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Treatment guidelines

Edentulous

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Skeletal consequences of edentulism

Teeth loss in the maxilla initiates residual ridge/alveolar resorption, especially in the anterior region, which is flared labially. The consequences of this resorption is a gradual medial or palatal shift of the crest of the maxilla. This...

Patient assessment
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Treatment guidelines

Edentulous

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Overarching considerations

The primary goal is a proper oral function. This implies not only chewing but also speaking, smiling. Patients’ adaptability varies enormously. Some are satisfied with removable dentures, others object to the esthetics of...

Local factors
Patient assessment
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Treatment guidelines

Edentulous

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Direct to implant vs. abutment

Advantages of abutment-supported prostheses are 1) When implants are not parallel to each other, the use of angulated abutments can "correct" for the non-parallelism 2) Angulated abutments are available for a screw-retained prosthesis and 3) Custom abutments can be...

Prosthetic strategies
Prosthetic materials
Implant prosthetics
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Treatment guidelines

Edentulous

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Anesthesia

The choice of anesthesia depends on many variables including the complexity of treatment, duration of treatment, need for patient awareness and the response during treatment, only to name a few. In general, the clinician and patient should discuss the...

Patient assessment
Preoperative procedures
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Treatment guidelines

Edentulous

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Soft tissue management

The aims of peri-implant soft tissue management in the edentulous mandible are the eventual reconstruction of attached gingiva or immobilizing the soft tissue at the implant-soft tissue interface. Vestibuloplasty means deepening of the...

Soft tissue management
Peri-implant therapy
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Treatment guidelines

Edentulous

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Alveolar atrophy and insufficiency

Teeth extractions are followed by a reduction of the bucco-lingual as well as the vertical dimension of the residual alveolar ridge. The ensuing resorption is progressive and even the basal jaw may become involved. In the lower jaw, the....

Radiology
Systemic factors
Patient assessment
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Treatment guidelines

Edentulous

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Biologic complications

This is the reversible inflammatory process in the soft tissues around functioning implants. Peri-implant mucositis occurs in almost 60% of subjects (± 30% of sites), restored with implants. Diagnosis is stated by clinical examination: redness, ...

Peri-implantitis
Peri-implant therapy
Local factors
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Treatment guidelines

Edentulous

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Radiological Control

At the beginning of the recall control it is necessary to define the intention of a radiograhical control and if it is needed. Radiological controls are only justified in the presence of certain symptoms, anamnesis and/or clinical examination...

Radiology
Aftercare / follow up
Peri-implant therapy
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Treatment guidelines

Edentulous

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Peri-operative care

As described in Patient Assessment, a thorough evaluation of patient factors influencing whether to proceed with surgical therapy is relevant.
Depending on the tpe of surgery prescribe pre-operative medication (for example antibiotic coverage), if...

Patient assessment
Preoperative procedures
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Treatment guidelines

Edentulous

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Salivary output

Physiological salivary output is 0.75 to 1.5 liters per day, with most originating from the submandibular glands. Saliva is a lubricant and has a complex set of protective and healing functions for the oral cavity. It adheres instantly to...

Local factors
Patient assessment
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Treatment guidelines

Edentulous

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Microbiology

Epithelial desquamation in the oropharynx limits bacterial accumulation, except on the tongue dorsum and in the tonsillar crypts. Loss of teeth dramatically reduces the load of periodontal pathogens except for Aggregatibacter actinomycetemcomitans and to a...

Implants in compromised sites
Local factors
Patient assessment
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Treatment guidelines

Edentulous

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Probing

Radiographical check-ups to evaluate bone levels cannot be repeated too often to avoid unnecessary radiation. Monitoring the overlying soft tissues may help to identify eventual problems of the underlying bone, although the correlation...

Aftercare / follow up
Peri-implant therapy
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Treatment guidelines

Edentulous

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Occlusion

A universally accepted definition of ideal occlusion has been elusive. This is because an ideal occlusion can only be defined in broad terms of a physiological range of form and function. Functional aspects of occlusion, rather than specific anatomical...

Biomechanics and occlusion
Patient assessment
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Treatment guidelines

Edentulous

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Hyposalivation and Xerostomia

Saliva plays a significant role in the preservation and maintenance of oral health and function. It supports digestion by preparing food for mastication and swallowing, contributes to taste perception, facilitates speech communication and provides oral tissues...

Local factors
Patient assessment
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Treatment guidelines

Edentulous

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Existing prosthesis

Examination of existing dentures provides invaluable information on patients’ perceptions of teeth and soft tissue esthetics, including facial vertical dimension support. It also informs clinicians regarding their patients’ overall...

Diagnosis and treatment planning
Patient assessment