Tag Archives: Dentures

Should My Husband Get All-On-Four Dental Implants?

My husband needs to replace his bottom teeth. His upper teeth have been gone for a while and he has dentures there. We were told that you shouldn’t do dentures on bottom teeth because they won’t stay in the way the top ones do. Our dentist said he needs to get all-on-4 dental implants. I just want to explore if there are other options before we make a decision?

Pricilla

Dear Pricilla,

All-on-4 Dental Implants

I am curious why that is the only option he gave your husband. A dentist is ethically obligated to give his or her patients all of their options. He is correct that dentures are a bad idea on bottom teeth. While it is true that dentures will struggle to stay in on the lower arch, that does not happen right away. This is an issue because of bone resorption.

When his teeth are removed, his body recognizes that and begins to resorb the minerals in his jawbone in an effort to be as efficient as possible with his body’s resources. The big problem with that is after ten or so years, he will no longer have enough jawbone left to retain his dentures. This is known as facial collapse.

This bone structure is important no matter what tooth replacement option he chooses.

All-on-4 Dental implants (pictured above) are what dentists will sometimes offer to patients who have lost some jawbone structure but still want dental implants. However, there are other options.

Implant-supported denture

The first thing to find out is whether or not he has lost bone structure. If he hasn’t, then his best option is to get an implant overdenture. This uses between for and six dental implants and then anchors a denture to them.

If he is missing bone, depending on the amount, he has two choices. First, he can have the all-on-4 procedure his dentist suggested, as long as he hasn’t lost too much bone. The one downside to this procedure, however, is that if one implant fails, the entire unit has to be redone. A second option, no matter how much bone he’s lost, is to have a bone grafting procedure done to build it back up. Then, he can do implant overdentures if he wants. He could get a denture too, but bear in mind he will end up with facial collapse. Having dental implants in the jaw bone, prevents that from happening.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Dentist Said I Have to Get Dentures

I have dental insurance for the first time and just started going to the dentist. My teeth are pretty bad and some of them have started coming out. My dentist said I have advanced gum disease and will need to extract my teeth and get dentures. Is it at all possible that I could get dental implants instead?

Susan A.

Dear Susan,

Implant Overdentures
Implant Overdentures

You are in a tough position. At some point, dental implants will be possible, but you are going to have to get that periodontal (gum) disease under control first. That will be imperative. After that, I would make sure your dentist does adequate diagnostics. That would need to include a CT for two reasons. First, you want to make sure you have enough bone structure left to retain your dental implants. Second, dental implants are a 3D procedure and you need 3-Dimensional images in order to ensure proper placement.

If you don’t have enough bone structure, you will need to have a bone grafting procedure done first. Then, after a time of healing, it will be okay for you to go forward with your dental implants.

What you will want to get is called implant overdentures or implant supported dentures. With this, you will have between four to eight dental implants placed and then, after a period necessary for osseointegration (meaning bone integrating with the implants), have a denture anchored to them.

This blog is brought to you by Lafayette, LA Dentists Drs. Foremen and Thimmesch.

Should I Keep My Last Two Teeth?

I am about to have another tooth extracted. This will leave me with only my two front teeth on my upper arch. They are fairly healthy and should last a good while. Most of my lower teeth are still there. I am wearing a partial denture right now to accommodate the upper partial. It’s really uncomfortable and makes it difficult to talk. Because I can eat everything but meat with it, I rarely put it on, unless I am going somewhere to socialize. Some people are telling me that I would probably be happier with a complete upper denture instead of my partial. There aren’t really people I know who have been in this situation where I can ask them if they thought removing those last two teeth was worth it. Have you an opinion on this issue? I’m kind of torn and having a hard time making my mind up. It’s not like I can change my mind after extracting those last two teeth.

Brent

Dear Brent,

Implant Overdentures

I am going to start with a tiny disclaimer that I can only give you general principles here. I don’t have your x-rays and haven’t examined you, so I am strictly going off the information you have provided me with.

In almost all cases it is better to preserve as many natural teeth as possible. That being said, your situation is unique. Yes, those two front teeth are healthy, but they are all you are eating with most of the time and the stresses on them will be tremendous. I don’t think they will last as long as you are hoping. In your case, I am going to suggest that you remove those last two upper teeth and replace the entire arch.

Tooth Replacement Options

The ideal would be for you to replace those teeth with implant overdentures. That would mean getting four to six dental implants and then anchoring a complete dentures to them. It is the most secure replacement possible. The only real downside to them is their expense.

Facial Collapse

The effects of facial collapse.

If these were your bottom teeth, I would tell you to do everything possible to ensure you get the implant supported dentures. This is because when your teeth are removed, your body immediately begins to resorb the minerals in your jawbone to redistribute them elsewhere in your body. With your bottom teeth, this is devastating. Not only does it age your appearance by decades, but your bottom denture simply rests upon your jawbone for its base. After ten or so years, you will not have enough bone left to retain your dentures. This is known as facial collapse.

Because you are dealing with your upper teeth, you are at a slight advantage. These are h eld in by suction and not your jawbone, so you will have more security and retention. Getting complete dentures in this case will be okay if you cannot afford the implant overdentures.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Dental Implants After Ten Years in Dentures

I have been in dentures for a little over ten years. To be honest, I have hated them the entire time. I knew fairly quickly after getting them that I would need to switch to dental implants, but just didn’t have the budget for it yet. I’ve finally saved up enough. Is it too late for me? My dentist retired and the new one said I’ve been in dentures for too long to switch.

Avery

Dear Avery,

Implant overdentures

Technically, it is never too late to get dental implants. That being said, there could be the possibility of needing one procedure to get your mouth in the right condition for dental implants to have a chance to succeed. If that is the case, why did your dentist tell you it is too late?

During Dental School, students are taught that it is important patients are confident in them. Because of that, many dentists do not want to admit when there is a procedure they are not comfortable doing. Instead of risking the patient’s respect by admitting they can’t do something, some dentists will simply steer their patient’s to another procedure they are more comfortable with.

It is never a good idea to pressure a dentist to do a procedure that is out of their comfort zone. The results are usually disastrous. This is especially true with dental implants, which is a very advanced procedure. The training required to do this well has to be done in a post-doctoral setting. Not many dentists invest in enough of it, which is probably why it is one of the procedures that tops the malpractice suit list. I’m going to recommend, you find a different dentist to do your porcedure.

Dental Implants and Facial Collapse

The consequences of years in dentures.

When your teeth were first removed for your dentures, your body recognized you no longer had tooth roots and, therefore, didn’t need any of your jawbone to help keep them in place. Our bodies are always striving to be as efficient as possible with its resources. To help with that goal, it will resorb the minerals in your jawbone to use elsewhere in your body.

While remarkable, this will have the unfortunate side-effect of slowly shrinking your jawbone. Eventually, there will no longer be enough jawbone to even support your dentures. This is known as facial collpase (pictured directly above).

For dental implants to be retained, they need the surrounding bone to integrate with it and keep it secure. If you don’t have enough bone to start with, that is impossible. You have been in dentures for ten years, which is enough time for significant bone loss.

The good news is there is a fairly simple solution. You can have a procedure done, known as bone grafting. It will build back up the bone in your jawbone. Once you have healed from that, you can have your dental implants placed and then anchor your new denture to them–a procedure known as implant overdentures.

You will have the secure smile you’ve always wanted with none of the problems and consequences that come with removable dentures.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Can I Get Dental Implants after 30 years in Dentures?

I’ve had dentures for around 30 years. I’ve never been crazy about them and always wanted to switch to dental implants. Now, I’m having trouble even keeping them in. I think this may be a perfect time to switch, but I don’t know if I waited too long. Is it still possible? If not, how do I get my dentures to stay in? Not even those nasty adhesives are working.

Marilyn

Dear Marilyn,

dental implant diagram

Technically, as long as you are in reasonably good health, you can get dental implants. Though, in cases like yours, an extra step will be needed. As you can see from the image above, your dental implant will need to be surrounded by bone in order to stay in place. This bone is also what holds your teeth in place as well, along with some ligaments. After this length of time with dentures, you are missing that bone.

You’re Dealing with Facial Collapse

When your teeth were removed 30 something years ago, your body immediately began resorbing the minerals in your jawbone to use elsewhere. It does this in an effort to be efficient with your body’s resources. It knows you don’t have teeth anymore and assumes that you won’t need the bones in your jawbone to hold them. True. However, your dentures rest on the ridgeline of your jawbone. As that shrinks, there is less and less of a ridge to hold your dentures in place.

After ten years in dentures, you likely noticed them starting to slip. By thirty years, it is almost impossible to keep them in. This is known as facial collapse. You’ve probably also noticed your jawline shrinking,, which makes you look much older than you really are.

There is a procedure to help with this– Bone grafting. You can have either natural or synthetic bone built back up in the area so that you’ll have enough bone there to integrate with your dental implants and keep them in place.

Implant Overdentures

implant-overdentures
Implant Supported Dentures

Once the bone grafting is complete, then you will be able to get the dental implants you hope for. You won’t want to do a one-to-one replacement for your teeth. That is way too expensive. Instead, you’ll get implant overdentures. With these, you’ll have four to six dental implants placed in each arch and then have a new set of dentures anchored to them.

Your dentures will be completely secure and will protect you from facial collapse in the future.

This blog is brought to you by Lafayette, LA Dentists Drs. Forman and Thimmesch.

Is it necessary for my son to get all of his teeth pulled?

My son is 23 years old. He is a drug addict who is in recovery, and his teeth are completely ruined. The dentist at the clinic says he should just have all of them pulled and replace them with dentures.

Right now, I recognize that this is the only avenue open to us. The teeth have to come out. He is only able to chew with a couple of teeth towards the front of his mouth.

My question is whether or not all of this can be done in one visit. It seems like a lot–he has 26 teeth that need to come out. Would they be able to fit dentures when they’ve just removed all those teeth? It doesn’t seem like they could do that until after his gums heal

Any advice you can offer would be appreciated. This has been a long, hard road.

Serena in Overton

Dear Serena,

This treatment plan is too extreme. It may seem like the easiest solution to the dentist, but it means a lifetime of dental trouble for your son. He is much too young to have all of his teeth removed.

As soon as all his teeth are removed, your son’s jawbones will start to shrink. When a tooth is lost, the body reabsorbs the bone of the jaw at the location of the missing tooth. When ALL the teeth are removed, eventually that person will experience “facial collapse”. You have probably seen pictures of people whose faces look as if they have collapsed inward. This happens when the jawbones deteriorate to the point that the patient cannot wear any kind of denture at all.

If he is in his early 20s now, this could happen by the time he is 40. He will be unable to eat normal foods, and at that point the repairs are much more complicated and expensive.

If at all possible, the goal should be to retain as many of his natural teeth as possible. They may not be in perfect condition, but every tooth that can be saved represents a more stable jawbone. Those remaining teeth could be used to anchor partial dentures or dental bridges.

If in fact none of his teeth can be saved, dental implants will work just like natural teeth to preserve the structure of his jawbone. The least expensive option would be mini-dental implants, where two implants per arch are placed and used to anchor dentures. Having ALL the extractions done in one sitting is too much. The amount of Novocain required to numb the upper jaw for a full set of extractions is significant, and poses a correspondingly significant risk.

It is time to get a second opinion. We recommend looking for a dentist that really makes you feel like he cares about your son, and your situation. Your son is on the road to recovery, and needs compassion to get the care he needs.

This blog is posted courtesy of Lafayette Louisiana cosmetic dentist Dr. Mike Malone.