RPD CLINICAL - INTRO TO RPD AND PATIENT ASSESSMENT Flashcards
why do patients have missing teeth
Caries Periodontal disease Endodontic infection Trauma Cancer Congenitally absent – hypodontia
what are the consequences of missing teeth
Anatomical
Aesthetic
Functional
Psychological
what are the extra oral anatomical consequences of missing teeth
Changes in facial appearance as teeth give shape to the face
bone resorption
Progressive bone loss results in the chin tipping
Severe bone atrophy occurs and the maxilla comes backwards and the mandible goes forward (class III) giving a sunken in appearance
what are the intra oral anatomical consequences of missing teeth
Alveolar resorption
Tooth movement
Tooth wear
what is the consequences of tooth movement due to missing teeth
o Overtime, the teeth start growing into the space
o There is no room for an implant or bridge
o Partial denture can not even be used sometimes due to over-eruption
o Drifting and tilting can also occur and this can cause problems in the long term as it will cause derangement to the occlusion leading to TMJ problems
what is the aesthetic consequence of tooth movement due to missing teeth
Loss of hard and soft tissues which support the face
what is the functional consequence of missing teeth
Can effect mastication which can effect diet as many denture patients are on soft diets depending on how well they can chew
Effects speech
what is the psychological consequence of missing teeth
The more teeth that are lost the bigger the decline in the quality of life
Can have social implications
how can we replace missing teeth
Resin bonded bridgework Conventional bridgework Implant crowns Implant bridgework Removable partial dentures Complete dentures Implant retained dentures
what is a resin bonded bridgework
can be messiah cantilever or fixed/fixed bridge
does not require destruction of tooth tissues
what is the pontic
fake tooth
what is the retainer
metal wing
what is the abutment tooth
tooth that the support goes on
what is a conventional bridgework
cantilever or fixed fixed
more destructive of tooth tissues as crown prep required
normally metal ceramic crowns
what are implant crowns
The dental implant goes into the bone
The implant abutment goes on top
Then the implant crown – can be cemented in or screwed in
what are implant bridgework
Similar to conventional bridgework except the retainers are put on implant abutmenets
what are the 3 different types of complete dentures
removable
implant retained
implant supported
what is a removable denture
no attachment for stability
what is implant retained denture
snaps in place
what is implant supported denture
screw retained and non removable
what are the advantages of a removable partial denture
Generally less expensive
Minimal tooth prep
Longer edentulous spans can be restored
Replacement of missing alveolar ridge tissues is possible
Can be removed for cleaning and adjustments and repairs
what are the disadvantages of a removable partial denture
Clasps may be unattractive
Designs may be bulky, complicated and plaque retentive
May cause gagging
Retention and stability may be problematic
What is a saddle
where there is no teeth
what is a shortened dental arch
dentition where most posterior teeth are missing and we can have satisfactory oral function without the use of a removable partial denture
what is priority given to in a shortened dental arch
anterior and premolar dentition in one or both jaws
what is the sufficient adaptive capacity in subjects
when 3-5 occlusal units are left
how many units is a pair of occluding premolars
1
how many units is a pair of occluding molars
2
how can we extend a shortened dental arch
bridgework - max 1 unit each side
implants - single tooth or cantilever/fixed bridge
RPD - bilateral free end saddle
what are the different types of support for a RPD
tooth borne
mucosa borne
tooth and mucosa
when assessing the patient what do we do
take history do examination special investigations diagnosis treatment plan
what do we ask when we take a full
o Why were teeth lost? o How long have they worn dentures for o How many dentures have they had o Have they got a favourite o Have they got a preferred design o Do they prefer metal or acrylic resin denture
what are the different material bases
acrylic
cobalt chrome
what problems do we look out for in a medical history
o Identify problems which could affect treatment arthritis neuromuscular mucosal disease xerostomia osteoporosis
what do we ask when taking a a social history
o Distance travelled/ability to attend o Accompanying person? o Hobbies – musical instruments o Smoking o Alcohol o Diet
what do we examine on the patient when doing an extra oral exam
Lower facial height Nasio-labial angle Limited opeing Any abnormalities Smile line – how much tooth do they show Aesthetics of existing dentures
what do we examine in the general examination in the intra oral exam
- Periodontal status
- Endodontic status
- Caries
- Tooth wear
- Indirect restorations
what do we examine when examining edentulous spaces in the intra oral exam
- Number
- Position
- Length
- Ridge form
- Displaceable tissue
what do we examine when we look at occlusion in the intra oral exam
- Occlusal vertical dimension
- Occlusal contacts
- Freeway space
what is the saddle for kennedy class 1
bilateral free ended saddle
what is the saddle for kennedy class 2
unilateral free ended saddle
what is the saddle for kennedy class 3
unilateral tooth bounded saddle
what is the saddle for kennedy class 4
bilateral tooth bounded saddle
what is craddock class I
tooth borne - saddles supported on both sides by substantial abutments
what is craddock class II
mucosa borne - vertical biting forces resisted entirely by soft tissues
what is craddock class III
both - tooth supported at only when end of the saddle
what do we examine in the denture
support
retention
stability
what are we looking for when we examine the support of a denture
The resistance to vertical movement of the denture towards the tissue – if it is too supported it will resist
what are we looking for when we examine the retention of a denture
The resistance to displacement of the denture away from the tissue
what are we looking for when we examine the stability of a denture
o The resistance to horizontal (lateral) movement of the denture
what do we examine with the denture
Aesthetics Extension Occlusion Material Design Condition of teeth and base
what do we look for in the health of the denture bearing area
look to see if there is denture stomatitis
why must we pick the best teeth for abutments
they are going to have more forces coming from different directions so you do not want to use teeth with bone loss for a bridge
what do we look for for abutments
Teeth structurally sound, with satisfactory appearance
Teeth in good alignment and position
The previous restorations and endodontic treatments are satisfactory
The abutment tooth roots and supporting alveolar bone are adequate
The soft tissue of the edentulous ridge is satisfactory in quantity and quality
what special investigations do we take for abutments
We take periapical radiographs to see what the bone support is and if there is any apical infection or disease
Sensibility testing (EPT &Ethyl chloride)
Clinical photographs
how should diagnosis be made
Should be structured, logical and discussed with patient
what is the possible diagnosis
Partial edentulism Endodontic Periodontal Caries Toothwear Shortened dental arch Combination syndrome
what are denture problems
Over/under extension Reduced o Support o Retention o Stability Fractured clasps/baseplate No FWS Poor aesthetics Worn teeth
