Intro to RPD and patient assessment Flashcards
Why do patients have missing teeth?
- caries
- periodontal disease
- endondontic infection
- trauma
- cancer
- congenitally absent
What are the consequences of missing teeth
- anatomical
- aesthetic
- functional
- psychological
Anatomical consequneces of missing teeth
Extra-oral
- change in facial appearance
- TMJ problems
Intra-oral
- alveolar resorption
- tooth movement
- toothwear
unwanted tooth movements
- over-erupted teeth
- drifting and tilting
aesthetic consequences of missing teeth
loss of hard and soft tissues which support face
functional consequences of missing teeth
mastication
speech
psychological effects of missing teeth
emotional
how can we replace missing teeth
- resin bonded bridgework
- conventional bridgework
- implant crowns
- implant bridgework
- RPDs
- complete dentures
- implant retained dentures
what are the different types of resin bonded bridgework (and conventional bridgework)
- mesial cantilever
- fixed-fixed
how are implants fitted
screw retained
dental implant, implant abutment, implant crown
how are implant bridges fitted
two implant abutments, a pontic in the middle
how can complete dentures be held in the mouth
- removable (no attachments or stability)
- implant retained (snaps in place)
- implant supported (screw retained and non-removable)
what is a saddle?
what are the different types of them
area with no teeth
free-end and bounded
Do we need to replace all missing teeth?
no, according to WHO you need min of 20
What is a shortened dental arch
a dentition where most posterior teeth are missing
do you need to fix a shortened dental arch?
depends, in the right circumstances, non replacement of posterior missing teeth can provide a stable and acceptable dentition
priority given to maintaining an anterior and premolar dentition in one or both jaws
how many occlusal units (teeth) should be left for sufficient adaptive capacity
3-5
(a pair of occluding premolars = 1 unit)
(a pair of occluding molars = 2 units)
how can we extend a shortened dental arch with bridgework
- max one unit on each side of the arch
- minimal contact in excursion
- heavy contacts may lead to failure
how can we extend a shortened dental arch with implants
- single tooth
- cantilever/ fixed bridge
how can we extend a shortened dental arch with RPDs
- bilateral free end saddle
How can you describe RPDs
By support
- tooth borne
- mucosa borne
- tooth and mucosa borne
By material
- acrylic
- cobalt chrome
What are the components of patient assessment for dentures
- history
- examination
- special investigations
- diagnosis
- treatment plan
How do you take a full denture history
- why were teeth lost
- how long have they worn dentures for
- how many dentures have they had
- have they got a favourite denture
- have they got a preferred design
- which do they prefer (metal or acrylic resin?)
How do you take a medical history for a denture patient
- routine medical history
- identify problems which could affect treatment (arthritis, neuromuscular disease, xerostomia, osteoporosis/biphosphonates, insertion and removal)
How do you take a social history for a denture patient
- distance travelled/ ability to attent
- accompanying person?
- hobbies - musical instruments
- smoking
- alcohol
- diet
what are the two arms of an examination for dentures
patient and denture
Describe the patient examination for dentures (extra oral)
Extra-oral
- lower facial height
- nasio-labial angle
- limited opening
- any abnormalities
- smile line
- aesthetics of existing dentures
Describe the patient examination for dentures (intra oral)
General examination
- periodontal status
- endodontic status
- caries
- tooth wear
- indirect restorations
Edentulous spaces
- number
- position
- length
- ridge form
- displaceable tissue
Occlusion
- occlusal vertical dimension
- occlusal contacts
- freeway space
Kennedy class 1
bilateral free end saddle
Kennedy class 2
unilateral free end saddle
kennedy class 3
posterior bounded saddle
kennedy class 4
anterior bounded saddle
craddock class 1
tooth borne
“saddles supported on both sides by substantial abutments”
craddock class 2
mucosa borne
“vertical biting forces resisted entirely by soft tissues”
craddock class 3
tooth and mucosa borne
“tooth supported at only one end of the saddle”
definition of denture support
the resistance to vertical movement of the denture towards the tissue
definition of denture retention
the resistance to displacement of the denture away from the tissue
definition of denture stability
the resistance to horizontal (lateral) movement of the denture
what do you examine in a denture
- aesthetics
- extension
- occlusion
- material
- design
- condition of teeth and base
What are the characteristics of teeth that you can use as abutments
- teeth structurally sound, with satisfactory appearance
- teeth in good alignment and position
- the previous restorations and endodontic treatments are satisfactory
- the abutment tooth roots and supporting alveolar bone are adequate
- the soft tissue of the edentulous ridge is satisfactor in quantity and quality
what special investigations can you do on abutment teeth
- periapical radiographs
- sensibility testing (EPT, ethyl chloride)
- surveyed study models
- clinical photographs
What can be diagnosed relating to the patient
- partial edentulism
- endodontic
- periodontal
- caries
- toothwear
- shortened dental arch
- combination syndrome
what can be diagnosed relating to the denture
- over/under extension
- reduced (support, retention, stability)
- fractured clasps/ baseplate
- No RWS
- poor aesthetics
- worn teeth
how are things diagnosed
structured, logical and discussed with the patient
