replacing missing teeth

Question 1

How should you plan for replacing missing teeth?

Answer 1

1. Restorative tx won’t be implemented for many yrs (long staged tx)
2. Need a predictable and durable solution
3. Consider need for transitional restorations (eg. Crown in RPD design, abutment bridge retainer)
4. Contingency planning (what if tooth looses vitality? Can’t stabilise perio?)
5. High pt expectation (under promise, over deliver)
6. Realistic tx plan (make pt aware of cost, time etc, specialist referral?)

Question 2

How can you manage a partially dentate pt?

Answer 2

1. No tx
2. Ortho space closure
3. Restore w removable prostheses
4. Restore w fixed prostheses
5. Restore space w endosseous implants

Question 3

What is the SDA?

Answer 3

Shortened dental arch
10 pairs of occluding teeth
Adequate function
No detrimental effects from prosthesis

Evidence- theres masticatory efficiency, no TMJ issues, no difference in success between removable/fixed

Question 4

What is a functional dentition?

Answer 4

Retention throughout life of a functional aesthetic natural dentition of not less than 20 teeth w/o prostheses
~WHO 1982

Question 5

What restorative options are there?

Answer 5

1. Composite build ups
2. RPDs
3. Bridges
4. Implant

Question 6

How should you do a clinical exam?

Answer 6

1. Occlusal relationship- guidance?
2. Inter-occlusal space
3. Centre line
4. Lip smile line
5. Position of teeth present
6. Shape and position of potential abutments
7. Restorative and vitality status of teeth

Question 7

How should you do a radiographic examination?

Answer 7

1. Position of normal anatomical features
2. Pathological conditions
3. PA status of abutment teeth
4. Alveolar support of abutment teeth
5. Root remnants/foreign bodies
6. Alveolar height and width

Question 8

How do RPDs replace teeth?

Answer 8

Replaces lost bone and mucosa
Can support tissues
Can affect perio health
If well designed- little impact, non destructive and fully reversible

Question 9

When might RPDs be used?

Answer 9

Appearance
Improve mastication
Prevention of tooth movement
Better load distribution
Prep for complete dentures

Question 10

What are disadvantages of RPDs?

Answer 10

1. Plaque accumulation
2. Direct trauma from components
3. Poor distribution of occlusal forces eg. Torquing
4. Intolerance of major connector
5. Poor appearance of clasps
6. Difficulty in pt acceptance

Caries, perio, chronic atrophic candidosis, denture stomatitis

Question 11

What are advantages of RPDs?

Answer 11

1. Non invasive
2. Versatile
3. Keep tx options open
4. Can restore long spans
5. Will replace teeth and supporting structures
6. Removable to assist cleaning
7. Can be modified for progressive tooth loss and bone resorption

Question 12

What does RPD success depend on?

Answer 12

Dentist- adequate dental care
Tech- accurate construction
Patient- plaque control

Question 13

Acrylic vs CoCr?

Answer 13

Acrylic often for upper as more SA of hard palate for retention

CoCr often for lower as less plaque retentive and tolerant due to thinner frame

Question 14

What are acrylics?

Answer 14

Low cost
Ease of modification
Short denture life expectancy
Alterations required- relines
Following tooth loss

Question 15

What are indications for acrylics?

Answer 15

If remaining teeth have poor prognosis
When interim denture required
For young pt to allow growth
Only a few teeth remain

Question 16

What are indications for CoCr?

Answer 16

Better tolerated and more retentive
Choice for permanent
When sufficient, healthy, tooth support can be obtained

Question 17

What are bridges?

Answer 17

Replace teeth only
Destructive
Unpredictable long term prognosis
Design of choice- single unit adhesive cantilevered

Question 18

What are implants?

Answer 18

Replace teeth
Can replace bone/soft tissue w grafts
Surgical option w higher morbidity
Predictable success rate >90%