Maintenance and monitoring Flashcards
Dental care involves more than the treatment of the
consequences of disease
It concerns preventing disease, repair when
necessary, and monitoring the restored state to
ensure health is maintained
Maintenance points
Plan for it from the outset
Part of the prognosis
Patient to understand limited life of all
restorations
Patient to commit to the time and financial commitment…for life!
4 factors that determine survival
Build quality
Environment
Maintenance
Product handling
Weibull survival curve
Like a bath-tub Burn-in testing eliminates early failures Early decrease in failure rate Stable for a while Increasing failure rate after long time **** look at graphs
Build quality: intra-oral assembly
The biological substrate and quality of building materials
Operator skill-set
Facilities and time
Loading (product handling)
Direct and indirect loading forces
-functional
-para-functional
What type of service will it see?
Environment
Constantly wet T changes Tooth-material interactions Variable pH Bacterial biofilm -understand the reality of the harsh environment of the mouth
Maintenance definition
A comprehensive purpose-designed
maintenance (service) schedule
Maintenance in the treatment plan
Emergency tx Disease control and stabilisation Evaluation of outcomes Rehabilitation - advanced restorative care Evaluation of outcomes Maintenance
Maintenance is key to
prognosis
Pt to understand implications
- Time
- Finances
- Own health
- Oral hygiene: Now and later
Maintenance discussed and agreed when?
Before finalising tx strategy
What to do at review
Check for new or continuing disease
– Plan remedial therapy and maintenance
Check adequacy of existing restorations
– Plan repair or replacement when required
– May require specialist care via referral
Check compliance with maintenance protocol
Determine future recall periods
Caries - tooth wear
– Is it trully new caries? Or did you (and patient) fail to manage existing disease?
– Is the tooth wear a new phenomenon or did you fail to manage this in the first
instance?
– Recurrent caries and root caries - use glass-ionomer cements or dentine bonded
composite to repair small defects
– Wear of adjacent and opposing teeth - a major problem with ceramics in group
function occlusion
Pulpal problems
– Pulpal inflammation and sensitivity
– Pulp necrosis and apical infection
Trauma
– Damage to crowns and bridges - sports
injury
– Root fractures
– Supply mouthguards to sports players
Periodontal disease
– Poor plaque control
– Failure to treat established disease
– Failure to maintain treated disease
– Endo/perio problems
Tooth fracture
Could it have been predicted? Why did it happen? What factors have led to this? What is involved in repairing this? Can the precipating factors be eliminated or managed?
Technical failure
Fractured restorations Marginal breakdown Tooth fracture Defective contour Appearance Retention failure
Deterioration vs failure
Unacceptable deterioration = Failure
When does deterioration become unacceptable?
Deterioration vs failure - the pt’s view
– Wide variation exists in what is acceptable
to patients
– Prognosis of types of repair/replacement
must be balanced
– Difference of opinion may prevent a
satisfactory outcome
– Importance in stating a PROGNOSIS at the
outset of treatmemt
Deterioration vs failure - the dentist’s assessment
– Minimal technical failures may not require
treatment
– Patching rather than replacement is often
appropriate
Planned maintenance vs emergencies
Plan for failure where prognosis is guarded
-use restorations and prostheses that can
be easily modified and maintained.
-anticipate tooth loss in cases with advanced periodontal disease and
doubtful plaque control
Failures at recall can be serviced before
they become emergencies
Early observation of failure may facilitate
cheaper repair rather than expensive
replacement
