Replacing missing teeth

Question 1

Planning for missing teeth

Answer 1

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

Question 2

Partially dentate patient options

Answer 2

No tx
Ortho space closure
Rstoring spaces with removable prostheses
Restoring spaces with endosseus implants

Question 3

Partially dentate patient - no treatment

Answer 3

Often the best option

Shortened dental arch

Question 4

Shortened dental arch

Answer 4

Adequate function achieved with reduced dentition
9-10 pairs of occluding teeth
No detrimental effect from prosthesis

Question 5

What is a functional dentition? WHO definition 1982

Answer 5

“…The retention throughout life of a functional
aesthetic natural dentition of not less than 20 teeth
and not requiring a prosthesis”

Question 6

Minimum for optimum function

Answer 6

21+ teeth - almost dietary freedom

21+ teeth - no need for prosthesis

Question 7

Shortened dental arch - evidence

Answer 7

Masticatory efficiency?
Problems to TMJ and periodontal tissues?
Fixed or removable prosthesis?

Question 8

Shortened dental arch - masticatory efficiency?

Answer 8

SDAs comprising anterior and premolar teeth, in general, fulfil the requirements of a functional dentition

Question 9

Shortened dental arch - effect on TMD joints?

Answer 9

No evidence that SDA causes overloading of joints and teeth

Neuromuscular regulatory systems control maximum clenching strength in accordance with occlusal scheme

Question 10

Shortened dental arch - prosthodontic management?

Answer 10

No difference in survival between SDAs restored with removable or fixed adhesive prostheses..
Fixed required significantly less maintenance

Question 11

Restorative options

Answer 11

Composite build-ups
Removable Partial Dentures
Bridges
Implants

Question 12

Clinical examination

Answer 12

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

Question 13

Radiograph examination

Answer 13

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

Question 14

Disadvantages of RPDs

Answer 14

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

Question 15

Hypodontia case

Answer 15

REFER

We cannot deal with this

Question 16

Advantages of RPDs

Answer 16

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

Question 17

RPD or no RPD?

Answer 17

Some form or damage is inevitable
Problems not always reported or noted
Appropriate maintenance is required
Many patients express satisfaction with their dentures

Question 18

RPD success depends on

Answer 18

Clinician: adequate dental care
Technician: accurate construction
Patient: plaque control
all 3 have to work as a team

Question 19

Acrylic vs Co/Cr RPDs

Answer 19

Acrylic:

• low cost
• ease of modification
• short denture life expectancy
• alterations required: relines
• following tooth loss

Question 20

Indications for acrylic RPDs

Answer 20

Remaining teeth have poor prognosis
Diagnostic (interim) denture is required
For young patient to allow for growth
When only a few teeth remain

Question 21

Indications for Co/ Cr RPDs

Answer 21

Generally denture of choice for permanent prosthesis

When sufficient, healthy, tooth support can be obtained

Question 22

Fixed partial dentures

Answer 22

Replace teeth only
Destructive
Unpredictable long-term prognosis
Design of choice: single-unit adhesive cantilevered

Question 23

Implants

Answer 23

Replace teeth
Can replace bone/ soft tissue with grafts
Surgical option with higher morbidity
Predictable success rate >90%