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Michigan Dental Seminars

Ara Nazarian, DDS
Bone Leveling Basics
1857 East Big Beaver Rd
Michigan Dental Center
Troy MI 48083
(248) 457-0500

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Basic Bone Leveling for Denture Prosthetics

Advanced Protocol for Assuring Denture Fitting Success

Partials Cause Significant Bone Loss
Our patient is a 40ish aged male who has worn denture partials for many years. Continued issues with gum disease and over-use of denture partials were making his bite very unstable.

Like most patients who have worn denture prosthetics for an extended time, he wasn't aware of the extent of bone loss caused by his partials.

Bone Leveling Benefits

Contrary to what many patients (and dentists too) assume about the "knife edge" characteristics of a bony ridge and how it can impact proper fitting and eventual comfort for denture prosthetics, the patient was educated about the benefits of releveling his ridge of bone.

Mandibular Bone Loss Focus
More and more denture labs are able to design removeable prosthetics that can compensate for bone height quite well and without any loss of comfortable fit or loss of aesthetic outcome.

The key to any "ideal" denture fitting is the width and homogeneity of the bony ridge.

A thick width of bone that spans the entire arch practically guarantees a perfect fit and the best degree of stability possible.

Perio Flap and Edentulation

Basic Dentures Include Leveling Physics

Many, if not most, general dentists have difficulties in delivering "exactly" what a new denture patient wants.

A decent set of teeth that function well and has acceptable cosmetics.

The bulk of new denture patients can be expected to have issues involving variable bone loss (sporadic untreated extractions), super eruptions, varying degrees of gum disease and possible history of cavernous zones of bone loss caused by denture partials.

Lowering Anterior Ridge
Since it is the quality, quantity and uniformity of the bony ridge that determines how a denture prosthetic functions with any given patient, a focus on this most preliminary step can help a dentist become as proficient as he/she wants to be in providing affordable solutions in full arch teeth replacement.

Hidden Benefits of Bone Leveling

One of the most common "outcome interruptions" for a denture patient is the healing process. Full edentulation, alone, creates multiple instances of extraction healing needs that are frustrating for every denture patient.

Full Arch Ridge Lowering - 1st Phase
Socket grafts and suturing can provide an almost immediate series of healing events but likely at considerable added expense for each patient.

Bone leveling, since it is anticipated for nearly every denture patient, may eliminate the need for a socket graft for each extraction site.

It is not an exaggeration to predict that many, most or ALL needs for socket grafts will be eliminated via bone leveling.

Disappearing Extraction Sites

Full Arch Ridge Lowering - 2nd Phase
The adjacent series of photos readily shows how multiple passes along the patient's bony ridge "create" wider and more dense bone while simultaneously making extraction holes literally disappear.

The prospect of bleeding extraction sites, abscesses, bleeding gums, bone slivers, multiple dry sockets and high spots/low spots that create dentures that flip and flop become, increaslingly, a thing of the past with each pass of a bone leveling procedure.

Notice how within the 1st two passes of bone leveling, the ridge gains substantial width in some areas.

Elimination of a Patched Knife Edged Ridge

Full Arch Ridge Lowering - 3rd Phase
While ridge splitting and variations in prosthetic design can overcome the problems associated with a thin ridge of bone.... a simple leveling of the bone can create not only an ideal fit for a new denture but provide future opportunities for the use of conventionally sized dental implants to secure a denture or provide an upgrade path to a fixed prosthesis.

No More Rock and Roll Clicking Dentures

With each pass of the bone leveling burr greater uniformity in ridge characteristics is assured. Multiple passes of bone leveling will actually accelerate the healing events that must occur with each denture patient.

Full Arch Ridge Lowering - 4th Phase
While the entire bone leveling process is completed in one appointment ..... there is no control over how long it may take for a denture patient to "be ready" for final fitting when no leveling was provided.

The overall "healing event" of a leveled bony ridge is a singular instance compared to several instances of multiple extraction sites. Although a modicum of graft material may be used to fill in minor variances of tissue... healing is rapid.

The use of an immediate denture product is uneventful. Pain and discomfort is short lived and managed with ibuprofen for most patients for a day or two. Most patients can enjoy eating a regular evening meal comfortably on the day of treatment or the next day.

Ridge Trimming - Height and Width
Basic dental function is practically immediate.

Effective Periodontitis Treatment

The bone leveling procedure seeks the most advantageous width, quality and quantity of bone for the patient. For most prospective denture wearers who have advanced gum disease issues, eradication of all instances of the disease process is practically a "given."

Compromised and porous bone essentially doesn't exist after bone leveling for most patients. Any deficiiences in gum tissue quantity are addressed during the final suturing phase of the treatment.

Ridge Trimming - Multiple Perspective

Anticipating the Best Width Characteristics

The adjacent series of pictures shows the ridge widening effects of each bone leveling pass. Comparing these photos with the photos at the beginning of this page show the dramatic changes that can be achieved that will require little to no followup "comfort visits" that are associated with old fashioned denture cases.

This patient may opt for dental implant placements in the future if budget constraints don't interfere.

His treatment upgrade possibilities could involve conventional implants with locator devices or..... possibly a full upgrade to a fixed titanium-porcelain fixed bridge.

Bone Leveling Success
New Uniform Bony Ridge - Final
The greatest number of future treatment options, if exercised, at negligible treatment costs in "today's dollars.

The last photo in our treatmeent series reveals a stout width and span of bone that could make a later upgrade that would require only two implants with locators to secure the denture.

More implants can be placed even later for increased stabilization (and for bone stimulation) or an entirely new fixed bridge.

Bone Leveling Seminars

Bone leveling seminars and workshops for basic denture dentistry are now forming. Feel free to contact Dr. Nazarian about the material and concepts covered on this page. He will respond to you directly with the information and answers you are seeking.

Join us for this training event in the future so you, too, can enjoy mastering a teeth replacement choioce that more and more patients are seeking. Remember also that denture prosthetics are the perfect gateway to more advanced and more profitable treatment options that you want to do more of.

Michigan Dental Seminars
Ara Nazarian, DDS Seminar Leader
1857 East Big Beaver Road
Troy MI 48083
(248) 457-0500 - Fax: (248) 457-0501

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