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BDS2 - prosthetics > intro to partial dentures and patient assessment > Flashcards

intro to partial dentures and patient assessment Flashcards

1
Q

what patients are likely to have missing teeth

A

head and neck cancer patients

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2
Q

what percentage of the population don’t have all their teeth

A

60%

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3
Q

what are reasons for missing teeth

A
  • caries
  • periodontal disease
  • endodontic infection
  • trauma
  • congenitally absent
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4
Q

in 2009 what was the average amount of sound and untreated teeth in Scotland

A

17.9

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5
Q

anatomical consequences of missing teeth

A 
extra-oral
*change in facial appearance 
*TMJ problems 
intra-oral
*alveolar resorption 
*tooth movement 
*toothwear
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6
Q

what happens with alveolar resorption in tooth loss

A
  • normally the teeth and the alveolar bone fill out the face, but if missing teeth then the denture must now do this
  • lack of pressure on the bone cause resorption
  • particularly in the mandible
  • maxilla goes back with bone loss and mandible gos forward (class 3 - sunken face)
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7
Q

what happens to tooth movement with tooth loss

A

teeth can start to grow into empty spaces from opposing arches or on the same arch and can move/tilt
- causes problems with biting

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8
Q

aesthetic consequences of missing teeth

A

loss of hard and soft tissues which support the face

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9
Q

functional consequences of missing teeth

A
  • mastication - soft diet needed possibly, depending on how well they can chew
  • speech
  • psychological - some patients can’t cope with the loss of their teeth and don’t want dentures (affects quality of life)
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10
Q

how to replace missing teeth

A
  • resin bonded bridgework
  • conventional bridgework
  • implant crowns
  • implant bridgework
  • complete dentures
  • removable partial dentures
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11
Q

what is resin bonded bridgework

A
  • cna have medial cantilever
  • retainer attached to abutment tooth
  • Pontic then attached on messiah side of this abutment tooth
  • probably most successful
  • can have fixed-fixed
  • a Pontic between 2 abutment teeth with retainer attached
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12
Q

what is an abutment tooth

A

a tooth which something rests on

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13
Q

what is a Pontic

A

a fake tooth

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14
Q

what is conventional bridgework

A
  • more destructive to tissues
  • like doing crown prep
  • can have cantilever or fixed-fixed - retainer is a fixed tooth that slides over and sits on abutment tooth
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15
Q

what are implant crowns

A
  • implant goes in the bone

* implant crown screws on to top of implant abutment

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16
Q

what is implant bridgework

A
  • 2 implant abutments are screwed into bone with missing tooth in the middle
  • implant crowns are on either side of Pontic (all attached) and crowns screw onto abutments
  • material is easy to take off incase there is any problems
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17
Q

what are complete dentures

A
  • removable dentures - no attachments for stability
  • implant retained denture - snaps into place, some teeth on denture will sit on implants
  • implant supported dentine - screw retained, non-removable
  • removable partial dentures
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18
Q

what are the advantages and disadvantages of removable partial dentures

A 
Advantages
- less expensive
-removed for cleaning 
-minimal tooth prep
replacement of tissues possible 
Disadvantages 
-clasps unattractive
- can cause gagging 
- retention and stability problematic
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19
Q

what are the advantages and disadvantages of fixed partial dentures

A 
Advantages:
- natural appearing 
- better stability 
- not easily removed 
- minimal sot tissue coverage 
Disadvantages:
- expensive 
- suitable for short span 
- lots of tooth prep required
20
Q

what is a saddle

A

area with no teeth

- can be free end or bounded

21
Q

what is a rest

A

makes tooth supported

- can have occlusal or cingulum

22
Q

what is a major connector

A

baseplate

- holds whole denture together

23
Q

what is a clasp

A

attached to the abutment tooth

24
Q

what does the WHO say about missing teeth

A

if the premolar region is intact and there is at least 1 pair of occluding molars then masticatory efficiency is not affected

25
Q

what people are likely to have missing molars

A

those with sever periodontal disease

26
Q

what is a shortened dental arch

A
  • dentition where most posterior teeth are missing
  • satisfactory oral function without the use of RPD
  • priority given to maintaining an anterior and premolar dentition in one or both arches
  • in some circumstances, don’t need to replace posterior missing teeth if there is a stable dentition
27
Q

what is occlusal stability determined by

A

*pdl support, number of teeth in arches, interdental spacing, occlusal contacts and tooth wear

28
Q

what typically occurs if there is one or more tooth missing in an arch

A

tooth mobility, tooth migration and supra-eruption of unopposed teeth

29
Q

what is sufficient adaptive capacity

A

when there is 3 to 5 occlusal units left

  • pair of occluding premolars = 1 unit
  • pair of occluding molars = 2 units
30
Q

how can you extend a shortened dental arch

A
  • bridgework - max one unit on each side of arch, minimal contact in excursion, heavy contact may lead to failure
  • implants - single tooth, can be cantilever or fixed bridge
  • RPD - bilateral free end saddle (most common)
31
Q

when is a patients occlusion considered stable

A

if they can achieve a reproducible ICP

- achieved by most patients with at least 10 occluding pairs of teeth

32
Q

what are the 3 types of support for removable partial dentures

A
  • tooth borne
  • mucosa borne
  • tooth and mucosa borne
33
Q

what is tooth borne support

A

everything rests on the teeth
- no free end saddle
most desirable as doesn’t rest on tissues

34
Q

what is mucosa borne support

A

everything rests on mucosa, none on teeth

35
Q

what is tooth and mucosa borne support

A

mixture of rests on teeth and mucosa

36
Q

what is the material (base) of RPD’s

A
  • acrylic (pink)

- cobalt chrome (metal)

37
Q

what must be included in the history taking of patient for RPD

A
  • need full denture history (how many, how long, what kind, preferred)
  • need full medical history (identify problems that could affect treatment)
  • need social history (distance travelled to practice, ability to attend, hobbies - musical instrument -, smoking, alcohol, diet)
38
Q

what problems could affect treatment

A
  • arthritis
  • neuromuscular
  • mucosal diseases
  • xerostomia (makes dentures rough feeling)
  • osteoporosis
39
Q

what must be included in the patient exam

A
  • extra-oral
  • lower facial height
  • nasio-labial angle
  • opening - how far? (enough for impressions)
  • any abnormalities
  • smile line
  • aesthetics of existing dentures
  • intra-oral
  • general examination (perio status, endo status, caries, toothwear, indirect restorations)
  • edentulous spaces (missing teeth, number, position, length)
  • occlusion (contacts)
  • missing teeth classes for saddle
40
Q

what are the missing teeth classes

A
  • Kennedy Class I - bilateral free end saddle
  • Kennedy Class II - unilateral free end saddle
  • Kennedy Class III - unilateral bounded saddle
  • Craddock Class I - saddles supported on both sides by substantial abutments
  • Craddock Class II - vertical boring forces resisted entirely by soft tissue
  • Craddock Class III - tooth supported at only one end of the saddle
41
Q

what must the dentures be examined for

A
  • support - resistance to vertical movements of the denture towards the tissue
  • retention - resistance of the displacement of the denture away from the tissue
  • stability - resistance to horizontal movement of the denture
  • aesthetics
  • extension
  • occlusion
  • material
  • design
  • condition of teeth and base
  • health of denture bearing area (denture stomatitis?)
  • abutments (choose best teeth)
42
Q

what special investigations are done

A

for abutments:

  • periapcial radiographs to ensure teeth are adequate
  • sensibility testing (EPT or ethyl chloride)
43
Q

what are some diagnosis given to the patient

A
  • endodontic
  • periodontal
  • caries
  • toothwear
  • shortened dental arch
  • combination syndrome - when have full upper denture and partial lower and so you have no teeth in one area to know how hard you are biting as no PDL (cause bone resorption)
44
Q

what can be some denture problems

A
  • over/under extension
  • reduced support, retention and stability
  • fractured clasps/baseplate
  • no freeway space
  • poor aesthetics
  • worn teeth
45
Q

how should the treatment plan be made

A

discussed with the patient for the best solution

BDS2 - prosthetics (10 decks)

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