RPD CLINICAL - INTRO TO RPD AND PATIENT ASSESSMENT Flashcards by Roisin Mousa

why do patients have missing teeth

 Caries
 Periodontal disease
 Endodontic infection
 Trauma
 Cancer
 Congenitally absent – hypodontia

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what are the consequences of missing teeth

 Anatomical
 Aesthetic
 Functional
 Psychological

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what are the extra oral anatomical consequences of missing teeth

 Changes in facial appearance
 Bone resorption
 Progressive bone loss –> chin tipping
 Severe bone atrophy occurs –> class 3 jaw relationship

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what are the intra oral anatomical consequences of missing teeth

 Alveolar resorption
 Tooth movement
 Tooth wear

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what is the consequences of tooth movement due to missing teeth

o There is no room for an implant or bridge
o Partial denture can not even be used sometimes due to over-eruption
o Can cause derangement to the occlusion leading to TMJ problems

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what is the aesthetic consequence of tooth movement due to missing teeth

 Loss of hard and soft tissues which support the face

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what is the functional consequence of missing teeth

 Can effect mastication –> soft diet

 Effects speech

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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

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how can we replace missing teeth

 Resin bonded bridgework
 Conventional bridgework
 Implant crowns
 Implant bridgework
 Removable partial dentures 
 Complete dentures
 Implant retained dentures

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what is a resin bonded bridgework

can be mesial cantilever or fixed/fixed bridge

does not require destruction of tooth tissues

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what is the pontic

fake tooth

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what is the retainer

metal wing

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what is the abutment tooth

tooth that the support goes on

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what is a conventional bridgework

cantilever or fixed fixed
more destructive of tooth tissues as crown prep required
normally metal ceramic crowns

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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

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what are implant bridgework

Similar to conventional bridgework except the retainers are put on implant abutmenets

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what are the 3 different types of complete dentures

removable
implant retained
implant supported

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what is a removable denture

no attachment for stability

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what is implant retained denture

snaps in place

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what is implant supported denture

screw retained and non removable

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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

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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

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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

how many units is a pair of occluding molars

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 denture history

``` 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

anterior bounded saddle (crossing midline)

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 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

What do we want for the abutment teeth

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 ```