Maintenance phase in RD

Question 1

Features of maintenance?

Answer 1

Plan it from the onset
Part of the prognosis
Pt to understand the limited life of all restorations
Pt to commit to the time and financial commitment for life

Question 2

What determines the survival length of the tx?

Answer 2

Build quality
Product handling (loading - functional and parafunctional)
Environment (wet, variable pH, bacterial biofilm, temperature changes, tooth-material environment)
Maintenance

Question 3

Define maintenance

Answer 3

A comprehensive purpose defined maintenance (service) schedule

Question 4

What should the pt understand regarding maintenance?

Answer 4

Time
Finances
Own health
OH - now and later

Question 5

Quality of build?

Answer 5

Biological substrate and materials
Operator skills
Facilities and time to provide tx

Question 6

What to do at a review?

Answer 6

Check for new/continuing disease
- Plan remedial therapy and maintenance
- May require specialist care via referral
Check compliance with maintenance protocol
Determine future recall periods
Ask why there has been a problem e.g. fracture

Discover new disease

• Caries - tooth wear - is it new or did you fail to manage existing disease? Is the tooth wear a new phenomenon or did you fail to manage this in the 1st place?
• Recurrent/root caries - use GIC or dentine bonded composite to repair small defects
• Wear of adjacent and opposing teeth - problem with ceramics in group function occlusion

Pulpal problems:

• Inflam and sensitivity
• Necrosis and apical infec

Trauma

• Damage to crowns and bridges
• Root fractures
• Mouthguards to sports players

PD

• Poor plaque control
• Failure to maintain treated disease or treat it

Question 7

Types of technical failure?

Answer 7

Fractured restorations
Marginal breakdown
Tooth fracture
Defective contour
Appearance
Retention failure