Reasons for Rendering a Patient Edentulous

Question 1

What is a complete denture?

Answer 1

A removable dental prosthesis that replaces the entire dentition and associated structures of the maxilla or mandible

Question 2

What are complete dentures usually made of?

Answer 2

PMMA
rarely Co/Cr

Question 3

Why isn’t flexi material used often for dentures?

Answer 3

because it is porous, it can house bacteria

Question 4

Why are acrylic dentures sometimes clear?

Answer 4

some patients are allergic to pigments in acrylic

Question 5

What are the effects of edentulism?

Answer 5

Loss of masticatory function Appearance
Self esteem
General health effects Quality of life
Speech

Question 6

What are the examinable effects of edentulism?

Answer 6

Ridge resorption
Soft tissue changes to lip & chin (witches chin)
Reduction in face height

Question 7

How does post extraction resorption occur?

Answer 7

Occurs rapidly after extraction particularly in 1st six months

Individually variable

May be dependent on pre- extraction status of teeth

Occurs throughout life

Question 8

What are the 6 stages of atrophy according to cawood and howell?

Answer 8

Stage I: Dentate (fully dentate jaw with complete tooth presence).

Stage II: Immediately post-extraction (with the socket still intact, but bone starting to resorb).

Stage III: Early ridge resorption (mild to moderate resorption after the initial healing).

Stage IV: Advanced ridge resorption (ridge becomes more rounded and less prominent).

Stage V: Severe atrophy (minimal remaining ridge height, often with a concave appearance).

Stage VI: Extreme atrophy (flat residual ridge with only basal bone remaining)

Question 9

What stages are PDD patients more likely to be?

Answer 9

4, 5, 6

Question 10

What are the disadvantages of complete dentures?

Answer 10

• Inefficient at mastication
• Require good neuro-muscular control
• Stability of a lower complete often compromised by tongue movements
• Appearance/speech can be sub-optimal
• NOT A DIRECT REPLACEMENT FOR NATURAL BUT BETTER THAN ON TEETH AT ALL
• Almost a treatment of last resort
• Managing expectations is paramount

Question 11

Why do we render patients edentulous and make complete dentures?

Answer 11

• Caries and its sequelae - Rampant
• Periodontal Disease – Advanced, Hopeless teeth
• Tooth wear – Severe and debilitating
• Failing dentitions – Overambitious treatment, cycles of replacement
• Occlusal collapse – often secondary to the above
• Appearance – often secondary to the above

Question 12

What are sequelae for rampant caries?

Answer 12

Xerostomia
Sjogren’s syndrome Radiation caries Developmental disorders Disability
Dementia
Addiction

Question 13

What might be the cause of periodontal disease?

Answer 13

Susceptibility
Disability
Dementia
Medical factors
Social history

Question 14

What might be the cause for tooth wear?

Answer 14

Erosion
Abrasion
Attrition
Lack of posterior support Supervised neglect

Question 15

What might be the cause for failing dentitions?

Answer 15

Overambitious treatment Cycles of replacement
Human, medical & social factors

Question 16

What might be the cause for occlusal collapse?

Answer 16

Often secondary to other reasons eg: Caries, perio, tooth wear etc

Question 17

What might be the cause for appearance?

Answer 17

Often secondary to other reasons eg: Perio drifting, severe tooth wear/occlusal collapse

Question 18

What are other, rarer reasons we render patients edentulous and make complete dentures?

Answer 18

• Head & Neck cancer chemo-radiotherapy
• Head and cancer : dentition lost in maxilla or mandible due to cancer
  resection and/or reconstruction
• Pre- chemotherapy in some cancers eg leukaemia and need for bone marrow transplant - When poor quality dentition & infection risk
• Pre-transplant: When poor quality dentition & infection risk
• Pre cardiac surgery eg prosthetic heart valve - When poor quality
  dentition & infection risk
• At patient’s request: Consent

Question 19

What are the 3 different methods of complete denture construction?

Answer 19

Conventional dentures Replica dentures (Digital dentures)

Question 20

What are conventional dentures and when should they be used?

Answer 20

Dentures made from scratch therefore they take longer, jaw registration are more complex and there are 2 impression stages in mouth. You can make major mods and correct faults more easily

They should be used if no previous denture, poor previous denture and unsuccessful

Question 21

What are replica (dundee) dentures and when should you use them?

Answer 21

Dentures made off the original design, with 1 less clinical stage, jaw registration simpler and 2 impression stage in the mouth

Should only be used for simple mods

Question 22

What are reasons we would use a conventional denture in one arch and a replica in another?

Answer 22

• Patient happy with upper aesthetics; show more upper teeth
• Patient coping well with upper and poorly with lower
• Lower of inadequate design eg: height/base extension

Question 23

What are the steps for digital dentures?

Answer 23

scan models
digital software workflow
milling machine
milling the denture base
milling the dental arch
cementing the denture base to arch