The contrast between the upper and lower arch has been fascinating to me since I have known this patient. Ten years ago she was given (by her periodontist) a hopeless prognosis for her lower teeth and a 10-year prognosis for her upper teeth. She has been committed to her periodontal maintenance appointments and maintains the upper teeth with pocket depths ranging from 2-4mm with mobility in the upper premolars.
How long must it take her to clean around the upper right first molar? How easy must it be to clean the lower arch in comparison to the upper arch?
Recently I have been asking patients if we have met their objectives for dental treatment comparing their desired outcome at the first visit to the actual outcome after some time in service. Keeping her teeth was important, particularly from an emotional point-of-view, and chewing function was also a part of her pretreatment goals.
Maintaining the maxillary arch provided a comfort for her in a natural as opposed to a manufactured appearance. Another one, two or even five years at this point will have exceeded the expectations set forth by her periodontist and positively reinforces the significant efforts she has made to meticulously maintain her oral environment.
The relationship between meeting a patient's objectives for dental treatment and the patient's willingness to accept or adapt to treatment is probably something we all do on a subconscious level when treatment planning.
Certainly, our goal in any dental treatment is to optimize the appearance of the teeth in the end result. In evaluating a treatment plan for a successful outcome, how would your treatment plan change if the patient's expectations focused on the esthetic outcome? Maintaining this patient's teeth for the past 10 years with generalized horizontal bone loss can be favorable for a dental implant supported prosthesis as there is room available for dental materials.
The V-shaped anatomic structure of her upper and lower arch presents challenges to our ability to meet the expectations of an esthetically driven patient. How will the experience with dental implant supported overdenture in the upper differ from the past 10 years with a dental implant supported lower prosthesis?
How would implants placed in the supporting bone of the maxilla affect speech sounds when considering the durability requirements of dental materials?
Douglas G. Benting, DDS, MS, FACP, Spear Visiting Faculty [ www.drbenting.com ]