Part 2: Tooth wear: Dentures, overdentures, & rehabilitation

Question 1

why lack of posterior support?

Answer 1

• Denture intolerance
• Denture refusal
• Supervised neglect

Question 2

why try to avoid complete dentures in tooth wear patients?

Answer 2

Bruxism does not stop.
So, fractured dentures; ridge resorption; pain & ulceration under complete denture

Question 3

what types of removable pros is used in tooth wear?

Answer 3

Overdentures
Transitional dentures
Metal based dentures
Simplifying Small saddles

Question 4

what does rehab of wear often involve?

Answer 4

increase in vertical dimension of occlusion (OVD)

Question 5

what is an overdenture?

Answer 5

• Any removable prosthesis that rests on one or more remaining natural teeth, the roots of natural teeth and/or dental implants.

Question 6

what are advantages of overdentures?

Answer 6

• 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

Question 7

Disadvantages of overdentures

Answer 7

• 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

Question 8

what to do to care for overdentures?

Answer 8

• Good oral hygiene
• Fluoride toothpaste application to roots
• Regular examinations & radiographs
• Denture hygiene

Question 9

what do transitional denture do?

Answer 9

increase OVD in cases where poor posterior support to create space for restorations

Question 10

when to use transitional dentures?

Answer 10

• patients who have never worn a denture before
• can patient adjust to new OVD

Question 11

how long do you wear transitional dentures for and what do you do?

Answer 11

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

Question 12

when to use metal based dentures?

Answer 12

bruxism

Question 13

what must you do before making co/cr for metal dentures?

Answer 13

Technically difficult
Need to have a wax trial of teeth before making Co/Cr

Question 14

what could you do for upper metal denture

Answer 14

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

Question 15

what is this

Answer 15

metal overlay denture with spint to protect remaining teeth

Question 16

how do simplifying small saddles work?

Answer 16

use cantilever bridgewith an aesthetic pontic with metal ceramic which is stronger than a denture tooth

Question 17

why don’t you use adhesive bridges for simplifying small saddles?

Answer 17

• in a bruxist the excessive forces will cause regular debonding

Question 18

what should you always try when dealing with dealing with restorations and prostheis?

Answer 18

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

Question 19

what often happens in toothwear?

Answer 19

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

Question 20

how do you plan toothwear rehab?

Answer 20

• 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)