Dentures and periodontally involved teeth

Question 1

In terms of acrylic and cobalt chrome dentures what is more periodontally destructive?

Answer 1

• Co/Cr less periodontally destructive but difficult to add to
• Acrylic more periodontally destructive but easy to add on
• Use clinical judgement to assess

Question 2

When thinking about partial denture design for periodontal health what should you be thinking about?

Answer 2

• Ideally want to be crossing and covering less gingival margins
• Need to think about what connectors you are using and ideally go for one that reduces tissue coverage where poss without compromising retention and stability
• I.e lingual bar not lingual plate (but plate easier to add teeth to)

Question 3

What teeth are useful to keep even if periodontally compromised when thinking about denture design?

Answer 3

• Canines or premolars
• Lone standing molars

Question 4

Ultimately periodontal pts will lose all or majority of their teeth. What teeth are the last ones to be lost? How can you aid the pt in this before complete dentures are needed? What can happen in this case?

Answer 4

• Lower anterior teeth last to be lost
• Aid the pt by giving them transitional partial dentures (bilateral free end saddle lower dentures - K. class I) to gain denture wearing experience
• Be careful of flabby ridge that may form on upper anterior region due to force of lower anterior hitting the upper denture - causing excess fibrous ridge

Question 5

Periodontal disease can cause mobility of teeth due to loss of attachment and loss of bone. What difficulties can arise when attempting to create a denture for patients with mobile teeth?

Answer 5

• Impressions can be hard to take due to mobility and give unwanted undercuts
• Tooth position may be splayed and not what we want so need to emphasise new design to lab
• Path of insertions can make the denture look awful due to loss of tissue eg flange - sometimes may need to do 2 paths of insertion
• Sometimes the fit of Co/Cr dentures like the clasps may not be perfect due to distortion of the teeth when taking impressions - inform lab so they provide relief areas to accommodate this on insertion and removal

Question 6

What is an advantages to providing no prosthesis to periodontally involved teeth? Give a disadvantage of not providing a prosthesis

Answer 6

• Often less damaging to periodontally involved teeth

But
- Lack of posterior support can lead to increased mobility of remaining teeth anyway
- And lack of denture wearing experience gives difficulty if need to wear complete form the onset

Question 7

When obtaining consent from a pt what do you need to include?

Answer 7

• Prognosis of remaining dentition
• Risk of dentures v no dentures (risk of may progress tooth loss,
• Benefits of dentures v no dentures
• Monitoring and maintaining dentition and what that perio txt involves
• Record all discussing in notes keeping good records