Treatment of toothless patients with advanced shrinking of the jaw - Prosthetic dentistry
Treatment of toothless patients with advanced shrinking of the jaw
In patients who have been toothless for a long time, the jaws may be severely shrunk and especially the lower jaw. We often see that the patient knows how to cope well, even if the prosthesis hardly meets the requirements of stability or support.
There remains a group of patients who have such functional and psychological complaints due to the severely shrunk jaw that making a new prosthesis alone does not provide a solution for these complaints. It is then useful to send the patient to the surgeon or a center for special dentistry (CBT). In such a center, a patient is seen by a team consisting of an surgeon, a dentist and a dental technician. In addition to the clinical examination, panoramic X-ray images (OPT) are made that give a clear picture of the degree of shrinking of the jaw, the height and width of the jaw, the location of the canalis mandibularis in the lower jaw and any remaining elements or root remains. The further treatment options are examined together with the patient. Because the lower jaw shrinks more than the upper jaw and therefore gives more problems, a list of treatment options for the lower jaw is given below. A distinction is made here between surgical treatment of the lower jaw and placement of implants in the lower jaw (see chapter "Implantology").
Surgical treatment of the lower jaw
The lower jaw is treated surgically to obtain a better basis for the prosthesis. This can be achieved by raising the lower jaw.
- An applied treatment is the relative increase of the lower jaw: the fold-over floor. Hereby the lower jaw is not raised, but the cover fold is placed deeper, so that more support is created for the prosthesis. The edges of the prosthesis to be made can be laid deeper. The dental surgeon makes the transition from the fixed to the non-attached gums further from the process (see image below).
Fold-over fold floor. a The attached mucosa on the jaw wall has a very small width, a narrow base for the prosthesis. b The fold fold is deepened.
- In addition to the relative increase, there is the absolute increase in the lower jaw. The lower jaw is split horizontally and between the two bone pieces, dice bone from the patient's hip or pieces of donor bone are placed. The whole is held in place with wire. The jaw has now been raised.
Pre-prosthetic surgery has a number of disadvantages as well as advantages. With the increase one often sees recurrence, relapse to the old situation or deterioration, occur. The condition of the patient is also important because this process cannot take place on an outpatient basis and is accompanied by hospitalization. This is therefore extra stressful for the patient.
After pre-prosthetic surgery, a prosthesis can be made in the manner previously described. This can be done by the home dentist or a dentist who is connected to the team in the hospital or center.