Terminal Dentition
Terminal dentition refers to the transitional stage between natural dentition and complete edentulism, where patients have severely compromised remaining teeth that are approaching the end of their functional lifespan and will likely require extraction and replacement with prosthetic rehabilitation. 1, 2
Clinical Definition and Context
Terminal dentition describes patients at the transition stage between natural dentition and edentulism, representing a prosthodontic classification rather than a specific age-related dental developmental stage 3
This condition is characterized by severely compromised remaining teeth due to advanced periodontal disease, extensive caries, or other pathology that makes long-term retention of natural teeth unfeasible 1, 2
The term is distinct from developmental dental stages (primary, mixed, or permanent dentition) and instead describes an end-stage clinical scenario requiring comprehensive prosthodontic planning 3
Pathophysiological Characteristics
Terminal dentition cases demonstrate elevated inflammatory mediator profiles, with gingival crevicular fluid showing high levels of prostaglandin E2 (PGE2), interleukin-1 beta (IL-1β), and interleukin-2 (IL-2) 3
Both adult periodontitis and early-onset periodontitis variants of terminal dentition show upregulated monocytic inflammatory mediator secretion, suggesting progressive disease associated with tooth loss 3
The inflammatory response is dominated by Th1 cytokines over Th2 responses, with monocytic activation providing the main source of proinflammatory mediators 3
Treatment Planning Considerations
Full-arch implant-supported restorations represent the common treatment modality for patients with terminal dentition or edentulous mouths 1
Digital workflow protocols facilitate treatment planning, including facially-driven 3D digital smile design, prosthetically-driven assessment prior to implant placement, and 3D printing of surgical templates and prefabricated interim prostheses 2
Treatment planning must address the new orientation of occlusal and esthetic planes as well as changes in vertical dimension of occlusion during the transition from terminal dentition to full-arch implant rehabilitation 2
Associated Systemic Health Risks
Complete edentulism (the terminal outcome of terminal dentition) is associated with multiple comorbidities including poor nutrition, coronary artery plaque formation (odds ratio 2.32), smoking (odds ratio 2.42), diabetes (odds ratio 1.82), and rheumatoid arthritis (odds ratio 2.27) 4
Patients with terminal dentition progressing to edentulism face increased risk for certain cancers (odds ratios 1.54 to 2.85 depending on cancer type) 4
Important Clinical Pitfall
- Continuous positive airway pressure (CPAP) mask use in patients with obstructive sleep apnea represents a lesser-known risk factor that can contribute to catastrophic implant failure in full-arch rehabilitations, and should be specifically assessed during treatment planning 1