Treatment of severe oral pathology in pre-geriatric patients: A proposal for a clinical protocol for same-day dentistry

This achievement is possible thanks to digitalisation procedures that guarantee greatly improved design techniques and the fabrication of medical devices in the laboratory utilising modern milling technologies. When applied in the laboratory, these tools provide manufacturing options that substantially expand the range of potential treatments. In-house methods can employ almost any manufacturing procedure, working with dry to wet ceramic composite materials, hybrids, metals, etc., in contrast to external milling centres, which frequently standardise production protocols, limiting applications.

The dentistry department of the IRCCS Ospedale Sacro Cuore Don Calabria, a hospital in Negrar in Italy, has been investigating clinical care models for dental pathologies that clinicians will face in the coming years. Understanding and comprehending these emerging diseases means developing tools that are capable of addressing the needs of future patients, and the treating team needs to be able to handle these new methods of addressing patient needs and diseases. The following are some important emerging fields of interest:

• applying artificial intelligence for diagnosis, previewing, 3D modelling and treatment simulation;
• restorative approach to same-day dentistry in terms of materials and methods;
• treatment of severe oral pathology in pre-geriatric patients involving same-day dentistry;
• dental malocclusions and orthodontic treatment with aligners;
• treatment of severely worn dentition with in-house procedures; and
• risks of and clinical strategies for clear aligner therapy.

Description

Adult patients with severe or extremely severe oral disease compromising the functions of the stomatognathic system are becoming increasingly prevalent. Unlike in the past, these patients are fully integrated into society. The lifestyle and dietary habits of these patients, even when they are older than 75 or 80, are comparable to those of younger adults, particularly in terms of their expectations. Clinically, these patients present with severe signs and symptoms that are frequently seen in other systemic diseases, including:

• compromised masticatory ability;
• spontaneous oral pain;
• recurrent infections of the mouth and oral tissue;
• deterioration of the dental system;
• periodontal disease; and
• xerostomia.

Changes in physical appearance are an important component of modern ageing, especially for people over 65. Age-related changes in the anatomical and functional integrity of the oral cavity have an effect on more than just dental health; they also affect the pathogenesis of systemic disease and nutrition. A deficiency in dental occlusion has the same impact as inflammation from periodontal disease in changing the alveolar bone structure.

One of the greatest challenges to overcome is the need to minimise the number of appointments while continuing to provide effective treatment. Recently, materials with high aesthetic and functional predictability have been introduced to the market, enabling rehabilitation of the completely edentulous arch in a very short amount of time. The intra-oral impression can be instantly accessed in the patient’s habitual intercuspation. Condylar determinants can be evaluated realistically with a digital facebow, combined with CBCT, and masticatory movements can be reproduced. Full-arch reconstruction with complete dentures is possible using 3D modelling software in just a few minutes, providing an accurate assessment of recovery of the vertical dimension of occlusion. It has become possible to reconstruct the integrated functional and aesthetic profile initially shared with the patient using simulations.