Objectives Treatment options for Edentulous spaces

Dr David C. Attrill d.c.attrill@bham.ac.uk Review some of the different options for replacing missing teeth and possible benefits Consider possibility of NOT replacing missing teeth Define some of the important terminology used in prosthetics Identify key components of removable partial dentures (retention/support)

What is prosthetics?
That branch of dentistry that deals with the replacement of missing teeth, and/or the replacement of missing tooth tissues Fixed prosthodontics (crowns/bridges) Removable prosthodontics (dentures) [implant retained/supported prosthodontics]

Complete dentures
Failure of all preventative strategies Loss of all teeth Replacement of 24-28 teeth in most cases

Transitional denture
Remaining natural dentition compromised Prosthesis(es) designed to smooth the inevitable transition between partial dentures and complete dentures Dentures designed in such a was as to facilitate addition of prosthetic teeth as and when remaining teeth need to be extracted

RPD - definition
A prosthesis (denture) that replaces some teeth in a partially dentate arch. It can be removed from the mouth (by the patient!) and replaced at will

Adhesive cantilever bridge replacements

Bridge - definition
Also called fixed partial denture (US) A prosthesis that replaces some missing teeth that cannot be removed at will by the patient

Cantilever adhesive bridge (distal cantilver in this instance) Avoids relatively large denture components where only one or two teeth need to be replaced Very selective set of circumstances; adjacent teeth need to be in relatively good condition Possible oral health benefits (cf. denture) in longer term
[Jepson et. al.; BDJ 2001 191(3) 140-144]

Osseointegrated implant
A device, usually made of metal (Ti) which is inserted into the bone 1) Body (implant)
Fixture, surgically placed in bone

Shortened Dental Arch (1)

A minimum of 8-10 occluding pairs of anterior teeth Must be periodontally sound Strictly speaking upper and lower second premolar to second premolar

2) Abutment
Supports and/or retains the prosthesis or superstructure

3) Superstructure

Shortened Dental Arch (2)

No prosthetic treatment may be an appropriate option THIS DOES NOT MEAN NO RESTORATIVE or PREVENTATIVE TREATMENT The provision of a distal extension RPD may not contribute any significant functional benefits Replacement of missing posterior teeth should be driven by demand and function, not by habit

Shortened Dental Arch

The shortened dental arch concept and its implications for oral health care. Witter DJ et al. Community Dentistry and Oral Epidemiology1999 Aug; 27(4): 249-58 Shortened dental arch therapy: views of consultants in restorative dentistry in the United Kingdom. Allen et al. Journal of Oral Rehabilitation 1996 Jul 23(7): 481-5 Caries incidence following restoration of shortened lower dental arches in a randomised controlled trial. Jepson et al. British Dental Journal 2001 191(3):140-144

Why replace missing teeth?

A S M Prevention of Preparation P

Treatment Options for Edentulous Spaces 1) 2) 3) 4)

5)

Large diversity of treatment complexity

Number of teeth to be replaced Health of residual dentition Health of patient Patient requirements Patient expectations Dentist competence Laboratory competence & liaison TIME! MONEY!

Saddle Removable partial dentures

That part of the denture that rests on the oral mucosa or alternatively The space(s) to be filled by the denture

Classification of Saddles
Bounded Saddles
(teeth present at both ends of the saddle area)

Free-end saddles
(teeth present at only the anterior end of the saddle)

Classification of RPDs based on anatomical location of the saddle(s)

Kennedy Classification summary

I II III IV Bilateral free-end saddles Unilateral free-end saddle Single, Bounded saddle Anterior bounded saddle

Modifications of Kennedy classification

Additional bounded saddles over and above the basic Kennedy classification are termed modifications For each additional saddle the term modification is used i.e. Mod. 1, Mod. 2 etc. Modifications are not possible with Kennedy Class IV

Support
The foundation area on which a dental prosthesis rests
or alternatively

Classification of Support
Tooth Mucosa Combination of tooth and mucosa
Others i.e. implants, overdenture (tooth)

The resistance to a vertical displacing force directed towards the mucosa

Retention
That quality inherent in a prosthesis acting to resist movement or displacement away from the mucosa

Mechanical Retention
Mechanical retention is commonly achieved in RPD prosthodontics by the use of clasps Terminal portion of a clasp engages an undercut area on a tooth surface Gingivally approaching vs. Occlusally approaching

Mechanical Retention Occlusally

approaching Gingivally approaching

Major connector
That component of a denture which unites saddles of a denture
Cast metal (Co-Cr) Acrylic resin