Toothwear - Dentures, Overdentures And Rehab

Question 1

How does lack of posterior support affect wear?

Answer 1

It is a modifying factor

Increases severity and rate of progression

Lead to occlusal collapse and functional and aesthetic issues

Question 2

Why do patients present with a lack of posterior support?

Answer 2

Denture intolerance or denture refusal
- pt refuses to wear a denture often as no aesthetic issue

Supervised neglect - extract posterior tooth and no advice given on this matter

Question 3

When are dentures contraindicated in toothwear?

Answer 3

Don’t give complete dentures to bruxists

• it doesn’t stop
• broken dentures
• ridge resorption
• pain and ulceration under denture

Question 4

What is an overdenture?

Answer 4

Any removeable prosthesis that rests on one or more remaining natural teeth, roots of natural teeth or dental implants

Question 5

Give some advantages of overdentures

Answer 5

Correction of occlusion and aesthetics

Proprioception due to remaining natural teeth / roots

Preservation of ridge form as teeth not extracted

Tooth borne support not only mucosal support

Can be used with precision attachments

good for MRONJ or radiotherapy patients as avoids XLA

Eases transition into edentualism

Question 6

Disadvantages of overdentures?

Answer 6

Needs excellent OH
- Increased caries or periodontal issues if not
- can be worse in care homes

Denture fracture as less space for acrylic

Infection around root if retained root becomes infected
- can lead to a more traumatic extraction

Question 7

What oral hygiene care is needed in overdenture cases?

Answer 7

Excellent OH

Fluoride toothpaste applied to tooth roots / short clinical crowns

Regular examinations and radiographs

Denture hygiene instructions are paramount

Question 8

What are transitional dentures useful for?

Answer 8

Increase OVD in cases where poor posterior support to create space

Question 9

What types of dentures may be useful in bruxists?

Answer 9

CoCr backed dentures

• adds metal to the functional cusp occlusal surface of teeth
• adding strength to the denture
• also CoCr denture base to prevent fracture of denture

Overlay denture - splint
- overlays teeth to protect remaining teeth

Question 10

What is needed when planning an extensive toothwear case?

Answer 10

In both conforming and changing

• impressions and facebow record
• mounted articulated casts and cast surveyed
• high quality interocclusal record
• diagnostic wax up
• stents - mock up of temporary tx for patient
• transitional dentures? - plan height and design of dentures
• clinical photographs
• radiographs

Question 11

What is the best evidenced way to deal with anterior toothwear?

Answer 11

Composite build up Dahl technique to prop open posterior bite and allow for eruption of molars into space. This will increase OVD