Replacing missing teeth Flashcards
Planning for missing teeth
Final tx may not be implemented for some time/ in some cases many years
Need a predictable and durable solution
Consider need for transitional restorations
Build-in contingency planning
High pt expectations
Realistic TP
Partially dentate patient options
No tx
Ortho space closure
Rstoring spaces with removable prostheses
Restoring spaces with endosseus implants
Partially dentate patient - no treatment
Often the best option
Shortened dental arch
Shortened dental arch
Adequate function achieved with reduced dentition
9-10 pairs of occluding teeth
No detrimental effect from prosthesis
What is a functional dentition? WHO definition 1982
“…The retention throughout life of a functional
aesthetic natural dentition of not less than 20 teeth
and not requiring a prosthesis”
Minimum for optimum function
21+ teeth - almost dietary freedom
21+ teeth - no need for prosthesis
Shortened dental arch - evidence
Masticatory efficiency?
Problems to TMJ and periodontal tissues?
Fixed or removable prosthesis?
Shortened dental arch - masticatory efficiency?
SDAs comprising anterior and premolar teeth, in general, fulfil the requirements of a functional dentition
Shortened dental arch - effect on TMD joints?
No evidence that SDA causes overloading of joints and teeth
Neuromuscular regulatory systems control maximum clenching strength in accordance with occlusal scheme
Shortened dental arch - prosthodontic management?
No difference in survival between SDAs restored with removable or fixed adhesive prostheses..
Fixed required significantly less maintenance
Restorative options
Composite build-ups
Removable Partial Dentures
Bridges
Implants
Clinical examination
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
Radiograph examination
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
Disadvantages of RPDs
Plaque accumulation Direct trauma from components Poor distribution of occlusal forces Intolerance of major connector Poor appearance of clasps Difficulty in patient acceptance Insidious nature of caries, perio and chronic atrophic candidosis
Hypodontia case
REFER
We cannot deal with this
Advantages of RPDs
Non invasive Versatile Keep treatment 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 or damage is inevitable
Problems not always reported or noted
Appropriate maintenance is required
Many patients express satisfaction with their dentures
RPD success depends on
Clinician: adequate dental care
Technician: accurate construction
Patient: plaque control
all 3 have to work as a team
Acrylic vs Co/Cr RPDs
Acrylic:
- low cost
- ease of modification
- short denture life expectancy
- alterations required: relines
- following tooth loss
Indications for acrylic RPDs
Remaining teeth have poor prognosis
Diagnostic (interim) denture is required
For young patient to allow for growth
When only a few teeth remain
Indications for Co/ Cr RPDs
Generally denture of choice for permanent prosthesis
When sufficient, healthy, tooth support can be obtained
Fixed partial dentures
Replace teeth only
Destructive
Unpredictable long-term prognosis
Design of choice: single-unit adhesive cantilevered
Implants
Replace teeth
Can replace bone/ soft tissue with grafts
Surgical option with higher morbidity
Predictable success rate >90%
