Denture Wearers Seek Better Options

Mrs. S. was a 65 year old female who had been wearing a denture for about 10 years. She lost a number of her teeth due to gum disease and decay at early age and was given a full dentures. She talked about a time when she first got the dentures: "big, clonky pieces of plastic which was really tough to get used to! It caused me to gag a lot and best I could eat was mash potato and puree apple. It never really fit well so I started getting sore spots all the time. My dentist tried to reline them a few times, but it would only remain comfortable for a short time. Over the next several years, I had to get more relines as the dentures seemed to have less hold on my jaw bone. Just slipping all the time. It was not till recently that I realized my jaw bone was gradually being lost due to the denture. I tried using denture glues, but did not really work well and I was spending a lot of money on them. The denture is so loose now that I can not keep it in even during normal talking. It's really embarrassing. I like to go out a lot and spend time with family and friends. And like to also eat. But just can't! It's just horrible......."

Stories like this are not uncommon. People are living longer and healthier lives and dentures are simply not compatible with an active and healthy life style. Aside from social aspects, denture wearers may have problem getting proper nutrition affecting their overall health.

These patients are seeking better options!

For Mrs. S., two dental implants were placed, a 30 minute procedure under IV sedation and allowed to heal for 6 weeks before a new overdenture was made. She has been using the new prosthesis for about a year now and is extremely pleased and happy with it. She has become more social again and is enjoying her favorite foods much more than before.

Dental implants have transformed dentistry and oral health in ways we could have never imagined and they are certainly transforming lives of many denture wearers who are suffering as Mrs. S. did. The solution is amazingly simple and predictable: Placement of 2 or 4 implants to support an overdenture.

The simplest design is placement of two implants, one one on each side. After a 6-8 week healing, special attachments are placed allowing the dentures to 'snap' on to them. The implants provide great support of an overdenture allowing the patient to eat and speak comfortably. It also prevents further bone loss. It can also be easily removed for cleaning. No more relines, No more glues, No more slipping and sliding!

The second option is placement of 4 implants, two on each side. This give improved stability of the overdenture and therefore allowing patients even more freedom in their choice of diet and overall function. This is the most common design for patients with full denture.

Implants have 98%+ success rate and have extremely low complications when properly done. Patients report minimal pain after the surgery and recovery is remarkably fast. Sometimes the denture can be placed on the same day as the implant surgery or in 6-8 weeks once healed.

Patients of any age can have dental implants successfully, even with osteoporosis. There is no reason to have to live with limitations that regular denture bring; There are better options to help many live a better and more happy and active life.

Dr. H. Ryan Kazemi
www.facialart.com
(301) 654-7070

Fear of Nerve Damage with Wisdom Teeth Extractions!

Over the years, I have treated a number of patients for their wisdom teeth who were initially discouraged to have it done because as they were told: "their teeth is on top of the nerve!". The nerve spoken of is a sensory nerve that runs in the jaw bone just below the lower wisdom teeth and in very rare occasions may be in contact with the roots of the wisdom teeth. In all of these patients, the recommendations were made solely based on a panoramic x-ray or a small dental x-ray that appeared to show close proximity of the lower wisdom teeth to the canal that carries this sensory nerve. The concern during any wisdom teeth surgery is possible close relationship between the nerve and tooth, and the potential nerve irritation that may result in some degree of numbness over the lip and chin region.

The question is how valid is this concern and the recommendations given?

First, it is a known fact that in majority of patients there is a separation between the nerve and the wisdom tooth, even though it may appear otherwise on the x-ray! It's important to realize that a panorex or a small dental x-ray is a 2-dimensional image and overlapping structures on these images do not necessarily mean they are in contact.

As mentioned, there is often a separation between the nerve and roots of the wisdom teeth despite the x-ray appearance and therefore risk of nerve damage is extremely low. Even in rare instances where they are in contact, meticulous and careful techniques used by surgeon can minimize any chances of long term problems. Therefore, fear of nerve disturbance, although always possible, is largely unsupported and not removing the wisdom teeth carries much more real and significant complications in the long term. I have personally treated thousands of patients whose x-rays showed the typical 'tooth on top of the nerve' and yet the nerve was not encountered and surgery was successful with no sensory deficits.

Panorex has been considered the radiograph of choice for oral and maxillofacial surgeon when treating impacted third molars. There are 9 radiographic signs associated with an intimate anatomic relationship between the canal and the lower third molars: Radiolucent band , loss of cortex of canal, change in canal direction, canal narrowing, root deviation, bifid apex, superimposition, and contact of canal with roots of the mandibular molars. Without these positive signs, the risk of injury is considered miniscule, whereas the presence of 1 or more positive signs is not a good predictor of injury to the nerve.

Icat and three dimensional imaging is an alternative technique that can demonstrate anatomical relationships between teeth and nerve and improves diagnosis, however, there is an ongoing debate in the literature about the need for CT scans before third molar removal, even when 1 or more of the signs is noted on the panorex.

While there is no consensus or standard of care on this issue, it is felt that CT scans should be considered in selected cased, chiefly when 1 or more of the telltale signs are present on the panorex. It is also recommended to discuss it during informed consent; including potential risks and benefits of undertaking third molar removal using a CT scan compared to no CT scan. Patient should ultimately make the decision considering all the facts and involved cost.

For more information, contact Dr. H. Ryan Kazemi at hkazemi@facialart.com

Visit our site: www.facialart.com

Office Telephone: (301) 654-7070

Office location: Bethesda, MD

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