Dentures & Periodontally Involved Teeth

Question 1

What are the advantages and disadvantages of acrylic and cobalt chrome dentures for periodontal patients?

Answer 1

• cobalt chrome
  
  • less periodontally destructive
    
    • kept away from gingival margins
  • difficult to make additions
• acrylic
  
  • more periodontally destructive
    
    • large area of mucosal borne acrylic
  • easier to make additions

Question 2

What considerations must be made when picking a connector for periodontitis patients?

Answer 2

• ideally crossing gingival margins as little as possible
• minimal tissue coverage
  • e.g. lingual bar rather than lingual plate
    
    • harder to make additions

Question 3

What key teeth may be kept where possible for periodontitis patients receiving partial dentures and why may this happen?

Answer 3

• canines and premolars
• lone standing molar
  
  • tunnel preparation
    
    • bone loss past the furcation
• better to have teeth
  
  • increased support
    
    • tooth support from abutments
  • increased retention
    
    • clasps

Question 4

Why might patients with periodontitis be encouraged to keep as many teeth as possible and wear a partial denture?

Answer 4

• transition to edendulism can be challenging
  
  • partial denture provides denture experience
  • easier to transition to complete dentures
  • harder in later life
• can prolong time before edentulism
  
  • usually lower anteriors left
    
    • often periodontally compromised
  • provide bilateral free-end saddle lower denture
    
    • denture wearing experience
    • reduced risk of flabby ridge

Question 5

What difficulties can mobile teeth as a result of periodontitis cause when providing a patient with partial dentures?

Answer 5

• impression technique
  
  • undercuts due to loss of attachment and spacing
    
    • alginate pulled of tray or breaks in undercuts
    • wax must be placed in undercuts
• tooth position
  
  • mobile teeth prone to drifting
  • space left challenging for tooth size
• path of insertion
  
  • significant tissue loss
    
    • two part denture
    • one chrome one acrylic
    • different paths of insertion and slot together
• fit of Co/Cr dentures
  
  • precision fit so can be challenging
    
    • impressions can distort tooth position
    • relief areas added to cast
    • aids seating of denture

Question 6

What is the result of not providing dentures for a patient with periodontal disease?

Answer 6

• often less damaging periodontally
• lack of posterior support
  
  • increased tooth mobility of remaining teeth
  • combination syndrome/flabby ridge
• lack of denture wearing experience
  
  • have to adapt in later life

Question 7

Why is consent important for periodontitis patients with dentures?

Answer 7

• patient must be well informed before proceeding with treatment
  
  • prognosis of remaining dentition
  • risk of dentures vs no dentures
  • benefits of dentures vs no dentures
• monitoring and maintaining remaining dentition
• good records required
  
  • record discussions with patient