Several opinions-collapsed arch, jaw, bite. Osteoporosis Implants

Good morning, @tmtm4 I’ve taken the past few days to give your post a lot of consideration before replying. Just to clarify, I have a strong dental background but I’m not a dentist so I’m not in a position to offer treatments or tell you to do.
I’d like to help you sort through a few things and narrow your options. I know this is a lot to take in all at once so I think the best way is to break this down into steps and with more than one conversation.
From what you’ve written, you have quite a long history of health, bone and dental concerns. Not having a healthy mouth can cause inflammation and potentially serious health issues in the rest of the body too. So, the goal is to get your mouth healthy again and have a smile return to your face. ☺️

Are you looking to have all your teeth extracted and replaced with dentures? Your current dentist nailed it by saying you’d need to have adhesive (goop) to keep them held in place. However, it is possible and is probably the least expensive option. Generations of grandparents lived that way. The upper would stay in place reasonably well, but the lower denture would have no where to rest solidly, even with adhesive, without a ridge. Do you still have your lower eye teeth? Are they solid? Sometimes those can be used as anchors for a lower denture.

Implants might be the way to go in your case, as I’ll explain further. I know there’s a hesitancy because of the Reclast, osteoporosis and cost. But they might give you a more permanent and fixed dental prosthetic. Implant replacements come in many sizes and options from individual teeth, to full mouth ‘bridges’ (with no palate) to anchors for removable dentures with a palate.
There are different types of implant anchors as well. Mini implants are short, not as long as standard, making them usable in people with diminished jaw bone. They can be used to hold dentures in place. Another option is bone grafting for dental implants if the patient’s bone loss is significant. That’s what’s used in the All on 4 technique.

I think to begin with, talking about bone support in your jaws is a good place to start. Jawbone loss is a common consequence of tooth loss. Physical stimuli such as biting and chewing strengthen the jawbone. Just like weight bearing exercises strengthen our body’s bones. Every time you eat or chew, the biting or chewing force travels through your teeth to the jawbone, stimulating the jawbone to grow and rebuild. After tooth extraction, the jawbone loses its stimuli, causing the jawbone to lose width, height, and volume. After while the upper and lower jaw bones shrink to the point where there is little ridge left on the top for a denture to grip and the lower jaw ridge becomes none existent.

Replacing missing teeth with bridges and dentures won’t solve the problem of bone loss because they don’t transmit the chewing and biting force to the jawbone. Dental implants can prevent jawbone loss because they act like natural teeth roots, and transmit the biting and chewing force directly into the jawbone.

One of the concerns of having dental implants with someone taking bisphosphonates for bone support, such as Reclast, has do with the natural regeneration of bone. Bisphosphonates slow down the deterioration process while reducing bone thinning to a substantial extent.
One concern for discussion is whether or not people who are taking bisphosphonates tend to have a worse prognosis compared to those who are not taking the medication. The reason for this is due to the constant bone renewal process referred to as “bone turnover.” This turnover is only accomplished when the bone has two types of cells – the first type eats up the old bone (osteoclasts) and the second lays new bone in its place (osteoblasts).

Well, because bisphosphonates interfere with the effectiveness of cells that eat up the bone (osteoclasts) it tends to increase bone density. But it isn’t allowing for old bone to be ‘eaten up’ or resorbed. It’s not a natural process of renewal.
Because implants need the bones to heal, the new bone around a newly placed dental implant must be ‘eaten up’ by osteoclasts before new bone can be formed. Because of bisphosphonates, this may be less effective and the area may not heal as well. In some cases, your dentist will recommend a blood test procedure called a serum CTX, which evaluates how your osteoclasts are being affected by Bisphosphonates.

However, you are now on Tymlos, which is another mechanism altogether. It actually allows for both parts of the natural bone building process which, in my opinion, makes you potentially a much better candidate for some implants.

May I ask how your tooth loss journey began? Did you have a history of gum disease/periodontal disease? That is generally how bone support in the mouth begins to fail. How many teeth do you have remaining on each arch that your current dentist feels are solid and could remain?

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@tmtm4 I don't have periodontal disease, but because of gun recession, my gums have thinned and the roots of my teeth are exposed a bit. Stress affects this a lot. This is likely from tension in my neck and jaw and it has been going on for years. It started when I was younger and dentists would ask if I was brushing too hard or using a hard toothbrush. Well, maybe I did. I was quite upset as a child getting cavities and didn't want it to happen again. The gums have to seal around the teeth roots, and if you have tension pulling on the gums through the jaw (as can happen with grinding teeth and stress), it can affect it. Even grinding teeth, or having a tooth that is "taller" than the others puts stress on that tooth and can start blunting the roots of the tooth from pressure and can loosen that tooth leading to possible loss. My dentist showed me an x-ray demonstrating this, and had me have my bite adjusted by filing down (very slightly), the teeth that were "too tall", so that it evened out the pressure of biting over the whole mouth.

For grinding at night, having a bite guard made and wearing it helps with the pressure. I had one for awhile, but after my implants and new bridge and bite adjustment, it no longer fits, and they say I don't need it now.

My mom has similar issues with her feet and deformity due to arthritis along with severe osteoporosis. It is good that you are treating the thin bones. My mom had a spontaneous compression fracture in her spine because of the severe osteoporosis because she had a problem with a parathyroid gland that was malfunctioning and causing calcium to be pulled out of her bones. If that is the situation, it's best to be seen by an endocrinologist because some medications for osteoporosis don't help enough in that situation. My mom was on Fosamax for 10 years before the spine fracture happened, and now is receiving injections of Evenity instead.

What brings you joy? You may wonder why I asked this, but you can find ways to distract yourself from the stress and health problems that you live with. Fear increases pain a lot, and finding something creative to do can take your mind away from it all. This is a lesson I had to learn myself because I was very fearful of pain and surgeries, and when I needed to choose between surgery for cervical stenosis and loosing the coordination of my arms, I decided to face my fear and embrace the surgery that changed my life. I had the voice of a small powerless child inside influencing me who had not resolved the past fearful issues. I worked through all of that, and left that fear behind. I realize your experience is different, but you can control the voice in your head and how it talks to you about your life. You can choose to occupy your mind with something that brings you joy. I say these words with kindness, not criticism. Mayo Clinic does have a pain management program that teaches people how to re-frame their thinking about pain, and all the artwork everywhere at Mayo speaks to this need to be inspired by beauty as part of healing. There is also a great discussion on Art and healing here on Connect.
https://connect.mayoclinic.org/discussion/art-for-healing/

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I have had two teeth pulled a long time ago on top. I do have periodontal disease. Two years ago my dentist wanted to put a bridge on both sides but I hesitated. By 2020 I had lost more teeth on top but in 2020 They started to spontaneously erupt. I needed back, shoulder and foot surgery pretty bad so I asked my dentist what to do first because by then he wanted to pull the rest of my teeth on top and make a denture. He said I could wait. Last year he was making my dentures and had already sent me to the oral surgeon for a plan. I asked him if I could get implants and he said no because I took Reclast for two years. (Last time was early June 2021.) My dentist had already measured my mouth and made part of the denture & sent it off for the first step. When I went in for my second appt he stopped in the middle of measuring and the nurse came into the room and said he would call me. After several days, I called him and asked what was going on. He said I have to go to a prosthodontist. The Pros. said my arch had fell and shows me this denture that he says is mine. He hadn't even looked in my mouth! It was a stock denture and he would see me a couple of weeks after they pull my teeth. Pros 2: Said I could get a denture but must have a pallet. Sent me to another surgeon who said I could get 6 implants for a implant supported denture which would be approx $25,000 + the cost of the Pros2.
Needless to say, I changed my primary dentist and my new dentist said the denture and/or implants would have failed because my arch has completely fell to almost a straight line and my jaw/bite collapsed too. She fit me for an occlusal Guard to put my jaw where it used to be.
I really wanted implants so I went to a dentist my ex told me about. He said I have a "very unique situation, since I have RA (infusions of Oriencia), periodontal disease, Osteop., hypothyroid, and severe back issues. He sent me to surgeon 3 who said I have more than enough bone and could do a bridge with 4 implants, pull my molars below and put two implants there for $15,000 and the dentist who referred me would take over until everything heals and then put in a permanent bridge for $10,000 more. That's if nothing goes wrong.
I cry every day because I don't know what to do. I'm scared my back is going to collapse before they can do something with my teeth. I have all my bottom teeth but two in the back but I have grinded them down from stress. I am retired and this is scaring me.

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Good morning, @tmtm4 I’ve taken the past few days to give your post a lot of consideration before replying. Just to clarify, I have a strong dental background but I’m not a dentist so I’m not in a position to offer treatments or tell you to do.
I’d like to help you sort through a few things and narrow your options. I know this is a lot to take in all at once so I think the best way is to break this down into steps and with more than one conversation.
From what you’ve written, you have quite a long history of health, bone and dental concerns. Not having a healthy mouth can cause inflammation and potentially serious health issues in the rest of the body too. So, the goal is to get your mouth healthy again and have a smile return to your face. ☺️

Are you looking to have all your teeth extracted and replaced with dentures? Your current dentist nailed it by saying you’d need to have adhesive (goop) to keep them held in place. However, it is possible and is probably the least expensive option. Generations of grandparents lived that way. The upper would stay in place reasonably well, but the lower denture would have no where to rest solidly, even with adhesive, without a ridge. Do you still have your lower eye teeth? Are they solid? Sometimes those can be used as anchors for a lower denture.

Implants might be the way to go in your case, as I’ll explain further. I know there’s a hesitancy because of the Reclast, osteoporosis and cost. But they might give you a more permanent and fixed dental prosthetic. Implant replacements come in many sizes and options from individual teeth, to full mouth ‘bridges’ (with no palate) to anchors for removable dentures with a palate.
There are different types of implant anchors as well. Mini implants are short, not as long as standard, making them usable in people with diminished jaw bone. They can be used to hold dentures in place. Another option is bone grafting for dental implants if the patient’s bone loss is significant. That’s what’s used in the All on 4 technique.

I think to begin with, talking about bone support in your jaws is a good place to start. Jawbone loss is a common consequence of tooth loss. Physical stimuli such as biting and chewing strengthen the jawbone. Just like weight bearing exercises strengthen our body’s bones. Every time you eat or chew, the biting or chewing force travels through your teeth to the jawbone, stimulating the jawbone to grow and rebuild. After tooth extraction, the jawbone loses its stimuli, causing the jawbone to lose width, height, and volume. After while the upper and lower jaw bones shrink to the point where there is little ridge left on the top for a denture to grip and the lower jaw ridge becomes none existent.

Replacing missing teeth with bridges and dentures won’t solve the problem of bone loss because they don’t transmit the chewing and biting force to the jawbone. Dental implants can prevent jawbone loss because they act like natural teeth roots, and transmit the biting and chewing force directly into the jawbone.

One of the concerns of having dental implants with someone taking bisphosphonates for bone support, such as Reclast, has do with the natural regeneration of bone. Bisphosphonates slow down the deterioration process while reducing bone thinning to a substantial extent.
One concern for discussion is whether or not people who are taking bisphosphonates tend to have a worse prognosis compared to those who are not taking the medication. The reason for this is due to the constant bone renewal process referred to as “bone turnover.” This turnover is only accomplished when the bone has two types of cells – the first type eats up the old bone (osteoclasts) and the second lays new bone in its place (osteoblasts).

Well, because bisphosphonates interfere with the effectiveness of cells that eat up the bone (osteoclasts) it tends to increase bone density. But it isn’t allowing for old bone to be ‘eaten up’ or resorbed. It’s not a natural process of renewal.
Because implants need the bones to heal, the new bone around a newly placed dental implant must be ‘eaten up’ by osteoclasts before new bone can be formed. Because of bisphosphonates, this may be less effective and the area may not heal as well. In some cases, your dentist will recommend a blood test procedure called a serum CTX, which evaluates how your osteoclasts are being affected by Bisphosphonates.

However, you are now on Tymlos, which is another mechanism altogether. It actually allows for both parts of the natural bone building process which, in my opinion, makes you potentially a much better candidate for some implants.

May I ask how your tooth loss journey began? Did you have a history of gum disease/periodontal disease? That is generally how bone support in the mouth begins to fail. How many teeth do you have remaining on each arch that your current dentist feels are solid and could remain?

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Kudos for a really good and thoughtful explanation of the situation and possible pathways forward. Kudos to the great moderators here in general.

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Oh golly, after all you’ve mentioned in your reply today, no wonder you’re filled with stress and worry. This situation with your teeth is certainly compounding things for you. I can empathize with you for the huge impact this is having on the quality of your life and health. Are you able to eat ok?

Well, the positive take away is that you still have your lower teeth except for 2 molars. If your periodontal disease is under control with regular dental cleanings and you maintain them at home with daily flossing and brushing, you should be able to keep those.
Your new dentist is prudent having you wear the occlusal guard to help keep your remaining teeth safe from stress grinding. It’s called bruxism. The guard will also help hold your jaw in alignment with what’s left of your remaining upper teeth.

The upper arch, having collapsed from the loss of teeth would make it difficult to have a good degree of holding power for a removable denture. As your current dentist mentioned, it would need to be held in place with dental adhesive such as poly grip. It would basically be for cosmetic purposes and very light eating as the grip wouldn’t be very strong.

It is entirely possible that you do have plenty of bone remaining to do the All on 4 technique as this was designed for situations like yours. The pins are put in at an angle in the back and are shorter, not requiring as much bone. They are also generally implanted with bone grafting material. But it is very costly.
This site I posted may be similar to the brochure you have. It gives some information about what’s involved and shows how the All on 4 implants works and some information
https://sharedentalcare.com/all-on-4-dental-implants/

Another consideration you might try is going to a university dental school. UM Kansas City has a dental program and it looks as though there are a couple other dentistry school in the state. They often have clinics where their dental students work with patients for a reduced fee. The dental students are supervised and overseen by their instructors.

https://dentistry.umkc.edu/
Do you think this could be a possibility for you?

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Good morning, @tmtm4 I’ve taken the past few days to give your post a lot of consideration before replying. Just to clarify, I have a strong dental background but I’m not a dentist so I’m not in a position to offer treatments or tell you to do.
I’d like to help you sort through a few things and narrow your options. I know this is a lot to take in all at once so I think the best way is to break this down into steps and with more than one conversation.
From what you’ve written, you have quite a long history of health, bone and dental concerns. Not having a healthy mouth can cause inflammation and potentially serious health issues in the rest of the body too. So, the goal is to get your mouth healthy again and have a smile return to your face. ☺️

Are you looking to have all your teeth extracted and replaced with dentures? Your current dentist nailed it by saying you’d need to have adhesive (goop) to keep them held in place. However, it is possible and is probably the least expensive option. Generations of grandparents lived that way. The upper would stay in place reasonably well, but the lower denture would have no where to rest solidly, even with adhesive, without a ridge. Do you still have your lower eye teeth? Are they solid? Sometimes those can be used as anchors for a lower denture.

Implants might be the way to go in your case, as I’ll explain further. I know there’s a hesitancy because of the Reclast, osteoporosis and cost. But they might give you a more permanent and fixed dental prosthetic. Implant replacements come in many sizes and options from individual teeth, to full mouth ‘bridges’ (with no palate) to anchors for removable dentures with a palate.
There are different types of implant anchors as well. Mini implants are short, not as long as standard, making them usable in people with diminished jaw bone. They can be used to hold dentures in place. Another option is bone grafting for dental implants if the patient’s bone loss is significant. That’s what’s used in the All on 4 technique.

I think to begin with, talking about bone support in your jaws is a good place to start. Jawbone loss is a common consequence of tooth loss. Physical stimuli such as biting and chewing strengthen the jawbone. Just like weight bearing exercises strengthen our body’s bones. Every time you eat or chew, the biting or chewing force travels through your teeth to the jawbone, stimulating the jawbone to grow and rebuild. After tooth extraction, the jawbone loses its stimuli, causing the jawbone to lose width, height, and volume. After while the upper and lower jaw bones shrink to the point where there is little ridge left on the top for a denture to grip and the lower jaw ridge becomes none existent.

Replacing missing teeth with bridges and dentures won’t solve the problem of bone loss because they don’t transmit the chewing and biting force to the jawbone. Dental implants can prevent jawbone loss because they act like natural teeth roots, and transmit the biting and chewing force directly into the jawbone.

One of the concerns of having dental implants with someone taking bisphosphonates for bone support, such as Reclast, has do with the natural regeneration of bone. Bisphosphonates slow down the deterioration process while reducing bone thinning to a substantial extent.
One concern for discussion is whether or not people who are taking bisphosphonates tend to have a worse prognosis compared to those who are not taking the medication. The reason for this is due to the constant bone renewal process referred to as “bone turnover.” This turnover is only accomplished when the bone has two types of cells – the first type eats up the old bone (osteoclasts) and the second lays new bone in its place (osteoblasts).

Well, because bisphosphonates interfere with the effectiveness of cells that eat up the bone (osteoclasts) it tends to increase bone density. But it isn’t allowing for old bone to be ‘eaten up’ or resorbed. It’s not a natural process of renewal.
Because implants need the bones to heal, the new bone around a newly placed dental implant must be ‘eaten up’ by osteoclasts before new bone can be formed. Because of bisphosphonates, this may be less effective and the area may not heal as well. In some cases, your dentist will recommend a blood test procedure called a serum CTX, which evaluates how your osteoclasts are being affected by Bisphosphonates.

However, you are now on Tymlos, which is another mechanism altogether. It actually allows for both parts of the natural bone building process which, in my opinion, makes you potentially a much better candidate for some implants.

May I ask how your tooth loss journey began? Did you have a history of gum disease/periodontal disease? That is generally how bone support in the mouth begins to fail. How many teeth do you have remaining on each arch that your current dentist feels are solid and could remain?

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Thank you, @callalloo that means a lot. ☺️
We are all one big family here, helping each other to find answers, offer suggestions, lend an ear; One big support system. Everyone has life experiences or journeys that prepare us to pay it forward.
Thank you for all your contributions to Connect as well! Together, we’re that ‘village’ that makes this world a better place.

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