Part 2: Tooth wear: Dentures, overdentures, & rehabilitation Flashcards
why lack of posterior support?
- Denture intolerance
- Denture refusal
- Supervised neglect
why try to avoid complete dentures in tooth wear patients?
Bruxism does not stop.
So, fractured dentures; ridge resorption; pain & ulceration under complete denture
what types of removable pros is used in tooth wear?
Overdentures
Transitional dentures
Metal based dentures
Simplifying Small saddles
what does rehab of wear often involve?
increase in vertical dimension of occlusion (OVD)
what is an overdenture?
- Any removable prosthesis that rests on one or more remaining natural teeth, the roots of natural teeth and/or dental implants.
what are advantages of overdentures?
- Correction of occlusion and aesthetics
- Support
- Tooth wear management
- Preservation of ridge form (for implants)
- Proprioception (pressure) (sense food in mouth)
- Denture retention
- Can be used with precision attachments
- MRONJ & radiotherapy patients – avoids extractions
- Psychological benefits
- Useful in elderly patients
- Eases transition to edentulism
Disadvantages of overdentures
- Need for good oral health
- Increased caries/periodontal problems
like Care homes - Denture fracture (less space for acrylic for denture)
- Discomfort/infection
worsened with Medical history - Potentially more traumatic extractions
what to do to care for overdentures?
- Good oral hygiene
- Fluoride toothpaste application to roots
- Regular examinations & radiographs
- Denture hygiene
what do transitional denture do?
increase OVD in cases where poor posterior support to create space for restorations
when to use transitional dentures?
- patients who have never worn a denture before
- can patient adjust to new OVD
how long do you wear transitional dentures for and what do you do?
Wear transitional dentures for a few months
If copes with transitional dentures and increased OVD
- Get rid of the impossible
- Crowns with rest seats & undercuts
- Definitive dentures – same OVD as transitional
when to use metal based dentures?
bruxism
what must you do before making co/cr for metal dentures?
Technically difficult
Need to have a wax trial of teeth before making Co/Cr
what could you do for upper metal denture
Metal palate with acrylic post-dam (acrylic post dam because chrome has a bad seal)
An attempt to make a complete denture both retentive & indestructible
what is this
metal overlay denture with spint to protect remaining teeth
how do simplifying small saddles work?
use cantilever bridgewith an aesthetic pontic with metal ceramic which is stronger than a denture tooth
why don’t you use adhesive bridges for simplifying small saddles?
- in a bruxist the excessive forces will cause regular debonding
what should you always try when dealing with dealing with restorations and prostheis?
Where possible try to conform to existing occlusion
Works best in a stable occlusion with sufficient index teeth
Ensure your prosthesis/restoration does not alter the occlusion
what often happens in toothwear?
changing (rehabilitation) of occlusion
Often occlusion is unstable and lack of sufficient index teeth
Usually more challenging to record occlusion
Decision on how much to increase OVD
how do you plan toothwear rehab?
- In both conforming and changing
- Impressions & facebow
- Mounted articulated casts on semi-adjustable articulator + or – surveying
- High quality Interocclusal record – with & without increasing the OVD
- Diagnostic wax up(s)
- Stents – mock-up – temporaries (if indirect); for build-ups; aids consent
- Temporary (transitional) dentures
- Clinical photographs
(Radiographs)
