Intro to partial dentures

Question 1

What is prosthodontics?

Answer 1

The replacement of missing teeth

Question 2

What are the 4 main causes of tooth loss?

Answer 2

• Caries
• Periodontal disease
• Trauma
• Planned orthodontic extractions

N.b. dont confuse tooth loss with congenital absence (hypodontia) although in some respect the consequence is all the same

Question 3

What are the consequences of tooth loss?

Answer 3

Anatomical, aesthetics, functional and psychological

Question 4

What are the anatomical changes associated with tooth loss?

Answer 4

• Bone loss (face falls in)
• Lip support
• Tooth movement (overreaction of antagonist tooth = overeruption & tooth tilting)
• TMJ

Question 5

What are the changes to aesthetics associated with tooth loss?

Answer 5

• Probably the main reason people request tooth replacement
• marked variation suggests that patients and dentists point of view of what is satisfactory appearance can differ markedly

Question 6

What are the changes in function associated with tooth loss?

Answer 6

• Classic description that lack of posterior teeth reduces chewing efficiency no true, would be fine without the 7’s
• BUT many patients with a large number of missing posterior teeth have little or no complaints about their ability to chew food

Question 7

What is an overdenture?

Answer 7

A denture that is placed over heavily eroded teeth for a quick fix

Question 8

What are the psychological effects of tooth loss?

Answer 8

Profound

Studies have found it can be more traumatic than divorce!

Question 9

What are our options for replacing teeth?

Answer 9

• Nothing
• Bridges (conventional or resin retained)
• Dentures
• Implant retained prosthesis
• (orthodontics) = redistribution not replacing

Question 10

No prosthodontic treatment indicated when…

Answer 10

• Risk outweighs the benefit (don’t want to damage a patients dentition)
• Shortened Dental arch concept (can live quite satisfactorily with 5 to 5, can have a varied diet and look acceptable)
• Functional dentition (people with 21 + teeth are unlikely to have dentures)

Question 11

What are the advantages of fixed bridges (both conventional or resin retained)?

Answer 11

• Better patient acceptance (don’t have to worry about it falling out or taking it out at night -> less psychologically ageing)
• Better tolerance (easier to keep clean = less plaque accumulation)

Question 12

What are the disadvantages of fixed bridges?

Answer 12

• Cost (not always -> depends on the lab)
• Conventional = extensive tooth substance loss (by the time you do a chamfer and shoulder into dentine & the teeth can die off), but no tooth loss for resin retained bridges but needs sound enamel to adhere to
• Operator sensitive
• Can be more technically demanding

Question 13

What are the advantages of removable dentures?

Answer 13

• Simple
• Cheap
• Reversible (leaves options open, especially for younger people where can’t implant because still growing)
• Non-invasive
• Further tooth loss isn’t an issue (can add to denture)
• A traumatic
• Restores long spans
• Alveolar bone loss restored (replaces both gums and teeth)
• Capable of modification

Question 14

Whats the most common method of replacing teeth?

Answer 14

Removable dentures = variation between countries dependent on the public and professional attitude to partial denture use and health care systems

Question 15

What are the disadvantages of removal dentures?

Answer 15

• psychological -> dont like taking teeth out at night, worried about it falling out as eating/ talking
• removable
• less acceptable
• damaging effects

Question 16

Which damaging effects can a removable denture have?

Answer 16

• decalcification
• caries
• inflammation of the gingival tissues
• inflammation of the mucous membrane (denture induced stomatitis, overgrowth of fungus below the denture)
• plaque
• resorption cause and effect not answered
• direct trauma from components

Question 17

What is an implant?

Answer 17

A screw to replace the root of tooth = undergoes osteointegration
n.b. must leave it for 6-8 months following insertion before the prosthesis can be put on top

Question 18

What are the advantages of implants?

Answer 18

• Good success rate
• Becomes part of your dentition
• Excellent stability and retention

Question 19

What are the disadvantages of implants?

Answer 19

• Cost = varies widely depending on who you go to
• Operator sensitive
• Cannot restore alveolar bone

Question 20

What is informed consent?

Answer 20

• must outline all options, the advantages and disadvantages of each
• patient makes a decision
  (n. b. if cannot have implants due to periodontal disease not being stable you need to explain why this makes them unsuitable)

Question 21

What re the indications for partial denture use?

Answer 21

Functionally orientated approach -> treatment effort and reassures directed a solving patient problems and preserving the teeth necessary to meet the patients aesthetic and functional needs

• number and distribution of missing teeth
• states of abutment teeth
• soft tissue loss
• anterior tooth spacing
• restoration of occlusal face height
• patient preference and cost
• an interim replacement

Question 22

What are some key points to remember?

Answer 22

• more people will retain their teeth into older age (6 is the most heavily restored tooth in the mouth because it comes through first)
• long term use of partial dentures can have a down side
• replacement of missing front teeth is main factor to wear partial dentures (improved mastication is of secondary importance)
• not all missing teeth need to be replaced
• provision is based on patient perceived need