In a recent Dawson Academy webinar, an important question emerged that challenges current trends in dentistry: Are we too quick to recommend full-mouth implant solutions for patients with worn dentition? 

As more patients present with severe dental wear, clinicians often face a critical decision point: save their natural teeth or move toward implant-supported restorations.

Through the lens of complete dentistry, a cornerstone of The Dawson Academy’s philosophy, the webinar explored how proper diagnosis and understanding of occlusal principles can lead to more predictable and conservative treatment outcomes. 

While implants play a crucial role in modern dentistry, the biological value of natural teeth often gets overlooked in treatment planning for worn dentition cases. Let’s look at how our thinking around full-mouth implant solutions may be shifting and the potential impact on our patients.

The Natural Advantage: Understanding Tooth Biology in Complete Dentistry

When evaluating treatment options for worn dentition cases, understanding the biological advantages of natural teeth is key for predictable, long-term success. 

At the heart of this advantage lies the periodontal ligament (PDL), a surprisingly sophisticated biological structure that does more than just act as an attachment mechanism.

This natural shock absorber is crucial in distributing occlusal forces and protecting the underlying bone structure. When comparing natural teeth to implants, the difference is striking – implant restorations impact like a hammer, while natural teeth function more like a mallet, providing a gentler, more distributed force pattern.

Research has shown that the functional bite force on implants can be up to four times higher than natural teeth, which can create significant challenges for patients with heavy occlusal forces. This becomes particularly relevant in patients with square-face forms, who typically exhibit higher bite forces.

What Is The Proprioceptive Advantage?

One of the most overlooked aspects of natural teeth is the sophisticated feedback to the brain.

Through the periodontal ligament, natural teeth provide something implants cannot replicate – a sophisticated neural feedback system. This feedback loop protects the entire masticatory system from excessive forces.

With implants, this feedback is lost, and patients with heavy bite forces or parafunctional habits can run into problems.

Inflammatory Response Considerations

New research shows natural teeth are better for inflammatory response. Studies comparing periodontitis to peri-implantitis show that the inflammatory infiltrate in the surrounding tissues is almost three times larger with implants than with periodontitis.

Hidden Complexities of Full-Mouth Implant Cases

While implants are great in modern dentistry, it’s equally as important to understand their limitations in worn dentition cases. This is in line with The Dawson Academy’s philosophy of complete dentistry, which is to consider all the factors before recommending any solution, such as full mouth implants.

The Role of Force Dynamics

When dealing with worn dentition cases, force management is key. Even a single posterior implant can fail if it’s taken out of occlusion. Unlike natural teeth, implants require precise force direction along their long axis – any interference or contacts on inclines can be detrimental to long-term success.

Occlusal Scheme Considerations

Natural teeth can tolerate some occlusal interferences and contacts on inclines, although not ideal. Implants are far less forgiving.

The occlusal scheme must be carefully planned and executed with forces directed properly. This becomes much more complex in full-mouth cases – patients with high bite forces or parafunctional habits.

Patient-Specific Factors

Another aspect of Complete Dentistry is to consider patient-specific factors when evaluating implant cases.

One relationship to consider is the face form and bite force connection – patients with square face forms generate much higher bite forces and, therefore, more risk with full mouth implant restorations. Knowing what to do in these cases should dictate our treatment planning decisions.

Treatment Planning

The above considerations and the unique patient evaluation should guide us for each individual case. Before we recommend full mouth implant solutions, one should consider:

• Bite forces
• Wear and parafunction history
• Face form
• Occlusal scheme
• Implant risk factors

A Conservative Approach to Worn Dentition

The Dawson Academy’s philosophy of complete dentistry emphasizes starting with the most conservative approach that can achieve predictable, long-term success.

For instance, it’s a common misconception in worn dentition cases that severe wear automatically means a collapsed vertical dimension. Yet, within a complete dentistry context, most patients with worn dentition maintain their vertical dimension of occlusion (VDO) through natural compensation mechanisms. 

Through a more comprehensive understanding, a dentist may find that what is actually occurring is either:

• Alveolar bone remodeling
• Tooth intrusion
• Or a combination of both

This understanding fundamentally changes our treatment approach, as we’re not always dealing with a truly collapsed vertical.

Once you know exactly what a patient may be dealing with, you’re better equipped to take the next steps that align with proper dentistry – as well as the long-term interests of the patient.

For example, when vertical changes are needed, research alongside complete dentistry principles recommends following conservative approaches. Then, successful rehabilitation of worn dentition cases can be achieved through gentle, minimally invasive techniques.

With a complete understanding of the underlying mechanisms at play, dentists can make informed decisions and provide personalized treatment plans that prioritize their patients’ overall health and well-being. This approach leads to better long-term results for patients and builds trust and communication between dentist and patient.

Making Evidence-Based Decisions for Long-Term Success

Choosing between saving natural teeth and proceeding with implants in worn dentition cases should never be made lightly. Successful treatment outcomes always depend on a thorough diagnosis and a full understanding of fundamental principles.

When evaluating worn dentition cases, consider:

Caries Risk and Periodontal Health

Look beyond the current decay to the patient’s caries history, hygiene habits, and periodontal stability. High caries risk patients may be better suited for implants, while those with stable periodontal conditions may be perfect for tooth preservation.

Crown-to-Root Ratios and Tissue Biotype

Look at the current ratios and how they will be affected by any crown lengthening procedures. Tissue biotype is key to healing and long-term stability, especially when considering surgical interventions.

Overall Restorative Prognosis

Look at the remaining tooth structure’s integrity, existing restorations, endodontic status, and the ability to achieve ferrule. Remember, even severely worn teeth can be predictably restored if the principles are followed.

Patient-Specific Factors Like Face Form And Bite Force

Square face forms generate much higher bite forces, which can impact the long-term prognosis. Consider muscle patterns, history of parafunction, and overall force management in your treatment planning.

Occlusal Scheme and Functional Patterns

Look at current wear patterns, envelope of function, and ability to establish proper anterior guidance. Consider how the proposed treatment will affect functional movements and whether stable occlusal contacts can be achieved in centric relation.