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DMD3 sem 2 > Edentulous Ridges > Flashcards

Flashcards in Edentulous Ridges Deck (22)
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1
Q

What health outcomes are associated with edentulism?

A

People who are edentulous often attend the dentist less often, have poorer diet, have shorter life expectancy, and have increased cardiovascular disease risk

2
Q

Who is more at risk of becoming edentulous?

A

Older groups

Increased in people with <9 years of schooling

Increased in patients eligible for the public dental services

Increased in people living in remote/rural areas

F > M ratio

19% of patients >65 are fully edentulous

3
Q

What is the trend of prevalence of edentulism?

A

Projections stated that by 2021 rate 2.7 - 3% and by 2041 0.4 - 1%

Average tooth loss per person was 10.8

So it is decreasing

4
Q

What are the classes of bone loss?

A

Class 1 - Tooth present no bone loss

Class 2 - Immediate tooth loss no bone loss

Class 3 - Rounding of the boney ridge

Class 4 - Knife edge ridge - good height but poor width

Class 5 - Flat ridge height and width loss

Class 6 - Resorption down to basal bone

5
Q

How is bone typically lost? (direction)

A

From buccal to lingual

6
Q

How do complete dentures affect chewing forces with time?

A

After 5 years there is 75% reduction in chewing forces and after 15 years 97%

7
Q

What problems are common in patients with complete dentures?

A

Comfort/sore spots

Aesthetics

Phonetics

Swallowing

Nausea

Loss of taste

Poorer quality of life

8
Q

What landmarks are used in the Misch-Judy classification?

A

Sextants divided by mental foramen and bounded by the retromolar pad.

Maxilla anterior sextant is bound by second premolars through to second molars

This is because their is definitive change between these areas

9
Q

How are edentulous arches classified by Misch-Judy?

A

Type 1, 2 and 3 each having subclasses of A B C D E F G H

Type 1 = Bone similar in all sextants. A = abundant bone, B = Abundant bone but only good for narrow implants, C = Good height poor width so onlay grafting needed, D - H = Poor height and width so major bone grafting needed.

Type 2 = Difference between posterior and anterior sextants. Sinus pneumatisation in maxilla and resorption of the posterior mandible.

Type 3 = Anterior sextants similar bone volumes and posterior sextants different. Right and left posterior differ and Grafting requirements are different between areas

10
Q

What affects the amount of bone loss?

A

The cause of tooth loss

Existing diseases pre-extraction

Genetics

Position

11
Q

Why is the bone ridge classification important?

A

Maxillary sinus is present above the maxillary molars meaning bone ridge is compromised in some people in that area.

Anterior maxilla tends to hold onto bone height but loses bone width.

Mandible posterior areas lose bone level quickly which impacts implants severely

12
Q

What strategies are available for implant retained prostheses?

A

All on 4 or all on 6.

Replacing every missing tooth with implants

13
Q

What does strategy of edenulous treatment depend on?

A

Amount of available bone

Choice of material for super structure

Proximity of sinus and pneumatisation

Proximity of neurovascular bundles

Previous history of periodontal diseases

Finances of patient

14
Q

When is all on 4 and all on 6 used?

A

6 implants are indicated for full arch fixed prosthesis in the maxilla

4 implants are sufficient in the mandible

15
Q

What are the advantages of using all on 4/6?

A

Tilted implants have made the all on 4 very predictable

Increase A-P spread of implants and improved biomechanics and force distributions

Decreases cantiilevers

Avoids major bone grafting

Great success rates

Good for immediate loading and provisionalisation

16
Q

Why are tilted implants used for all on 4?

A

Tilted implants provide increased A-P spread of the prosthesis

17
Q

When are implant retained prostheses used for edentulous patients?

A

Depends on:

Amount of available bone

Inter-arch force

Choice of material for super structure

Proximity of sinus and pneumatisation

Proximity of neurovascular bundles

Previous history of periodontal disease

Finances of patient

18
Q

What are the advantages for implant retained overdentures?

A

Improved stability and retention of the structure

Decreased soft tissue trauma and soreness

Improved chewing forces and speech

Reduced prosthesis size in some cases

19
Q

What are the indications for using implant retained overdentures?

A

Where patient has limited bone volumes and distribution

Patients who have been unsuccessful in wearing conventional well made complete dentures

Mandibular cases have higher success rate than maxillary cases

20
Q

What are locators? Why aren’t locators typically used in the maxilla?

A

Locators are individual implants not connected with the other implants by a bar

21
Q

How much interarch space is required for overdentures?

A

15mm in anterior maxilla and 12mm in posterior maxilla to accomodate superstructure

22
Q

What are the treatment options available for an edentulous mandible?

A

Single implant supported lower overdenture: Good for patietns unable to afford implants, lingual bone is a good shock absorber, uses a large ball attachment but this method can get hinging and rocking of overdenture

2 mandibular implants: Gold standard. Ball attachments

3 implants: Bar supported overdenture, significant improved retention and stability, needs tripod design and increased interarch space

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