Replacing Missing Teeth

Question 1

How to tx plan for missing teeth?

Answer 1

Final tx may not be implemented straight away
Need predictable and durable solution
Pt expectation vs realistic tx plan

Question 2

What options are available for partially dentate pt?

Answer 2

1. No tx - shortened dental arch theory
2. Ortho space closure
3. Restore w/ removable prosthesis
4. Restore w/ fixed prosthesis
5. Restore w/ endosseous

Question 3

What is the shortened dental arch theory?

Answer 3

Adequate function can be achieved w/ reduced dentition
9-10 pairs of occluding teeth (5–>5)
No detrimental effect

Question 4

What is the effect of SDA on mastication?

Answer 4

SDA comprising of anterior and premolar teeth meet requirement of functional dentition

Question 5

What is effect SDA on TMJ joint?

Answer 5

No evidence SDA causes overload teeth/ joint

Neuromuscular regulatory system controls maximum clenching strength in accordance occlusal scheme

Question 6

Should SDA be prosthodontically managed - fixed or removable?

Answer 6

No difference between survival rates

Fixed required less maintenance

Question 7

What is WHO definition functional dentition?

Answer 7

Retention throughout life of functional aesthetic natural dentition of no less 20 teeth and not requiring prosthesis

Question 8

What does 21+ teeth suggest?

Answer 8

Dietary freedom

No need prosthesis

Question 9

What are the restorative options?

Answer 9

Composite build up/ RPD/ bridge/ implant

Question 10

What should be included in clinical exam?

Answer 10

1. Occlusal relationship
2. Inter-occlusal space
3. Centre line/ lip smile line
4. Position teeth present
5. Shape and position of abutment teeth
6. Restorative and vitality status of teeth

Question 11

What should be considered when doing radiographic examination?

Answer 11

1. Position anatomical features
2. Pathology present
3. Periapical status abutment teeth
4. Alveolar support
5. Root remnants
6. Alveolar height and width

Question 12

What is RPD?

Answer 12

Replace whole dento-alveolar complex

Non-destructive and fully reversible

Question 13

What needs to be considered prior to providing RPD?

Answer 13

Appearance
Speech implication - missing incisors
Mastication- missing molars for this to be affected
Preventing tooth movement
Load distribution

Question 14

What support should you avoid in perio pt?

Answer 14

No posterior support

Demise perio condition if bilateral free ended saddle used

Question 15

What are the disadv of RPDs?

Answer 15

Plaque accumulation
Trauma from components 
Poor distribution of occlusal force
Intolerance of connector 
Poor appearance clasp
Pt acceptance
Nature: caries, perio, atrophic candidiasis

Question 16

What are the adv of RPDs?

Answer 16

Non-invasive
Reversible
Versatile - keep tx options open
Can restore long space
Replace teeth and supporting structure 
Removed to assist cleaning 
Modified for progressive tooth loss

Question 17

What factors are involved in RPD success?

Answer 17

Clinician- adequate dental care
Technician - adequate construction
Patient - plaque control

Question 18

Adv/ disadv of acrylic RPDs?

Answer 18

Low cost
Easy to modify

Short denture life expectancy
Alteration required - reline

Question 19

Indications acrylic RPD?

Answer 19

Remaining teeth poor prognosis
Diagnostic denture required
Young pt allow growth
Few teeth remain

Question 20

What is a fixed partial denture?

Answer 20

Replace teeth only
Destructive
Can have unpredictable long-term prognosis

Question 21

What is implants?

Answer 21

Replace teeth
Can replace bone/ soft tissue w/ graft
Surgical option