options for tooth replacement Flashcards
Why might teeth be missing?
Vascular Infective Traumatic Autoimmune Metabolic Iatrogenic Neoplastic Social factors Congenital Degenerative Endocrine
What infective diseases could lead to tooth loss
Caries
Perio
Endo
What congenital conditions could lead to tooth loss
Clefts
Hyperdontia/anadontia
Cysts
List the different classifications of trauma
- Tooth/ root fracture
- Concussion
- Subluxation
- Lateral luxation
- Intrusive luxation
- Extrusive laxation
- Avulsion
What is a concussion
Injury to the tooth supporting structures without an increase in mobility or displacement of the tooth but with pain to percussion
What is subluxarion
Injury to the tooth supporting structures with an increase in mobility but without displacement of the tooth
What is Luxation
Injury to the tooth supporting structures with an increase in mobility AND displacement of the tooth
What is avulsion
The tooth being lost from the socket
List some options for tooth replacement
- Dentures
- Bridges
- Implants
- Transplant (RARE)
- No treatment
After thinking about a treatment option for replacing missing teeth what do we do next?
Determine the timing of tooth replacement
How can we time our tooth replacement
- Immediate replacement
2. Definitive replacement
What is an immediate replacement
When artificial teeth are provided the same day that the teeth are removed
This may be a short term solution
What is a definitive replacement
Artificial teeth provided as a long term definitive replacement
Why might tooth replacement be delayed
To allow the bony infill to enclose the socket
How long might we delay definitive replacement treatments
6 months to allow the bone to resorb completely
What is an immediate denture
A denture constructed primo to the extraction of the natural teeth and inserted immediately after their removal
List some advantages of immediate dentures
- No period being without teeth,
- Keeps a record of appearance, lip support, occlusal plane, OVD and type of occlusion
- Aids in masticatory function
- Helps speech
- Maintains facial contour and muscle tone
- Made in lab so cuts down on surgery time
- Denture can be removed, repaired and refitted
What are the advantages of a denture being removable
- It can be removed to clean both it and the mouth
- We can easily access the socket
- Can carry out permeant restoration/ preparations to adjacent teeth
List some disadvantages of immediate dentures
- It needs to be constructed prior to extraction so it may not fit or be incorrect shade/ shape
- Healing will change the shape of the underlying ridge
- It is rarely a permanent solution
- A lot of mucosal coverage
- Increased plaque accumulation
- Patient may find it uncomfortable so just not what it leading to tooth drifting
- Pressure on the ridge could increase bone resorption
- Poor retention and aesthetics can be a challenge
What are the key aims of a restoration
- Aesthetics
- Function
- Comfort
- Stability
- Maintainability
What harm can restorations do
- Exacerbate periodontal disease
- Destruction of tooth tissue
- We open dentinal tubules
- Plaque accumulation factor
Give some indications for a removable denture
- Patient with many missing teeth
- Questionable prognosi of remaining teeth
- Young patient
- Sports player
- Gross alveolar resorption
Give some reasons against removable dentures
- Covers gingival margins
- Poor patient tolerance
- Plaque retention
- Patient acceptance
Why might we give a patient a fixed prosthesis
- More acceptable to patient as they don’t need to take it out
- Direct forces axially
- Does not cover the gingival margin
- Restores occlusion
- Periodontal splinting
- Ortho retention
Give some reasons against a fixed prosthesis
- Destruction of tooth tissue
- Requires very good oral hygiene
- Longevity of bridge could be issue in a younger patient
- Periodontal implication sif subgingval margins involved
- Higher cost
Describe a fixed fixed conventional bridge
- 2 retainers surrounding the Pontic
- All joints are soldered or cast in one piece
- Rigidly connects all abutment teeth
- Requires good retention at either end
- Prep is parallel
Describe a cantilever bridge
- Has a pontic connected to retainer at only one Side
- Is moe conservative
- More pressure on abutment tooth so limited span length achievable
What general factors do we need to consider before undertaking fixed prosthodontics
- Patient motivation
- Patient age
- Occupation
- Attendance
- Cost (including biological)
- Anxiety
- Patient expectations
What general factors do we need to consider before undertaking fixed prosthodontics
- Oral hygiene
- Periodontal condition
- Caries status
- Existing restorations
- Endodontics status of abutment tooth
- Apical pathology
- Occlusion
- number of teeth to replace
- Condition of alveolar bone
