replacing missing teeth Flashcards
How should you plan for replacing missing teeth?
1. Restorative tx won’t be implemented for many yrs (long staged tx)
2. Need a predictable and durable solution
3. Consider need for transitional restorations (eg. Crown in RPD design, abutment bridge retainer)
4. Contingency planning (what if tooth looses vitality? Can’t stabilise perio?)
5. High pt expectation (under promise, over deliver)
6. Realistic tx plan (make pt aware of cost, time etc, specialist referral?)
How can you manage a partially dentate pt?
1. No tx
2. Ortho space closure
3. Restore w removable prostheses
4. Restore w fixed prostheses
5. Restore space w endosseous implants
What is the SDA?
Shortened dental arch
10 pairs of occluding teeth
Adequate function
No detrimental effects from prosthesis
Evidence- theres masticatory efficiency, no TMJ issues, no difference in success between removable/fixed
What is a functional dentition?
Retention throughout life of a functional aesthetic natural dentition of not less than 20 teeth w/o prostheses
~WHO 1982
What restorative options are there?
1. Composite build ups
2. RPDs
3. Bridges
4. Implant
How should you do a clinical exam?
1. Occlusal relationship- guidance?
2. Inter-occlusal space
3. Centre line
4. Lip smile line
5. Position of teeth present
6. Shape and position of potential abutments
7. Restorative and vitality status of teeth
How should you do a radiographic examination?
1. Position of normal anatomical features
2. Pathological conditions
3. PA status of abutment teeth
4. Alveolar support of abutment teeth
5. Root remnants/foreign bodies
6. Alveolar height and width
How do RPDs replace teeth?
Replaces lost bone and mucosa
Can support tissues
Can affect perio health
If well designed- little impact, non destructive and fully reversible
When might RPDs be used?
Appearance
Improve mastication
Prevention of tooth movement
Better load distribution
Prep for complete dentures
What are disadvantages of RPDs?
1. Plaque accumulation
2. Direct trauma from components
3. Poor distribution of occlusal forces eg. Torquing
4. Intolerance of major connector
5. Poor appearance of clasps
6. Difficulty in pt acceptance
Caries, perio, chronic atrophic candidosis, denture stomatitis
What are advantages of RPDs?
1. Non invasive
2. Versatile
3. Keep tx options open
4. Can restore long spans
5. Will replace teeth and supporting structures
6. Removable to assist cleaning
7. Can be modified for progressive tooth loss and bone resorption
What does RPD success depend on?
Dentist- adequate dental care
Tech- accurate construction
Patient- plaque control
Acrylic vs CoCr?
Acrylic often for upper as more SA of hard palate for retention
CoCr often for lower as less plaque retentive and tolerant due to thinner frame
What are acrylics?
Low cost
Ease of modification
Short denture life expectancy
Alterations required- relines
Following tooth loss
What are indications for acrylics?
If remaining teeth have poor prognosis
When interim denture required
For young pt to allow growth
Only a few teeth remain
