Complete edentia

Complete edentia A complete absence of teeth on one or both jaws. Etiology : Hereditary factors Obtained / acquired factors: Caries and dental decay - a destructive chronic process. Parodontal disease. General pathological abrasion of the teeth. Operation in relation with buccal new grows or tumor. Trauma Occlusal disorders. Avitaminosis. Different general diseases. Marginal generalized periodontal diseases. Can be at the same time surgical treatment, pathological abrasion. Iatrogenic Symptoms : Extraoral Falling cheeks Reduction of facial skeleton. Displacement of lower jaw - especially lower 1/3 of the face. Lowering labial commissures. Expressed lowering the tip of the nose. Changes in the frontal part of cheek bone - because of atrophy and situation of teeth in inclination. Prominence of nasal labial and chin folds. Wrinkles of the cheek - because of decreasing vertical dimension. Changes of soft tissues. Changes in construction of muscles elevating lower jaw. Intraoral Complete absence of teeth- can be situated on one jaw or both. Different degree of atrophy of the mucosa if oral cavity or in some cases hypertrophy of mucous. Different degree of atrophy of alveolar process.

Factors - Clinical picture of complete edentia will depend of several factors: Etiological factors - e.g. Extraction after caries or after marginal periodontitis in these two cases the patients will have different atrophy levels. Topography of partial edentia of the opposite jaw - e.g. in case of only one jaw complete edentia. Age of the patient.

Time passed after extraction. Type of extraction- e.g. Trauma after extraction. General condition of the organism of the patient.

Symptoms - At complete edentia will be present changes in : Alveolar process of the jaw: Changes appear because of nonfunctional atrophy. At the absence of function alveolar process will not have possibility to function normally, this is why at the presence of teeth at one jaw and the complete edentia at the opposite jaw will be present different degree of atrophy on both jaws. Muscles (both in mimec and mastication): Atrophy of muscles because of loss of function. TMJ & Jaws - as a rule especially if passed long time after development of total edentia will be present changes in TMJ, all these changes will create pathological conditions. Changes in tmj will be present in: At complete edentia the body and ramus of the lower jaw become thinner, the angle of lower jaw will not have the same size like at the presence of all teeth. 145 angle pressure is less which causes changes. Changes in hearing with headache because the TMJ pressure changes and applied on ear. Temporal fossa because of degenerative processes that occur in all components of tmj will become flat and condyles will change the position with displacement upwards and distally. Lateral movements of lower jaw and movements of lower jaw forward will provoke the pressure in TMJ making articular disk thinner or in some cases puncture or perforation in the disk. Articular eminence or tuberosity the same will have different degree of atrophy and in rest position of lower jaw the condyles will occupy more distal position in articular fossa then in case of complete presence of teeth (more in distal). Because of all changes in articular elements the lower jaw will have possibility to make all movements in a larger amplitude and with time articular capsule because of articular ligaments that not have elasticity (normal elasticity) will create conditions for subluxation and luxation of lower jaw. Pain in the region of TMJ Appears some noise in the region of TMJ - clicking, popping or grating sounds. Appears headaches. Mucosa of oral cavity & Tongue: Changes in taste. Changes in appearing sensation of burning in tongue and oral mucosa. Very often the patient will say that his tongue was increased in volume, the patient will complain about tongue increasing in size and he will stay with open mouth. Salivary glands: Hypo / Hyper salivation. In the skin of the face: May be realized in the form of atrophy with formation of folds and changes in position of these formations. Tip of the nose will drop down. Will be pronounced nasolabial folds. Corners of the mouth. Lowering of the cheeks and going inside and down.

The lower third of the face will decrease in size. Thats the person has senile expression. Because of the laws of atrophy of bone tissues, the face of the patient looks like in case of cross bite. General condition of the organism: Headache - Pressure from TMJ alteration may cause unexplained headache which caused by absence of teeth and not by any neurological problem. Deteriorating health from decrease diversity of elimination.

Degree of atrophy of alveolar process were described by different authors: More often are used classification of atrophy of alveolar process on the upper jaw by Schroder but on the lower jaw by Kollur (german). Upper jaw (By Shredder, 3 classes): 1. Equal degree of atrophy of alveolar process in lateral and frontal parts: That have the shape like square. With a little degree of atrophy of maxillary tuberosities. This alveolar process is covered with medium degree of thickness mucosa. This first class the most convenient the best for future prosthetic treatment with complete denture where we have good suction and fixation of the complete denture. 2. Medium degree of atrophy of alveolar process and maxillary tuberosities: In this case it will have like a "V" almost. The vestibular slope and palatal will not be parallel between them like fist type - more converging direction. 3. More atrophy (about complete in some cases) of alveolar process: Complete disappearing maxillary tuberosities that create conditions for hard palate to be flat. The position of the labial frenulum and cheek frenulum is very close to the top of alveolar process. Lower jaw (By Kuller, 4 classes): 1. Normal or "U" shaped alveolar process: Well pronounced and equal on the whole alveolar process with well pronounced mandibular tuberosities. The slopes of vestibular and lingual sides are parallel to each other. Place of attachment of labial and chin folds are situated further from the top of the alveolar process. Alveolar process is covered with medium degree of playability. Is the best for prosthetic treatment. 2. Big degree of atrophy of alveolar process: In some cases with disappearance alveolar process (negative alveolar process- only the body of alveolar jaw with no alveola) & with disappearance of mandibular processes Covered with very thin mucosa and in some cases very painful on pressure. Is very often meet this situation and very difficult to make treatment. 3. More pronounced in frontal 4. More pronounced in lateral area.