Replacing Missing Teeth

Question 1

Things to consider

Answer 1

Takes time
Predictable and durable solution required
Consider need for transitional restorations
High expectations

Question 2

Partially dentate - options

Answer 2

Nothing
Orthodontic space closure
Restoring with prostheses
Restoring with implants

Question 3

Shortened dental arch - prognosis

Answer 3

Adequate fx
9-10 pairs of occluding teeth
Prosthesis add fx

Question 4

Functional dentition - WHO definition

Answer 4

The retention through life of a functional aesthetic natural dentition of not less than 20 teeth and not requiring prostheses

Question 5

Effect of SDA on TMJ

Answer 5

No evidence of overload

Proprioceptive fx controls maximum pressures etc

Question 6

Effect of SDA on prostho management

Answer 6

No diff in survival restored with fixed or removable

Fixed requires less maintenance

Question 7

Restorative options for missing teeth

Answer 7

Composite Build up
RPDs
Bridges
Implants

Question 8

Clinical exam - features to note

Answer 8

Occlusal relationship 
Inter occlusal space
Centre line
Lip smile line
Position of teeth present 
Shape and position of potential abutments 
Restorative and vitality status of teeth

Question 9

Radiographic examination

Features to note

Answer 9

Position of normal anatomical features 
Pathological conditions 
PA status of abutment teeth 
Alveolar support of abutment teeth 
Root remnants and foreign bodies
Alveolar height and width

Question 10

RPD - characteristics

Answer 10

Replace whole Dento alveolar complex
Non-destructive
Fully reversible
Effective permanent or transitional option

Question 11

RPD things to consider

Answer 11

Appearance
Mastication
Prevention of tooth movement

Question 12

Disadvantages of RPD

Answer 12

Plaque accumulation
Direct trauma from components
Poor distribution of occlusal forces
Intolerance of major connector
Poor appearance of clasps
Difficulty in patient acceptance

Question 13

Disadvantages of RPD - patient factors

Answer 13

Caries
PD
Chronic atrophic conditions

Question 14

RPD - advantages

Answer 14

Non-invasive 
Versatile 
Keep tx options open 
Restore lots of teeth 
Replace teeth and supporting structures
Removable to assist cleaning 
Can be modified for progressive tooth loss and bone resorption

Question 15

RPD or no RPD? What to consider

Answer 15

Some form or damage is inevitable
Problems not always reported or noted
Appropriate maintenance is required
Many patients express satisfaction with
their dentures

Question 16

Success of an RPD depends on and why

Answer 16

Clinician - for dental care
Technician - accurate construction
Patient - plaque control

Question 17

Acrylic RPDs - features

Answer 17

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

Question 18

Indications for acrylic

Answer 18

Remaining teeth have poor prognosis
Diagnostic (interim) denture is required
For young patient to allow for growth
When only a few teeth remain

Question 19

Indications for Co/Cr

Answer 19

Permanent choice

Sufficient, healthy tooth support

Question 20

Fixed partial dentures

Design of choice?

Answer 20

Replace only TEETH
Destructive
Unpredictable in long term
Single unit adhesive cantilevered

Question 21

Implants

Answer 21

Replace teeth only
Can replace bone/soft tissue with grafts - higher morbidity
> 90% success rate