diagnosis and treatment planning1 · carious lesions and their restorations, restoration of...

Partial Dentures

Diagnosis and treatment 1planning

Prof Emad Agamy

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Life expectancy in Egypt is: 71.3 male and 75.4 female average 73.3 ( WHO data 2011). Nearly 24 million are above 40 (IS egypt 2014)

Nearly 50% of the age group45+ are partially edentulous (almost 10 million Egyptians)

This number is increased on the average by 800 thousands yearly

We need a sound treatment that should last for at least 15 years or more

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•Physiologic age is considered

•Effect of decreased salivary flow

•Dental caries and Periodontal disease

•Need for replacement of existing prostheses

•Need for replacement of missing teeth with FPDs or RPDs

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RPD’s will be needed in the future ◦ Numbers of patients continues to expand ◦ Unmet needs continue to increase

Implants will not replace RPD’s ◦ Barriers to receiving implants

Economic concerns

Poor patient compliance

Patient satisfied with the RPD

Fearful or skeptical of the result

Bassi et al, 1996 4

Pneumatized sinus

Presence of inferior alveolar nerve

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Why consider an RPD

Loss is creating more partially edentulous patients

Cost of implants precludes this therapy for most

patients

Tooth loss patterns are changing:

Most commonly retained teeth #22-27

Average number of teeth decline with age

Probably less than 5% of all partially edentulous

patients will be restored with implant therapy

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Clinical trials – Fixed vs Removable ◦ 5 year followup

◦ Removable vs fixed outcomes in Class I and Class II patients

◦ RPD’s vs tooth and implant supported FPD’s

Results ◦ No periodontal differences at 5 years

◦ Maintenance needs for RPD’s is greater

◦ Chewing efficiency : recent systematic reviews and meta analysis >>>>>> no differences (Shahmari et al and Esposito et al 2009, 2010

Kapur et al, 1989

Budtz-Jorgenson et al, 1990 7

RPD’s and oral health ◦ Perceived compromise of the remaining teeth

not supported by the evidence

◦ No evidence of destruction of the periodontium of remaining teeth

◦ Most important factors are patient compliance and close followup

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Causation or association ◦ Many have maintained that the presence of an RPD

accelerates existing dental disease

◦ However, the risk is reduced with appropriate followup and oral compliance

◦ Poor outcomes in some studies may be related to the fact this patient group may have low dental IQ

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Objectives

The elimination of disease,

The preservation, restoration and maintenance of

the health of the remaining teeth,

The selected replacement of lost teeth,

The restoration of function and comfort in an esthetically pleasing manner

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Patient history

Clinical examination

Radiographic examination

Preliminary impression

Articulated diagnostic casts

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Age: tolerance, oral hygiene, pulp size, muscular coordination, clinical crown length, mental attitude and salivary flow…….. Physiologic age is much more important.

Sex: females; esthetics; menopause Habits: bruxism smoking or pipe

smoking…… design Occupation: hazards; boxing..demand ;

esthetics or speech Medical condition: debilitating diseases,

malignancies, artheritis 12

Diagnosis and treatment planning must take into consideration:

The periodontal condition of the remaining teeth,

Carious lesions and their restorations, Restoration of harmonious occlusion, Restoration of small modification spans by

fixed prosthesis, Allergies, gagging and or tissue

abnormalities that may interfere with the construction of removable partial denture,

The choice between fixed prosthesis, removable partial denture, complete denture or the use of implants.

Other factors to be considered may be Speech: Psychological factors

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No treatment

Implant supported restoration

Fixed partial denture(bridge)

Removable partial denture (RPD) *A fixed replacement is usually the preferred

treatment of choice.

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Abutments: N, Location, condition, alv. Bone

Edentlous span : N, size, contour

Oral hygiene

Opposing occlusion

Other factors: patient health, cost, age, patient needs, caries rate, cooperation

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1. Long edentulous spans

2. Absence of adequate periodontal support

3. Structurally and anatomically compromised abutments

4. Need for cross-arch stabilization

5. Distal extension

6. Need to restore soft and hard tissue contours

7. Anterior esthetics

8. Age and health

9. Attitude and desires of pt.

10. Ease of plaque removal

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Bridges

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Oral Hygiene

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