negatives that need to be presented carefully. Furthermore, patients will have their own reasons for leaning towards one solution over the other such as financial constraints or aesthetic expectations, and these must come into consideration too.
Out of the three treatment options, partial dentures are the most common. Research claims that as many as 90% of people who suffer from edentulism have dentures,[vii]and this is likely because this treatment option is the most inexpensive, and can still provide aesthetic, functional results. Due to recent advances in dentures, they can be completely indiscernible from natural teeth. However, they do come with various negative side effects.
As partial dentures are removable, they do nothing to combat the eventual bone loss that occurs from tooth loss, and some studies have argued that wearing partial dentures may actually increase the bone loss experienced at edentulous sites.[viii]Furthermore, dentures may regularly need to be replaced and wearing them will likely not feel natural.
On the other hand, dental implants provide a number of benefits. Not only are they a fixed, permanent solution, but they also help to prevent bone loss caused by tooth loss.[ix]Furthermore, as they are drilled into the bone they prevent surrounding teeth from shifting out of place. Perhaps the biggest downside to dental implants for patients is their cost. Due to the complexity of the procedure they often come with a significant price tag, and for some patients this investment won’t be viable. Furthermore, complications with implants are still a reality, and peri-implantitis can quickly accelerate bone loss and result in implant failure if not properly managed.[x]
Fully edentulous patients
In many ways, the same treatment options are also best employed for fully edentulous patients, just in different forms. Full dentures offer much the same positives and negatives as their partial counterparts, though they do come with extra drawbacks like the risk of certain oral conditions such as denture stomatitis – an itchy, uncomfortable rash that may lead to poorly fitting dentures in the future.[xi]
When it comes to implant solutions, we must now consider implant-supported prostheses as the most suitable treatment. Although multiple individual implants would arguably work, the time and cost of treatment like this would be unethical, especially when there are already some excellent full arch solutions on the market.
For years, the All-on-4®treatment concept from Nobel Biocare has been regarded as the gold standard for treating fully edentulous individuals. Utilizing only four implants, this innovative treatment concept has been proven to provide fast rehabilitation for edentulous patients, returning long-term function and aesthetics.
Where the cost of this procedure is prohibitive for patients, the new Trefoil™ from Nobel Biocare may be preferable treatment option for the edentulous mandible. Comprised of three implants supporting a pre-manufactured bar that allows for passive fit, this is a more accessible treatment for individuals that can still offer exceptional results.
Many paths to take
Patients are all individuals and therefore it’s imperative that professionals explore all of the options for combatting edentulism. It may be the case that one type of treatment or a combination of many types is best for the patient.
For more information, contact Nobel Biocare on 0208 756 3300, or visit www.nobelbiocare.com/trefoil
[iii]Oral Health Foundation. Dentures. Link: https://www.dentalhealth.org/dentures[Last accessed December 18].
[viii]Ozan, O., Orhan, K., Aksoy, S., Bilecenoglu, B., Sakul, B. The Effect of Removable Partial Dentures on Alveolar Bone Resorption: a Retrospective Study with Cone-Beam Computed Tomography. J Prosthodont. 2013 Jan;22(1):42-8. doi: 10.1111/j.1532-849X.2012.00877.x. Epub 2012 Jun 1.
[ix]American Academy of Implant Dentistry. About Dental implants. Link: https://www.aaid.com/about/Press_Room/History_and_Background.html[Last accessed December 18].
[xi]The Oral Health Foundation. Denture Stomatitis. Link: https://www.dentalhealth.org/denture-stomatitis[Last accessed December 18].