shortened dental arch Flashcards
What is a shortened dental arch?
A dentition where most posterior teeth are missing
Satisfactory oral function without the use of an RPD
Priority given to maintaining an anterior and premolar dentition in one or both jaws
Name 4 things associated with the loss of molars
Any from:
- reduced masticatory efficiency
- mandibular displacement
- alterations in food selection
- aesthetic issues
- loss of occlusal stability
- TMJ problems
Give 4 indications for a shortened dental arch?
Any from:
- missing posterior teeth with 3-5 occlusal units remaining
- sufficient occlusal contacts to provide a large enough occlusal table
- favourable prognosis for remaining anterior and premolar teeth
- patient not motivated to pursue complex tx plan
- limited financial resources for dental care
What is key for SDA to work?
Remaining natural dentition is preserved for remainder of the patients lifetime
Give 4 contraindications of SDA
Any from:
- poor prognosis for the remaining dentition
- untreated or advanced periodontal disease
- pre-existing TMD
- signs of pathological toothwear
- significant malocclusion - severe class II or class III
What considerations should you make when planning for a SDA?
Does the patient have any problems chewing food?
Does the patient have any appearance or cosmetic concerns from the missing teeth?
Does the patient have any discomfort from the missing teeth?
Is there evidence of occlusal instability because of the missing teeth
If yes, consider replacing the missing teeth
What should be noted in an extra-oral exam when planning for a SDA?
Signs of TMD
Skeletal relationship
What should be notes in an intra-oral exam when planning a SDA?
Signs of bruxism
Signs of toothwear
Periodontal assessment
Occlusal assessment
Note teeth of poor prognosis
What does a periodontal assessment include for SDA?
Non surgical periodontal management if there is active disease
Patient must be able to maintain periodontal health
What are the negative consequences of failure to establish stable periodontal health?
Drifting of teeth under occlusal load
Loss of alveolar bone leading to a compromised denture bearing area in the long term
Loss os space for denture teeth in the long term
What are the consequences of distal tooth migration in SDA?
Increases anterior load
Increases number and intensity of anterior occlusal contacts
Increases interdental spacing
Exacerbated by inadequate periodontal support
What is occlusal stability?
The stability of tooth positioning relative to its spatial relationship in the occluding dental arches
What are the 5 requirements of occlusal stability?
- Stable contacts on all teeth of equal intensity in centric relation
- Anterior guidance in harmony with the envelope of function
- Disclusion of all posterior teeth on the non-working side during mandibular protrusive movement
- Disclusion of posterior teeth on the non-working side during mandibular lateral movement
- Disclusion of posterior teeth on the working side during mandibular lateral movement
Give 4 factors which determine occlusal stability
Any from:
- abscence of pathology eg - tooth wear and periodontal disease
- periodontal support
- number of teeth in the dental arches
- interdental spacing
- occlusal contacts
- mandibular stability
Name 4 ways a traumatic occlusion may manifest?
Fracture of restorations and/or teeth
Tooth mobility
Dental pain not explained by infection
Tooth wear
(May also be a contributing factor to TMD)
