Intro to partial dentures Flashcards
What is prosthodontics?
The replacement of missing teeth
What are the 4 main causes of tooth loss?
- 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
What are the consequences of tooth loss?
Anatomical, aesthetics, functional and psychological
What are the anatomical changes associated with tooth loss?
- Bone loss (face falls in)
- Lip support
- Tooth movement (overreaction of antagonist tooth = overeruption & tooth tilting)
- TMJ
What are the changes to aesthetics associated with tooth loss?
- 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
What are the changes in function associated with tooth loss?
- 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
What is an overdenture?
A denture that is placed over heavily eroded teeth for a quick fix
What are the psychological effects of tooth loss?
Profound
Studies have found it can be more traumatic than divorce!
What are our options for replacing teeth?
- Nothing
- Bridges (conventional or resin retained)
- Dentures
- Implant retained prosthesis
- (orthodontics) = redistribution not replacing
No prosthodontic treatment indicated when…
- 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)
What are the advantages of fixed bridges (both conventional or resin retained)?
- 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)
What are the disadvantages of fixed bridges?
- 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
What are the advantages of removable dentures?
- 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
Whats the most common method of replacing teeth?
Removable dentures = variation between countries dependent on the public and professional attitude to partial denture use and health care systems
What are the disadvantages of removal dentures?
- psychological -> dont like taking teeth out at night, worried about it falling out as eating/ talking
- removable
- less acceptable
- damaging effects
Which damaging effects can a removable denture have?
- 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
What is an implant?
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
What are the advantages of implants?
- Good success rate
- Becomes part of your dentition
- Excellent stability and retention
What are the disadvantages of implants?
- Cost = varies widely depending on who you go to
- Operator sensitive
- Cannot restore alveolar bone
What is informed consent?
- 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)
What re the indications for partial denture use?
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
What are some key points to remember?
- 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
