The edentulous milieu.

D ental disease as a consequence of tooth loss has plagued mankind for several centuries. As a result prosthodontics and oral surgery justifiably boast of an ancient, if not always distinguished, heritage. The Phoenicians and Egyptians, for example, have left evidence of fixed prostheses that consisted of carved ivory teeth attached with gold wire to adjacent natural teeth. Few dentists appreciate what the first complete dentures really looked like and what kept them in place. Still fewer know that Queen Elizabeth I used rolls of cloth to pad out her lips or that the American presidential world cruise was ruined for President Grant by the loss of his teeth overboard. Slightly over 100 years ago, artificial teeth were so insecure that they were commonly removed during eating. For reasons of delicacy, many a lady wearing dentures did much of her eating in the privacy of her bedroom. The modern dental era reflects a profound awareness that the preservation of function of the masticatory system is best served by the conservation and protection of tissues that remain. Our professional objective has been to avoid, or at worst delay, Shakespeare’s description of that “last scene of all”: the one “that ends this strange eventful history, (is) second childishness and mere oblivion, saris teeth, saris eyes, saris taste, sans everything.“t To most of our patients, the loss of a few teeth is mutilating and provides a strong incentive to seek dental care to preserve and restore normal speech, masticatory function, and a socially acceptable appearante. To most dentists the loss of teeth poses an even greater mutilation: the destruction of part of the facial skeleton and the distortion of the morphology and function of soft tissues (Figs. 1 and 2). Fig. 1. A and B, Total tooth loss almost invariably leads to advanced bone loss. This undermining of integrity of facial skeleton distorts overiying soft tissue. This is evident in soft tissue shadow in A and in frontal and profile appearance of patients seen in Fig. 2.