Dentures and Periodontally Involved Teeth Flashcards
What are the ADV of CoCr dentures?
- less periodontally destructive- framework can be kept away from gingival margins, not creating plaque trap
- Less mucosal coverage
- Rigid material
- High modulus of elasticity
- High thermal conductivity
- One piece casting- can add retentive, support components
What are the disadvantages of CoCr?
- Difficult to add to- if teeth fall out (so have contingency plan)
- Careful with design- can only use certain teeth as abutments (tags can be added so that teeth can be added, difficult)
What are the ADV/DIS of acrylic dentures?
ADV
- More aesthetic
- Simple to add to
- Cheap
DIS
- Covers more of soft tissues (perio destruction)
- Addition of retentive components weakens
How should RPDs be designed for perio health?
- Try not to cross gingival margins
- Reduce tissue coverage where possible
- Lingual bars are difficult as they are extremely difficult to add to if teeth are lost (big gap)- also doesn’t have great indirect retention
How is indirect retention achieved?
Put denture up against vertical surface
Tooth
Bone
What are the key teeth and why should we keep them?
Canines/premolars/molars
-> big/multiple roots- good for support
-> undercuts- good for retention, triangular pattern of retention with clasps
Lone standing molar- if lost this will make triangular pattern of retention very difficult
Consider keeping roots for overdentures to allow transfer of force onto alveolar bone
What is the difference in bite force with dentures compared to natural teeth?
- Can only generate 50MPA against 700MPA in bite force between dentures and natural teeth
What is the difficulty with transition to eduntulism?
We need to get patient used to wearing dentures
-> but dentures could make perio condition worse
What can happen as a result of lower anteriors outlasting all other teeth?
-Different level of resorption in posterior region which may have been lost some time ago
-> difficulty with retention
More likely to develop flabby ridge
What are the issues carrying out pros with mobile teeth? How may these be solved?
Issues with impressions- teeth move so casts inaccurate and denture may not fit
-> Consider Cutting window in tray and use light bodied impression material (when pressure applied it doesn’t move teeth, flexible coming out)
Distorts path of insertion- ideally single for good retention (goes in one way and comes out one way)
What can be done if patient has had trauma resulting in bone defect and there is multiple paths of insertion when putting in denture?
Make denture in 2 pieces (like fixed moveable bridge)
-> Framework around posteriors has one path of insertion, flange made with another POI (connect together)
Why must we be careful when taking impressions of teeth with recession?
They may have large undercuts
Block out with wax
Put Vaseline over to prevent sticking of impression material
What is the effect on dentures in perio patients if oral hygiene is excellent?
No adverse effect
What are the ADV/DIS of providing no prothesis?
ADV
-> Can be less damaging periodontal (not going to accelerate it)
DIS
-> Lack of posterior support- which can put more pressure on anterior teeth (which can accelerate periodontal disease)
-> Lack of denture wearing experience when teeth are lost
How is the BRAN acronym for consent applied?
- Benefits
- Risks
- Alternatives
- No treatment
-> record in notes
