Article
Homemade dentistry reconstructing superior central incisors
The absence of teeth significantly impairs the ability to chew and digest food. It can also promote changes in the gingiva owing to the trauma caused by eating and brushing teeth. Loss of teeth can also cause bone loss, which can modify the bite and consequently lead to problems in the temporomandibular joint, such as clicking, headache and pain in other sites such as the neck, back and ears. In addition to functional alterations and development of pain, absence of teeth, particularly the anterior ones, can cause an important aesthetic problem. These situations can lead to social, psychological and emotional consequences that impact quality of life, self-image and self-esteem.1,2,3,4
Usually, absent teeth are replaced by total crowns, conventional removable partial or complete dentures, and implant-supported dentures, procedures that are performed by dentists. However, when access to professional dental care is not possible, particularly because of low income or low education level, some patients may eventually try to solve the situation by themselves. In the past, it was not unusual for some patients to perform their own dental procedures, such as tooth extraction, tooth and denture repair.5,6 This activity has been recognized as do-it-yourself (DIY) dental treatment.7 However, these days, homemade devices are very rare, with few reports in the English-language literature.8 Almost 20 years ago, our group published a case of a 63-year-old man who was a heavy smoker with uncontrolled diabetes and severe periodontitis. The patient had extracted his own superior and inferior incisors, and constructed bridges using PVC-type plastic strips that were fixed with superbond to the palatal and lingual surfaces of canines and carried the crown of his natural incisors.9
We recently attended a 53-year-old male patient who smoked and had been referred to the undergraduate clinic of a public school of dentistry for extraction of all teeth. On clinical examination, poor oral health was observed, with many teeth absent, severe periodontal disease with mobility, dental plaque, dental calculus and dental caries. However, the superior central incisors presented with an intriguing white material covering most of the crowns (Figure 1). The patient reported that he was so ashamed because of this aspect of his mouth that he had performed his own reconstruction of the central incisors with paper towel and cyanoacrylate super glue in order to at least improve their aesthetic appearance. He also mentioned that he had to constantly fix these teeth, which caused embarrassing situations. A panoramic radiograph was taken and confirmed the generalized bone loss with furcation involvement of remaining molars and absence of several teeth (Figure 2).
A detailed periodontal evaluation was performed. It was decided that the best option would be extraction of all the teeth, placement of an immediate full prosthesis, and later, rehabilitation with definitive full dentures. However, owing to the logistics of a busy teaching dental clinic, it was not possible to offer the immediate prosthesis. Therefore, as the patient would have to remain for a time with no prosthesis, he decided to continue with his homemade teeth until the immediate prosthesis placement was possible. Although the patient had precarious oral health and financial conditions, he opted to keep his homemade restoration because he worked with many people and was aware of the importance of having teeth.