The dentist has a wide range for replacing missing teeth And these can due to dental disease trauma developmental anomalies All these have an impact on the condition and prognosis of the remaining teeth ID: 920504
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Slide1
Assessment of dentition and treatment options of replacing missing teeth
Slide2The dentist has a wide range for replacing missing teeth . And these can due to dental disease, trauma, developmental anomalies.
Slide3All these have an impact on the
condition and prognosis of the remaining teeth
which will therefore require very assessment careful to determine whether they require remedial
treatment and furthermore whether they
would provide suitable abutments for fixed or
removable prostheses.
Slide4Initial examination and considerations
The minimal clinical examination should assess
the restorative status of the teeth, a periodontal
screening, mucous membranes, TMJs, jaw and occlusion
Slide5. Vitality testing should also be carried out where appropriate and complete periodontal examination for all those whose screening indicates significant periodontitis.
Slide6Dental panoramic tomogram is the most convenient overall radiographs.
It may needs to be supplemented
with intra-oral radiographic examination.
Bitewing radiographs are adequate for dentitions minimally affected by caries or early periodontitis
Slide9Slide10Periapical
radiographs
using a paralleling technique should be advisable for all potential abutment teeth,
heavily restored teeth, teeth with known or suspected endodontic problems and teeth with moderate to advanced periodontitis.
Slide11Slide12Following a full clinical and radiographic
examination, it may be helpful to assign a prognosis to individual teeth , taking into account all factors restorative, endodontic, periodontal.
Slide13The prognosis may be simply
categorised
e.g.
excellent/good, fair, questionable/poor, hopeless.
Slide14Important factors which adversely affect individual tooth prognosis
Restorations and caries Extensions
subgingivally
or onto root surfaces
Extension within the pulp chamber or root canal
Minimal remaining coronal tooth substance
Inadequate or overextended posts in root filled teeth
Endodontic factors
Periapical
symptoms/signs
Inability to control the coronal seal
Inadequate previous RCT including broken instruments in root canal
Sclerosed
canals
Fractures/splits
Slide16Periodontal factors Probing depths over 6 mm
Attachment loss over 6 mm
Bone loss, more than 50%
Poor root morphology — especially short roots
Involvement of
furcations
— especially grade II/III
Mobility — especially grade III
Occlusal
factors
Signs of
parafunction
or severe attrition
History of repeated tooth restoration/fractures
Slide17Potential abutment teeth
The size and shape of the natural crown and
root form are important considerations.
Slide18Healthy
unrestored
teeth make the best abutment for fixed bridges. But teeth with short and conical crown offer poor retention and support .And this can be
overcome by surgical crown lengthening.
Slide19The edentulous area
The requirements for restoring an edentulous
area depend upon its location and size. In cases of missing molars
Slide20patients will accept or prefer non-replacement
of missing molars. The concept of the shortened
arch is well established and most patients
will accept a dentition extending from first
molar to first molar or from second premolar to
second premolar.
Slide21But replacing of missing molars is important to
prevnt
the
overeruptioon
of the opposing ones
Slide22Single missing teeth
The size of the edentulous space of
singl
missing units varies enormously. Orthodontic
realigment
may need to be considered to either eliminate the space or provide enough .space to accommodate the missing unit
In spaced dentitions the prosthetic
options for replacement of the single missing
tooth are more limited
Slide26Multiple missing teeth
In these cases we have to consider the
aethetic
requirement including the number and size of teeth , the shape and the height of the ridge, and the
the
alveolar
resorption
either vertical or horizontal.
Slide27These information can be collected from existing prosthesis, or carry out a diagnostic wax
up,or
temporary denture.
Loss of ridge height and width may
necessitate prosthetic replacement of the missing
soft and hard tissues to provide adequate
aesthetics at the gingival margin and lip support.
Slide28In cases of removable prostheses this can be
achieved with a labial flange but if a fixed
restoration is to be chosen, then some form of
ridge augmentation may be necessary.
Slide29Occlusal
relationships
Examination of the occlusion should encompass
basic jaw relationships and determination
of the
intercuspal
position.
Slide30For individuals with
edentulous spans greater than one unit it is
advisable to take accurate study casts and
mount these in a semi-adjustable articulator
using a
facebow
. This will allow a clear assessment
of the
occlusal
scheme and implications
of the treatment alternatives to be more accurately
assessed.
Slide31Tilted and
overerupted
teeth , patient with
parafunctional
activitis
or sever
occlusalwear
may need to be
corrected before a satisfactory restoration can
be provided.
Slide32Treatment options
Removeable
prostheses
These are a commonly prescribed treatment
option and may be used as a long term or provisional restoration prior to a fixed prosthesis.
Slide33Advantages
• Replace multiple teeth in multiple sites
• Support obtained from mucosa and/or teeth
• Generally do not require extensive preparation
of abutment teeth
• May be designed to accommodate future
tooth loss
Slide34Can be used to replace missing soft tissue
• Can provide good lip support by incorporating
labial flanges
• Aesthetics may be very good
• The least expensive of restorations
Slide35Disadvantages
•
Removeable
prostheses may not be liked by
patient and may reduce self-confidence
• Connectors cover soft tissue such as the
palate and
gingiva
• In subjects with less than ideal oral hygiene
they may compromise the health of the periodontal
tissues and promote caries around
abutment teeth.
Slide36Retentive elements such as clasps may spoil
aesthetics
• Moderate maintenance requirements and
durability
Slide37Fixed prostheses
Fixed prostheses fall into two main categories
1.Resin bonded bridgework .
2.Conventional partial or full coverage bridgework
Slide38Resin bonded bridgework
Advantages
• Minimal or no preparation required
• Fixed restoration
• Good aesthetics if ideal spacing exists and
abutment teeth are satisfactory
Slide39• Less expensive than conventional bridges
• Consequences of failure are relatively small -
caries is readily diagnosed in most instances.
Cantilever designs for single tooth replacements
minimise
potential problems
Slide40Disadvantages
• Lack of predictability:
decementation
leading
to loss of retention or caries under one of the
retainers — average life span 5 to 7 years.
• Dependent upon meticulous technique and
available enamel surface area for bonding
Slide41Change in
colour
/translucency of abutment
teeth due to presence of retainer
• May interfere with occlusion, particularly
incisal
guidance
• Patients may feel sense of insecurity with
restoration, especially if their bridge has
debonded
previously
Slide42Conventional partial or full coverage
bridgework
Advantages
• Fixed
• Good appearance, including that of abutment
teeth if they need to be improved/
harmonised
Slide43• Medium term predictability is good for short
span bridges
• Good control of occlusion possible
• Minimally compromise oral hygiene
Slide44Disadvantages
• Involve considerable tooth preparation
which sometimes result in
pulpal
sequelae
• Failure due to
decementation
and caries of
abutment teeth may lead to further tooth
loss
• Moderately expensive
Slide45• Highly operator dependent requiring exacting
techniques both clinically and technically
• Requires lengthy clinical time and temporary
restorations
• Irreversible
Slide46Implant retained prostheses
Advantages:
• Fixed or
removeable
• Independent of natural teeth — can provide
fixed restoration where no abutment
teeth exist
• Immune to dental caries
• High level of predictability
• Good maintenance of supporting bone
Disadvantages
• Dependent upon presence of adequate bone
quantity and quality
• Involves surgical procedure(s)
• Highly operator/ technique dependent
• High initial expense and lengthy treatment
time
• Moderate maintenance requirements especially
for
removeable
or extensive fixed prostheses
Slide48Treatment choices:
dependent upon the patient
expectations/desires, financial budget and willingness to undergo treatment
the patient’s expectations are realistic
and achievable.
Slide49Conclusion
The patient should be presented with the
treatment alternatives and an indication of
their respective advantages and disadvantages
in their particular case.
Slide50important to ensure that the
patient understands the treatment plan and a written consent to the agreed treatment
plan is advisable.
Slide51Thank You
Slide52Slide53Slide54