Prosthodontic Treatment of the Edentulous Patient
• Master of family dentistry
• Batch 3
INTRODUCTION
• Facial and Social Significance of Dentition
• The face, though a small part of the body, is critical for social identity and
interpersonal communication.
• Deviations from culturally accepted facial esthetics, especially due
to edentulism (tooth loss), are often perceived negatively by patients and
their social circles.
• Treatment of edentulous patients involves managing not only oral
biomechanics but also individual identity, requiring technical skill and
empathy.
Dr. Nadia Habbal
Historical Perspective on Complete Denture Therapy
• Early prosthodontics focused on technical fabrication of complete dentures
aiming to restore function and esthetics comparable to natural dentition.
• Despite improvements, complete dentures cannot fully replicate natural
teeth but have significantly enhanced quality of life for many edentulous
patients.
• The frequent use of complete dentures sometimes led to unnecessary extractions
instead of preserving teeth through periodontal/restorative care.
• Complete dentures remain a cost-effective, routine treatment, widely taught
and practiced globally, especially in public health.
Epidemiology and Etiology of Edentulism
• Tooth loss results from a combination of dental disease, cultural, financial,
attitudinal, and healthcare system factors.
• Despite declining edentulism rates in some countries, the unmet need for
denture treatment remains high, especially among the growing elderly
population.
• Treatment of long-term edentulous elderly patients is more challenging than
recently edentulous younger individuals, requiring advanced clinical skills.
• Edentulism is often viewed by patients as a form of mutilation, emphasizing the
importance of psychological and biomechanical considerations in care.
Dr. Asrar Sindi
• Edentulous state
Loss of all natural teeth leading to morphological, functional, esthetic, and adaptive
change .
• Centric relation (CR)
The most posterior position of the mandible relative to the maxillae at the stablished
vertical dimension.
• Parafunction
Nonfunctional occlusal activity (e.g. bruxism ) .
• envelopes of motion
A 3D diamond shape representation the maximum range of mandibular border
movements
Envelop Motion
Morphological Changes Associated with the
Edentulous State
• Deepening of nasolabial groove
• Loss of labiodental angle
• Decrease in horizontal labial angle
• Narrowing of lips
• Increase in columella-philtral angle
Prognathic appearance
Edentulous in one or both arches without perior dental treatment
1. Complete denture
2. Implant supported over denture
3. Implant suported fixed prothesis
Edentulous in one or both arches with an adaptive complete denture
Treatment 1. Complete denture
options for 2. Implant supported over denture
3. Implant suported fixed prothesis
Edentulous Edentulous in one or both arches with history of maladaptive
patients denture wearing exprenses
1. implant supported over denture
2. Implant suported fixed prothesis
Systemic Health Aspects and Nutritional
Considerations for Edentulous Patients
This presentation explores the complex relationship between systemic health conditions, oral
tissues, and nutritional status in patients who wear dentures.
Key Oral-Systemic Conditions Affecting Denture Wearers
1 2
Mucosal Conditions Oral Movement Disorders
• Vesiculoerosive Conditions (VEC) like oral lichen planus These disorders, ranging from hyperkinetic (bruxism,
(OLP), mucous membrane pemphigoid (MMP), and dystonia) to hypokinetic (Parkinson’s disease) jaw
erythema multiforme (EM) are inflammatory diseases movements, severely impact denture function and
that impair mucosal tolerance to denture pressure. retention. Patients with systemic movement disorders may
• Systemic Lupus Erythematosus (SLE) also causes oral have limited prosthesis control, requiring careful patient
erosions, compromising tissue tolerance. selection for removable prostheses.
• Burning Mouth Syndrome (BMS) is managed palliatively.
3 4
Salivary Dysfunction Diabetes
• Sjogren’s Syndrome (SS), a chronic autoimmune
disease, causes dry mouth and eyes, gland
enlargement, and increased dental caries. Diabetes causes microvascular complications that affect
• Xerostomia (dry mouth) is common in elderly denture oral tissues, leading to mucositis, candidiasis, and reduced
healing capacity. These conditions can significantly
wearers due to medications, autoimmune diseases,
complicate denture wear and overall oral health
radiation, dehydration, and aging, leading to difficulty
management.
wearing dentures and oral infections.
• Hypersalivation is less common but can occur.
Nutrition and Dental Status: A Critical Link
Complete denture wearers generate only about 20% of the bite force of individuals with natural teeth. This
significantly impacts chewing efficiency, which in turn can affect overall nutritional intake and quality of life.
While nutritional status is multifactorial and not solely dependent on dental status, the ability to chew effectively
plays a crucial role in dietary choices and enjoyment of food.
Dietary counseling should be integrated into prosthodontic care to enhance patient outcomes and support systemic health.
20%
Bite Force
Denture wearers' bite force compared to dentate
individuals. 80%
Reduced Efficiency
The percentage reduction in chewing efficiency for
denture wearers.
The Aging
Edentulous Patient
Dr. Wejdan Azlzahrani
Oral Changes with Aging
• Residual Ridge
• Continuous and irreversible bone resorption
• More severe in the mandible than the maxilla
• Leads to poor denture stability and retention
•
• Oral Mucosa
• Oral tissues become thin and weak
• Easily sore and inflamed
• Higher risk of denture stomatitis
• Saliva
• Dry mouth (xerostomia) is common in elderly
patients
• Caused by medications and medical diseases
• Less saliva → poor denture comfort and
retention
Mastication
Weak bite force
Difficulty chewing food
Functional Patient prefers soft food
Changes Speech
Missing teeth affect speech
Unstable dentures make speech worse
Esthetic Changes
• Loss of vertical dimension of
occlusion
• Sunken cheeks
• Wrinkles
• Pseudo-prognathism
• Psychological & Social Aspects
• Losing teeth can make elderly patients feel they lost part of their body
• Some patients do not like change and prefer old dentures
• Good communication helps patient accept treatment
• Systemic Health Considerations
• Elderly patients often have medical problems such as:
• Diabetes
• Heart diseases
• Osteoporosis
• These conditions affect denture comfort and treatment plan
Sequelae Caused by
Wearing Complete
Dentures
Master-Level Prosthodontics Lecture
(Clinical • Exam • Evidence-Based)
Category Examples
Direct sequelae Mucosal
inflammation, ulcers,
stomatitis Classification
Indirect sequelae Muscle atrophy,
nutritional changes
of Sequelae
Structural sequelae Residual ridge
reduction
Denture Stomatitis – Classification
Type Clinical Features Common Site
Type I Pinpoint hyperemia Localized mucosa
Type II Generalized erythema Denture-bearing
mucosa
Type III Granular hyperplasia Midline palate
Candida-Associated Denture Stomatitis
Aspect Details
Etiology Candida albicans adherence to
acrylic
Predisposing factors Continuous wear, poor hygiene
Diagnosis Smear / culture
Significance Most common denture lesion
Traumatic Ulcers vs Denture Hyperplasia
Feature Traumatic Ulcer Epulis Fissuratum
Onset Acute Chronic
Cause Pressure / Long-term flange
overextension trauma
Management Adjustment Surgery + new
denture
Residual Ridge Reduction
Aspect Details
Nature Chronic and irreversible
Most affected Mandible
Clinical impact Pain, instability, loss of VDO
Modern solution Implant-supported prostheses
Prevention & Long-Term Control
Strategy Rationale
Night denture removal Mucosal recovery
Hygiene measures Reduce microbial load
Regular recall Early detection
Implant support Preserve function
Comprehensive Clinical Protocol
for Edentulous Patients
Successful prosthodontic care goes beyond technical skills. It
demands a holistic approach, integrating clinical expertise
with patient-centered understanding.
The First Appointment
• Build Trust:
Establish mutual trust and build good rapport.
• Align Expectations:
Acknowledge patients psychological expectations and present realistic treatment outcomes.
• Understand Patient Needs:
Address fears, concerns, and past dental experiences.
The Foundation of Holistic Diagnosis
• Social & Mental Health
Assess social background, mental health, and systemic medical history to identify potential recovery obstacles.
• Extraoral Examination
Evaluate facial symmetry, temporomandibular joint (TMJ) function, and muscle tone.
• Intraoral Examination
Assess residual ridges, oral mucosa, salivary flow, and neuromuscular coordination.
Extraoral Examination:
FacialContours and Lip Support
•Cheeks and Lip Support (Extraoral Soft Tissue)
•The external contour of the cheeks and lips depends primarily
on underlying dental and ridge support.
• A rolled-in vermilion border is a classical sign of inadequate
labial support.
•Dentures may enhance facial support; however, they cannot
fully eliminate age-related wrinkles.
•TMJ Assessment
• Palpate for pain, tenderness, and joint sounds. Healthy
TMJs are a pre-requisite for recording correct Centric
Relation
Dr. Leyana radi
Intraoral Soft Tissue:
Mucosa Health and Pathology
•Normal vs. Pathological
•Common Pathoses
• Denture Stomatitis (Candida albicans): often from continuous wear.
• Epulis Fissuratum: Reactive hyperplasia from overextended flanges.
• Papillary Hyperplasia: ”Cauliflower-like" proliferation on the palate.
•Tissue health must be restored (tissue rest, reline, or antifungal therapy)
before final imprissions.
The Dynamic Environment:
Tongue and Saliva
Tongue
• Hypertrophy expands into edentulous spaces →
dislodging force
• Position:
Retruded → breaks lingual seal
Relaxed → improves retention
Saliva
• Flow rate: Normal resting ≈ 0.3–0.4 mL/min
• Viscosity:
• Thick/ropey → displaces dentures
• Thin → reduces retention
Floor of Mouth and Mylohyoid Muscle:
• Elevates floor during swallowing
• Denture flange must accommodate movement
Edentulous ridge morphology
Maxilla Mandible
Resorption Pattern: Resorbs inward and upward. Resorption Pattern: resorbs downward and outward. Resorbs
Resorbs occlusally > Arch becomes smaller and occlusally -> Arch appears wider relative to maxilla
narrower.
Sharp Crests: Cannot support direct load requires relief.
Ridge Shape: Broad, parallel-sided ridges > optimal
support. Mental Foramen: In severe resorption, the foramen sits on the
V-shaped ridges > less resistance. crest. Pressure causes pain.
Posterior Landmarks: locate hamular notches and Mylohyoid Ridge: Palpate for sharpness/tenderness.
vibrating line for posterior palatal seal.
Retromylohyoid Fossa: Critical for stability (S-curve of flange).
Tori: Requires removal only if it extends beyond the
vibrating line or prevents seating
Evaluating Existing Dentures
Wear Patterns: Asymmetric wear indicates chewing preference. Facets
indicate bruxism
Vertical Dimension: Assess freeway space and speech with current set.
Extensions: Check borders for ulceration (overextension) lack of retention
(underextension).
Esthetics: Use the old denture to discuss esthetic likes/dislikes.
Preprosthetic Preparation
NONSURGICAL & SURGICAL METHODS
Dr. Ghaida Zagzoog
Preprosthetic Nonsurgical Methods
Tissue Rest Conditioners Clinical Protocol
The most effective Soft liners cushion • Withhold faulty dentures
method is removing tissues for patients
dentures for 48–72 who cannot go without or use soft liners.
hours. This allows dentures. They help • Adjust occlusion and
deformed tissues to determine the optimal
recover and is Vertical Dimension of tissue coverage.
essential before final Occlusion (VDO) and
• Fabricate new dentures
impressions. assess facial support.
only after tissues are
healthy.
Surgical Correction:
Soft Tissue
• Hyperplasia: Mobile or enlarged tissues
(e.g,, Epulis Fissuratum) interfere with
stability. Massage to reduce edema before
excision.
• Frenular Attachments: Frena near the
ridge crest (especially the upper labial
frenum) compromise border seal.
• Removal is preferred before construction to
avoid postoperative pain.
• Pendulous Tuberosities: Fibrous tuberosities
encroaching on interarch space usually require
surgical excision.
Surgical Correction:
Bony Anomalies
Mental Foramen Undercuts
Prominences & Tori
Severe resorption may Routine excision is
Removed only if they leave the foramen at
cause pain or prevent avoided to preserve
the ridge crest. Primary
a seal. Maxillary Tori bone. Most are
management is denture
are rarely removed relief; surgical nerve managed by
unless they create repositioning is rare. adjusting the path of
undercuts or extend insertion, except for
past the hard palate sharp, tender
junction. mylohyoid ridges.
Enlargement of Denture-Bearing Areas
Ridge Augmentation
Involves onlay bone grafts or synthetic
materials to restore ridge height.
Status: Rarely preferred today due to
invasiveness and uncertain outcomes.
Vestibuloplasty
•Surgical procedure to deepen the sulcus
•Done by detaching muscle attachments
(e.g. mentalis muscle)
•Allows better denture flange extension
•improves denture stability
Dr. Ola Somali
THANK YOU