Gerald S. Fine, D.D.S.
Oral and Maxillofacial Surgery
This past week two patients were seen in my office in consultation for full mouth extractions and the insertion of an immediate full upper denture. The first patient's referring dentist included a referral note asking for the removal of all the remaining teeth only. The second dentist requested the removal of all of the remaining teeth and preparation of the arches for an immediate full upper denture. Although full mouth extractions are less frequently performed in my office now than a decade ago, there are still patients who are in need of either a partial or a full denture. Hard and soft tissue variations. depending upon their location and extent, may hinder a patient's ability to adapt to a removable prosthesis. In certain cases, preposthetic surgery may be needed to ensure prosthetic success.
Some anatomic areas which should be evaluated critically and addressed are:
Soft Tissue -- a small labial frenum that interferes with the denture base can be released with a simple incision. A larger frenum may require a more complicated surgical procedure. A lingual frenum may need to be released if normal tongue movement will dislodge the denture. Papillary hyperplasia lesions should be removed and biopsied. Epulis fissuratum marked by inflammatory fibrous tissue must be eliminated. Redundant, unsupported soft tissue over the bony ridge must be corrected. Excess fibrous tissue over the maxillary tuberosity should be excised. If the retromolar pad is enlarged, the best choice often times is to reduce the opposing tuberosity.
Hard Tissue -- Root tips covered only by a thin layer of tissue that may be traumatized by the denture should be removed. When practical, unerupted teeth should be extracted. A torus palatinus requires removal when it is large, pedunculated, covered with thin friable tissue, or if it interferes with the denture's posterior palatal seal. Mandibular tori should usually be removed before a complete denture is made. Buccal exostosis which creates severe undercuts should be removed surgically. A sharp lingual shelf can be smoothed to improve a patient's comfort.
The patient who had been referred for "full mouth extractions" did require pre-prosthetic surgery to permit the upper denture to seat as well as to prevent the lower denture from dislodging. A brief conversation with the referring dentist prior to treatment facilitated successful patient care. Pre-prosthetic surgery to correct anatomic variations can help some patients to wear a denture that would otherwise not be tolerated.
Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery