Best Evidence Consensus Statements Flashcards
Angle’s Classification - Campbell and Goldstein
- Is Angle’s classification useful for the management of the completely edentulous patient?
No. The max/mand arches are positioned at CR and the casts are articulated there.
Since there are no teeth present and complete dentures are related by condyles.
Cephalometric radiographs could be utilized but the mounted casts already show the relationship, so no need to expose the patient to unwarranted radiation.
Lastly, molar and canine anatomy for patients who need oral rehabilitation may have been altered due to wear, caries, Perio, ortho, and restorations. Utilizing the teeth in those patients is precarious.
Angle’s Classification - Campbell and Goldstein
- If you don’t use Angle’s classification, how do you set denture teeth?
The occlusal surfaces of denture teeth are not dictated by nonexistent tooth positions/root positions. They are occlusally customized to meet the need of patients.
Position of denture teeth are dictated by occlusal plane and arch form anatomy.
Felton - Complete Edentulism
- What’s avg life expectancy?
- According to ACP website, how many completely edentulous people in the US?
- Who reported that the risk of death is how many times greater for an edentulous patient than partially/fully dentate?
- 78
- More than 36 million
- Brown 2009 - Public health paper - 1.5x greater for edentulous
Felton - Complete Edentulism
Edentulous patients are at increased risk for what?
What about patients with at least partial tooth loss?
- Reduced nutritional intake, malnutrition, obesity, COPD-related events, decline in cognition, cardiovascular disease mortality,
- Increased head/neck cancer, increased mortality
Felton - Complete Edentulism
Poorly maintained removable prostheses are associated with what?
Global incidence of edentulism increasing or decreasing?
Increases in pneumonia-related hospitalizations
Decreasing from 4.4 to 4.1% as of 2010
SG Report
- When will there be more adults over age 65 than youth in our country?
By 2035 - more geriatric than youth
SG Report
- What percent of older working-age agents age 50-64 are edentulous?
- What % of adults age 65 and older?
- What groups and ethnicities are more likely to be edentulous?
A. 6%
B. 13%
C. Those living in poverty are 3 times more likely.
Non-hispanic black are 2x more likely than non-hispanic white or Mexican.
SG Report
- Men vs women - Who has more oro-pharyngeal cancers?
- What percent of OPC’s in US are caused by HPV?
A. Men have 3.5 times more OPC - associated with HPV
B. 7 out of 10
Goodacre Stomatognathic System
- Do the head and neck muscles adapt to changes in occlusion?
Yes, as evidenced by their adaptation to artificially produced occlusal interferences.
They can modify their size, cross-sectional area, and fiber properties.
They can also decrease with less EMG activity (think change from group to canine guided occlusion)
Goodacre Stomatognathic System
- Do the teeth and bone adapt to changes in occlusion? What are four examples?
Yes, orthodontics is a good model to demonstrate physiologic adaptation of teeth and bone to positional changes.
Facial development affects occlusion but functional outcome is usually optimal.
Tooth flexion (up to 1 um).
Changes in lateral occlusal guidance due to ortho and/or tooth wear also indicate that patients can change.
Goodacre Stomatognathic System
- Does the TMJ adapt to changes in occlusion? (5)
Yes, TMJ has a dynamically modified periosteum on the articular surfaces of the condyle and fossa with three subarticular layers of fibrocartilage that absorb and dissipate peak and sustained loads.
Mandibular condyle is adaptable, regenerate structure.
The bone supporting the condyle and fossa can strengthen by increasing in density and thickness.
Patients without TMD symptoms adapt fairly well to artificially produced occlusal interferences, but those with TMD do not.
Occlusal changes produced by ortho do not appear to induce TMD.
Kattadiyil CR
- 8 techniques to measure CR
- Shanahan - “Swallowing or free closure”
- Schuyler - Patient was asked to touch palate with tip of tongue
- Gysi - Gothic arch tracing
- McCollum - Chin point guidance
- Dawson - Bimanual or bilateral manipulation
- Jankelson - Myo-monitor
- Lucia/Long - Anterior deprogrammer
- Roth - Power centric
Kattadiyil CR
- Kantor reported what on CR reproducibility?
15 subjects tested
- Chin point guidance with Lucia jig (hybrid of McCollum, Lucia, and Long) and bilateral manipulation (Dawson) had most consistent and reproducible
- Myomonitor (Jankelson) showed considerable variations and were 700% less dependable
Kattadiyil CR
- Which six techniques are found to be comparable in reproducibility and precision/accuracy?
- Which technique produced inconsistent and generally poorer results? Why?
A. Chin point guidance, bimanual manipulation, power centric, Gothic arch tracing, leaf gauge, and Lucia jig
B. Myomonitor due to the predominant masseter muscle contraction and limited contraction of other muscles of mastication. Also variations in electrode position, stimulating current intensity, or resistance of skin and underlying tissue could affect the position of the mandible
Kattadiyil CR
- Summarize three studies that investigated CR methods
- Kantor - 15 subjects - Chin point guidance, Lucia jig, and bilateral manipulation most accurate
- Simon and Nicholls - 5 times on 5 patients - chin point guidance, chin point guidance with ramus support, and bimanual manipulation
- Hobo and Iwata - 10 adults - unguided mandibular closure, bimanual manipulation, and chin point guidance
