Replacing Missing Teeth Flashcards
How to plan for missing teeth?
Restorative treatment will not be implemented for years - need stability first
Need a predictable and durable solution
Consider need for transitional restorations
Build in contingency planning
Pt expectations
Realistic tx plan
Options for partially dentate pts?
No tx - shortened dental arch
Ortho space closure
Restore spaces with removable/fixed prostheses
Restore spaces with endosseous implants
Shortened dental arch?
Adequate function achieved with a reduced dentition
9-10 pairs of occluding teeth
No detrimental effect from prosthesis
What is a functional dentition?
Retention throughout life of a functional aesthetic natural dentition with no less than 20 teeth and not requiring a prosthesis
What number of teeth may require prosthesis?
What to consider with a shortened dental arch?
Less than 21
21+ = almost dietary freedom
BUT consider masticatory efficiency, problems to TMJ and periodontal tissues, fixed or removable prosthesis?
What is masticatory efficiency?
Shortened dental arches comprising anterior and premolar teeth, in general, fulfil the requirements of a functional dention
Effects of TMD joints?
No evidence that shortened dental arch causes overloading of joints and teeth
Neuromuscular regulatory systems control maximum clenching strength in accordance with the occlusal scheme
Restorative options for missing teeth?
Composite build ups
RPD
Bridges
Implants
Clinical exam for missing teeth?
Occlusal relationship - guidance? Inter-occlusal space Centre line Lip smile line Position of teeth present Shape and position of potential abutments Restorative and vitality status of teeth
Radiographic exam?
Position of normal anatomical features Pathological conditions Periapical status of abutment teeth Alveolar support of abutment teeth Root remnants and foreign bodies Alveolar height and width
RPD features?
Replace the whole dento-alveolar complex
Non destructive
Fully reversible
Effective permanent or transitional option
Disadvantages of RPD?
Plaque accumulation Direct trauma from components Poor distribution of occlusal forces Intolerance of major connector Poor appearance of clasps Difficulty in pt acceptance
Insidious nature of:
- Caries
- PD
- Chronic atrophic candidosis
Advantages of RPD?
Non-invasive
Versatile
Keep tx options open
Can restore long spans
Will replace teeth and supporting structures
Removable to assist cleaning
Can be modified for progressive tooth loss and bone resorption
RPD or no RPD?
Some form of damage is inevitable
Problems not always reported or noted
Appropriate maintenance is required
What does the success of an RPD depend on?
Clinician - adequate dental care
Technician - accurate construction
Pt - plaque control
All working as a team