ASK THE DENTIST
THURSDAY MARCH 5, 2009.
Dear Dr. Mady: I have only three remaining teeth left on the top and I am wearing a worn out partial plate. The teeth are not in great condition and soon have to go. When I smile, I show more gum than teeth and I talked to a relative who is a denture therapist that said it would not be possible to make me a regular upper denture because of the excessive bone I have. He said it would look terrible. I was wondering exactly what options I have for replacing my other teeth because I have to make a decision very soon. Marie in South Windsor
It sounds like you have a real dilemma here and I will try to guide you as much as I can. I have dealt with cases just like yours many times and the decisions alone that the patient has to make are demanding. If you do possess a “gummy smile” with excess bone in the maxilla (upper jaw) then placing a denture over this can make your upper lip stick out and cause you to show even more gum (will be pink acrylic at that point) and could even cause difficulty with respect to closing your lips together. It could result in an esthetic nightmare.
As I see it you most likely have five treatment options. The first option would be to do nothing at all and stay the way you are. It appears that this is not a desirable or maybe even not a possible route for you to take if your remaining three teeth are in very poor condition. If you choose this you could end up losing one or more of those teeth and may not even be able to wear your current partial denture anymore.
The second option is to extract the remaining upper teeth and have a standard upper complete denture fabricated. This can be done prior and placed immediately when the teeth are extracted or you can wait for healing to occur and then have the prosthesis made. This however would mean that you would be completely without upper teeth for a while. If you work or are in the public this may not work. However as I stated earlier, this would be very displeasing from an esthetic perspective and I personally would not push you toward choosing this modality of treatment.
The third choice for replacement of your upper teeth would be to extract and place (again either immediately or after healing) a different type of complete denture. This is one that will suit your situation better and give an esthetic result similar to what you look like now and the way you have always looked. This denture is known as a “butt gum” denture meaning that the teeth butt right against the gums on the bottom of the ridge. This kind has no acrylic in the front at all except where the teeth are held in place. The teeth on the replacement look like they are actually coming right out of the gums and if just replacement with a denture is your desire, this is the way to go for results that are satisfactory, most economical and involve less surgery. My dad practiced dentistry for fifty years and he swore by these butt gum dentures and said that his patients were always satisfied with the results. My personal findings when dealing with these over the years is that they look pleasing but often lack retention due to the loss of suction from not having the acrylic flange in the front. Patients who choose this type often end up using denture adhesives inside them to assist in retention, especially when they have recently had a lot of teeth extracted and shrinkage has occurred.
The fourth option is to have the teeth extracted by an oral surgery specialist, have bone reduction (alveoplasty or ridge augmentation) completed at the same time and after healing, have a standard complete denture made. This option will ultimately result in a better fitting prosthesis with better esthetics than if you had placed it over your present bone. There are things to consider like healing time, being without replacements for a certain amount of time and future relining that may have to be done more than once.
Lastly I will discuss the option that I would most recommend for you to contemplate, as long as it is financially acceptable and assuming you are a candidate from a health and bone level perspective. This would begin with extraction and ridge augmentation (reducing the front bone that gives the gummy smile) by an oral surgeon and fabrication of a temporary denture. After your oral surgeon has determined healing is complete or close to it, placing of dental titanium implants will occur. A good number to have placed if possible would be six implants. You would continue to wear your temporary denture for at least three more months, modified of course to not impinge on the implants and affect their healing and bone integration. When implant healing is complete, you would have a denture fabricated without a palate on it and less acrylic that can be screwed directly to those implants and removed by your dentist any time for cleaning purposes. Also the denture could be made to clip, snap in or lock in somehow rigidly, but so that you could remove it yourself daily. Without the acrylic palate present, it would seem more like your own teeth and allow more enjoyment of your food. Your mouth would feel less full. You may even be a candidate for permanent implant retained porcelain restorations at a much increased cost.
Overall the final decision is yours and your goal must be not only for esthetics, but also for digestion and nutrition stability for overall health. I do understand that cost has to be considered in these type of cases. Check out all your options. Have your dentist refer you to an oral surgeon for a consultation and after full informed consent is obtained from you, I am sure they will be able to make you look and feel better.
Any questions for Dr. Mady can be e-mailed to firstname.lastname@example.org and also visit his blog at www.dentalden.com (dental education network)
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5