Tooth wear, dentures, overdentures and rehabilitation Flashcards
Lack of posterior support is a modyifying factor of what? What are the consequences of this?
- Tooth wear
- Increases severity and rate of progression of wear
- Ultimately can leas to occlusal collapse
- Functional and aesthetic problems
Why do so many pts have lack of posterior support?
- Denture intolerance
- Denture refusal
- Supervised neglect
What is the key principle of denture and tooth wear pts? Why?
- Try avoid complete dentures in tooth wear pts
- Bruxism does not stop therefore see more
- Fractured dentures
- Ridge resorption
- Pain and ulceration under complete denture
What are some removable prosthodontics that can be utilised in tooth wear cases?
- Overdentures
- Transitional dentures
- Metal based dentures
- Simplifying small saddles
Rehabilitation of tooth wear often involves doing what?
- Increasing vertical dimension of occlusion (OVD)
What is an overdenture?
- Any removable prosthesis that rest on one or more remaining natural teeth, roots of natural teeth and or dental implants
What are some other names for overdenture?
- Overlay denture
- Overlay prosthesis
What are some advantages of overdentures?
- Correction of occlusion and aesthetics
- Tooth and mucosal Support
- Tooth wear management (particularly in cases >2/3rds crown height)
- Preservation of ridge form in prep for later implants
- Proprioception as maintaining roots or natural teeth
- Denture retention due to undercuts
- Can use precision attachments
- Avoids extractions in MRONJ and radiotherapy pts
- Psychological benefits
- Useful in elderly pts
- Eases transition to edentulism
What are some disadvantages of overdentures?
- Need for good oral health
- Increased caries / periodontal problems
- Care Homes harder to maintain oral health
- Denture fracture due to less space
- Discomfort or infection around roots
- If pt has compromised medical history may make infection higher risk
- Potentially more traumatic extractions of infected root compared to whole tooth
What is your approach to this tooth wear case?
- Caries and OHI and prevention
- need to increase OVD
- Get rid of grossly caries teeth
- Place upper and lower overdenture to increase OVD
- Allow extraction sockets to heal
- Cobalt chrome denture ustilising undercuts
What is involved in the care of overdentures?
- Good oral hygiene
- Fluroide toothpaste application to roots
- Reg examinations and radiographs to assess any pathology
- Denture hygiene important as don’t want affecting stability of roots underneath
What are transitional dentures used for?
- Used to assess whether a pt can tolerate wearing dentures to build popsterior support or to increase OVD
- No point in making overdentures for tooth wear build ups if pt can’t wear the denture that will stop the tooth wear in the first place
If a pt can tolerate and wears transitional dentures for a few months what are the next stages of txt?
- If copes and increases OVD
- Get rid of poorly prognosis teeth
- Can place crowns with rest seats and undercuts or RCT and composite build up (comp first as cheaper)
- Definitive dentures with the same OVD as the transitional dentures to reduce chance of fracture or continued tooth wear
What commonly happens with bruxists who have dentures?
- Teeth fall off due to high occlusal forces
What is a txt option to combat teeth that fall of partial dentures for a pt with bruxism?
What do you need to do before making this?
- Metal based dentures
- Done via Co/Cr backing where cobalt chrome is placed on occlusal force of either anterior or posterior teeth and teeth hit metal not tooth
- Need to have a wax trial of teeth before making Co/Cr
What can you do when a complete denture wearing is a bruxist and why?
- Teeth still fall off dentures
- Use metal palate with acrylic post dam
- Attempt to make complete denture both retentive and indestructible
