How to tx plan for missing teeth?
Final tx may not be implemented straight away
Need predictable and durable solution
Pt expectation vs realistic tx plan
What options are available for partially dentate pt?
- No tx - shortened dental arch theory
- Ortho space closure
- Restore w/ removable prosthesis
- Restore w/ fixed prosthesis
- Restore w/ endosseous
What is the shortened dental arch theory?
Adequate function can be achieved w/ reduced dentition
9-10 pairs of occluding teeth (5–>5)
No detrimental effect
What is the effect of SDA on mastication?
SDA comprising of anterior and premolar teeth meet requirement of functional dentition
What is effect SDA on TMJ joint?
No evidence SDA causes overload teeth/ joint
Neuromuscular regulatory system controls maximum clenching strength in accordance occlusal scheme
Should SDA be prosthodontically managed - fixed or removable?
No difference between survival rates
Fixed required less maintenance
What is WHO definition functional dentition?
Retention throughout life of functional aesthetic natural dentition of no less 20 teeth and not requiring prosthesis
What does 21+ teeth suggest?
Dietary freedom
No need prosthesis
What are the restorative options?
Composite build up/ RPD/ bridge/ implant
What should be included in clinical exam?
- Occlusal relationship
- Inter-occlusal space
- Centre line/ lip smile line
- Position teeth present
- Shape and position of abutment teeth
- Restorative and vitality status of teeth
What should be considered when doing radiographic examination?
- Position anatomical features
- Pathology present
- Periapical status abutment teeth
- Alveolar support
- Root remnants
- Alveolar height and width
What is RPD?
Replace whole dento-alveolar complex
Non-destructive and fully reversible
What needs to be considered prior to providing RPD?
Appearance Speech implication - missing incisors Mastication- missing molars for this to be affected Preventing tooth movement Load distribution
What support should you avoid in perio pt?
No posterior support
Demise perio condition if bilateral free ended saddle used
What are the disadv of RPDs?
Plaque accumulation Trauma from components Poor distribution of occlusal force Intolerance of connector Poor appearance clasp Pt acceptance Nature: caries, perio, atrophic candidiasis
What are the adv of RPDs?
Non-invasive Reversible Versatile - keep tx options open Can restore long space Replace teeth and supporting structure Removed to assist cleaning Modified for progressive tooth loss
What factors are involved in RPD success?
Clinician- adequate dental care
Technician - adequate construction
Patient - plaque control
Adv/ disadv of acrylic RPDs?
Low cost
Easy to modify
Short denture life expectancy
Alteration required - reline
Indications acrylic RPD?
Remaining teeth poor prognosis
Diagnostic denture required
Young pt allow growth
Few teeth remain
What is a fixed partial denture?
Replace teeth only
Destructive
Can have unpredictable long-term prognosis
What is implants?
Replace teeth
Can replace bone/ soft tissue w/ graft
Surgical option
