Treatment of Teeth in Partial Edentiulism - Choice between dentures, bridges and implants Flashcards
Cantilevered conventional bridge from a root filled tooth survival?
10yrs
52%
Partial denture survival?
10yrs
50-69%
Cantilevered conventional bridge on a vital tooth? Average post and average RBB?
10yrs
80%
Average post
10yrs 80%
Average RBB 10yrs 80%
Tooth vitality after crowing survival?
10yrs
85% survival
Fixed fixed conventional bridge survival?
10yrs
89%
PFM crown survival rate?
10yrs
96%
Implant survival rate?
10yrs
96%
Survival of root treated teeth?
8yrs
97%
What tooth replacement option lasts the longest and shortest amount of time?
SHORTEST
- Cantilevered conventional bridge from a root treated tooth = 52% survival, 10yrs
What reduces the survival of RCT teeth?
Sinus or PA pathology
(PAP reduces success by 50%, further reduces by 14% for every 1mm of increasing size)
Success reduced by 12% for every mm short of apex
Irrigating with CHX
Perforation
Long root filling
What increases the success of root treated teeth?
Achieve patency
Good coronal restoration
What are the main determining factors when choosing between bridge, RPD or implants?
Restorability of tooth
- Assess amount of remaining coronal dentine i root treated teeth
Resistance and retention form for crowns and bridges
- Resin cements help overcome problems but ferrule is critical
- Ferrule of at least 2-3mm is considered critical
- More important on anterior teeth
- More important on the resisting surface in guidance (palatal of uppers)
Structural durability of the supporting structures
e.g. amelogenesis impacts qual of tooth structure
Compromised support
- Root treated teeth more prone to fracture at the cervical margin
- Becomes more significant when considering cantilevered pontics
- A post and core can also predispose to vertical root fracture
Perio support and periodontal health
- Can pt control OH?
- Inappropriate support = increased mobility and failure of rigid components or fracture of the abutments - debonding of a retainer, an uneven distribution of loading on the abutment teeth
- Abutment teeth are more prone to periodontal inflammation
Cleansability and maintenance
- Partial dentures = root caries if poor oH
- accumulate plaque and predispose to gingivitis
- Peri-implant mucositis and peri-implantitis are huge problems (60% of pts will suffer peri-implant mucositis) (20% will suffer peri-implantitis - only option is open flap debridement to tx)
Willingness for surgery and maintenance
- Pts must understand how implant therapy works
- Normally 2 surgeries
- Often sedation
- Grafting from donor sites may be needed
- Need for further surgery
- 2nd stage surgery
- THEN rehab and maintenance
Implant complications
Overall risk
Pts require good periodontal care and occlusal control
Retaining teeth as overdenture abutments?
- Proprioception retained
- Improved retention/stability
- Maintain alveolar bone height
- Psychological benefit
- Increased biting force
- Less mucosal coverage possible
RPD - does extraction and provision of a denture expedite the loss of other/more teeth?
Not if well maintained
Give OHI regularly, after 10 yrs there were no differences to control groups in terms of periodontal outcomes - Bergman 1982
Wright 1992 = if just given prostheses, 57% of those wearing a partial denture = higher evidence of root caries
Jepson and Walls 2011
- Narrative review
- Clear evidence that they can increase plaque and gingivitis
- Increase risk of root caries
- No clear risk of periodontitis
- Can possibly improve QoL
What to do before creating the tx plan?
Full perio assessment before tx plan confirmed
- BPE, recent radiographs showing bone support, pathology with the standing teeth
Individ perio involved teeth may not be suitable for supporting crown and bridge work or indeed a tooth borne prosthesis
Occlusal assessment
- Study models = space for restorations, occlusal contacts, guidance patterns, whether any occlusal anomalies exist is important
Complications of implants?
Bone loss >2mm over 5yrs - 5%
Screw or abutment loosening over 5yrs - 9%
Loss of retention over 5 yrs 4%
Fracture of veneering material over 5 yrs 4%
