Managing Tooth Loss During Periodontal Disease Treatment: Key Considerations

During the treatment of periodontal disease, the issue of tooth loss after extraction?

Hello, Doctor.
I have a few questions: I am 59 years old and undergoing integrated periodontal care at a regional hospital due to severe periodontal disease.
Last week, I had subgingival scaling of the lower left teeth (root planing).
Due to severe mobility in two teeth of the lower left bridge, I had the bridge removed (lower left second premolar + edentulous first molar + second molar).
I do not have wisdom teeth, which means I have lost all teeth posterior to the lower left first premolar.
The integrated periodontal care may take about six months, and I may need to undergo periodontal flap surgery due to my severe periodontal disease, which could extend the treatment time.
Reconstruction (implant or partial removable dentures) can only be done after treatment completion.
I am concerned that during the treatment period (six months to one year), the three upper left teeth without opposing teeth may over-erupt, and the lower left first premolar may tilt toward the edentulous space, affecting subsequent reconstruction (implant or partial removable dentures).

1.
During the periodontal treatment period (six months to one year), considering my age of 59, is it likely that the aforementioned situations will occur?
2.
Is it necessary to place a temporary removable denture now? When would be the best time to install it? Or do you have other suggestions?
3.
Should I wait until the aforementioned situations occur before placing a temporary removable denture?
4.
I found information about "alveolar ridge preservation," which prevents significant alveolar bone loss and increases the difficulty of reconstruction.
If I need to extract more teeth in the future, is it appropriate to perform this preservation procedure at the time of extraction for severe periodontal disease? Or can it be done within a few months after extraction?
Thank you!

Xiao Wen, 50~59 year old female. Ask Date: 2022/10/15

Dr. Zeng Guanghui reply Dentistry

1.
If there is a gap from missing teeth or opposing teeth for six months to a year before periodontal treatment, it may cause the edentulous area to tilt.
2.
When the periodontal condition is relatively stable, consideration can be given to placing a temporary denture.
3.
It is more effective to place it before tilting occurs.
4.
Consult with the extraction dentist to evaluate whether performing socket preservation at the time of extraction can achieve the desired outcome.
Dr.
Tseng Kwang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2022/10/15

More Info

Managing tooth loss during periodontal disease treatment is a complex issue that requires careful consideration of various factors, especially in your case, where you are undergoing treatment for severe periodontal disease. Here are some key considerations and recommendations based on your situation:
1. Impact of Tooth Loss During Treatment: Given your age (59 years) and the severity of your periodontal disease, it is indeed possible that during the treatment period (which could last from six months to a year), you may experience changes in your dental structure. The absence of opposing teeth can lead to over-eruption of the upper teeth, while the adjacent teeth may tilt towards the edentulous space, potentially complicating future restorative options. This is a common concern in dentistry, as tooth loss can lead to a cascade of issues affecting occlusion and overall dental health.

2. Temporary Dentures: Considering the potential for tilting and over-eruption, it may be advisable to consider a temporary removable partial denture (RPD) or a flipper. These options can help maintain the space and prevent adjacent teeth from shifting. Ideally, this should be done before significant movement occurs, so if you are experiencing any discomfort or if the situation seems to be worsening, it would be prudent to discuss this with your dentist. The timing of when to place a temporary denture can vary, but it is often best to do so as soon as possible to maintain dental alignment.

3. Waiting for Complications: While it may seem reasonable to wait until complications arise before taking action, this approach can lead to more significant issues down the line. Proactive management, such as placing a temporary denture, can help mitigate the risk of further complications, making it easier to restore your dental function after the periodontal treatment is completed.

4. Socket Preservation Techniques: Regarding the alveolar ridge preservation technique, this is indeed a valuable procedure that can help maintain the bone structure after tooth extraction. In cases of severe periodontal disease, it is often recommended to perform socket preservation at the time of extraction to minimize bone loss. This technique can be beneficial not only immediately after extraction but also in the months following, as it can facilitate future implant placement or other restorative options. It is best to discuss this with your oral surgeon or periodontist to determine the most appropriate timing for this procedure based on your specific condition.

In summary, it is crucial to maintain open communication with your dental care team throughout your periodontal treatment. They can provide tailored advice based on your unique situation, including the potential need for temporary dentures and the timing of any socket preservation procedures. Early intervention can often lead to better long-term outcomes, so addressing these concerns proactively is advisable. Regular follow-ups and monitoring will also be essential in managing your periodontal health and planning for any necessary restorative treatments in the future.

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