PEMICU 1

1. Etiologi dan Mekanisme wajah pasien lebih tua?

Etiologi: Vertikal dimensi pasien menurun

Mekanisme:

2. Etiologi dan Mekanisme lengkung RB terlihat lebih besar dari RA?

Consequences on the Bony Structures

Basal bone forms the dental skeletal structure, contains most of the muscle

attachments, and begins to form in the fetus before teeth develop. Alveolar

bone first appears when Hertwig’s root sheath of the tooth bud evolves (Fig. 1-

5).44 The alveolar bone does not form in the absence of primary or secondary

tooth development. The close relationship between the tooth and the alveolar

process continues throughout life. Wolff’s law states that bone remodels in

relationship to the forces applied.45 Every time the function of bone is

modified, a definite change occurs in the internal architecture and external

configuration.46 Bone needs stimulation to maintain its form and density.

Roberts et al.47 report that a 4% strain to the skeletal system maintains bone

and helps balance the resorption and formation phenomena. Teeth transmit

compressive and tensile forces to the surrounding bone. These forces have

been measured as a piezoelectric effect in the imperfect crystals of durapatite

that compose the inorganic portion of bone.48 When a tooth is lost, the lack of

stimulation to the residual bone causes a decrease in trabeculae and bone

density in the area, with loss in external width and then height of the bone

volume. 49 The width of bone decreases by 25% during the first year after

tooth loss and an overall 4 mm in height during this first year following

extractions for an immediate denture. 50 In a longitudinal, 25-year study of

edentulous patients, lateral cephalograms demonstrated continued bone loss

during this time span; a fourfold greater loss was observed in the mandible

(Figs. 1-6 and 1-7).51 However, because the mandible begins with twice the

bone height of the maxilla, maxillary bone loss is also significant in the

long-term edentulous patient.

TAMBAHAN: JURNAL 2007

Arahkan ke arah resorbsi rahang atas: bukal ke palatal. Alasan: Karena daerah tulang di

daerah bukal kurang compacta, akibat mastikasi lebih cenderung diperankan oleh cusp palatal

Dan sebaliknya untuk rahang bawah rb tampak lebih besar

3. Jelaskan etiologi dan mekanisme terjadinya sakit kepala dan nyeri di sekitar rahang

yang dirasakan oleh pasien tersebut !

The etiology of TMD in clinical dentistry has been considered as one of the most

controversial issues. The concept of mandibular over closure proposed by Dr. James

Costen, an otolaryngologist in 1934 was related to various ear symptoms.4 This was

expanded in the 1970’s into mechanical displacement theory. This theory claimed

that deflective occlusal contacts and lack of molar support were directly responsible

for the eccentric positions of condyles in fossa and that these eccentric positions

caused pain and dysfunction. This theory was based on the hypothesis that the

condyles had to be in a central position for proper function. (Gerber, 1971;Weinberg,

1983).

This hypothesis has been disapproved by several investigators, demonstrating

eccentric condylar positions in many asymptomatic patients.20 The proponents of

mechanical displacement theory believed in the diagnostic value of TMJ radiographs

and articulated casts and provided prosthetic reconstruction of patient’s dentition to

achieve therapeutic condyle repositioning.

The second theory that evolved in 1970’s was based on assumption that occlusal

interferences or loss of molar support caused hyperactivity in the masticatory

muscles.19 The altered periodontal receptor input will adversely affect the sensory

feedback mechanism and result in disturbed patterns of muscle contractions.12 The

patients tried to remove the interferences by parafunctional muscular activity or to

stabilize the jaw in cases where occlusal stability was not present. Interferences were

thought to be the direct cause of parafunction leading to jaw muscular pain and joint

overload and dysfunction.22, (Ramfjord & Ash 1966, Dawson 1974). Similar

responses were seen during hyperextension that may occur in yawning, biting or

prolonged dental procedure or an inadvertent injury to medial pterygoid muscle

during administration of local anesthesia in inferior alveolar nerve block procedure.

The spasm and pain may occur in any or in combination of masticatory muscles. Once

it occurs the problem can be self perpetuating and this could account for some cases

of myofacial pain dysfunction.23 This neuromuscular concept was not applicable to

all the TMD patients who resulted in bringing the dental profession’s attention to the

relationships between different morphological parts of the masticatory system (joints,

occlusion, and muscles) and the psychological and behavioral characteristics of

patient.

TAMBAHAN: JURNAL 2010

4. Jelaskan kemungkinan penyebab saliva sedikit dan kental dan bagaimana cara

pemeriksaan laju aliran saliva yang sesuai dengan kasus ini !

The diabetes mellitus type 2 (non insulin-dependent) or adult diabetes affects people

aged over 40, frequently overweight or obese. This metabolic variety is characterized

by the partial shortage of insulin that is proved by disturbances in the metabolism of

glucose and therefore the normal assimilation process is affected (1,2). The most

common alterations, at a stomatologic level, include periodontal diseases, caries,

candidiasis, commissural quelitis and sialomegaly. All of the already mentioned are

linked to the xerostomy and glandular hypofunction (1,3-6). Some authors (2,3,7)

state that the decrease of the salivary stream in diabetics is caused by the increase of

diuresis or poliuria, that make the extracellular liquid decrease notoriously, and as a

consequence, the production of saliva.

Diabetes mellitus is one of the etiological causes of sialosis, a pathology generally

characterized by a bilateral enlargement, neither neoplastic nor inflammatory, of the

parotid gland (8-10). Sialosis, however, can have different origins, having been

described as a consequence of hormonal, nutritional or metabolic disturbances,

medicamentosus or neurohumoral alterations (3,11,12). Furthermore, the process is

not exclusive to the parotid, but also affects, to diverse degrees, the other larger and

smaller salivary glands (13-16). Clinically it is said that the swelling of diabetic origin

frequently has a prearicular ubication (1,3,7) different from the alcoholic sialosis is

located at an retromandibular level. In addition, the diabetic sialosis shows a more

pronounced swelling (1,17).

The sialosis generally involves glandular hypertrophy, produced either by adipose

infiltration or by acinar hypertrophy. There are authors who accept the coexistence of

both modifications, while others deny such a possibility (18,19). The fact is that

acinar hypertrophy is not always present in sialosis, as a consequence some authors

centre their attention on the glandular dysfunction. This dysfunction is generally

manifested as salivary hypofunction and xerostomia (12).

This pathology is not considered neither inflamatory nor tumoral, but a degenerative

one. It is also linked to an alteration in the autonomous glandular neuroregulation

(1,7,12) produced by a demielination (or sympatic denervation) and an atrophy of the

mioepithelial cells. This would interfere with the secretion mechanism that is

produced by the stimulation of the alpha and beta adrenergic receptors of the acinar

cells, that phisiologically induce exocytosis (3,5,12).

In previous studies of parotid glands from individuals with alcoholic sialosis we

described heterogeneous accumulations of secretory granules of different sizes,

irregularly distributed throughout the cytoplasm of the acinar cells, unlike the Von

Ebner serosa glands, where the granules were smaller, homogeneous and

preferentially located in the apical region. Likewise, the alterations at the epithelial

level of the ductal system were highly evident. The striate ducts exhibited an

epithelium of pseudostriated appearance, with elongated nuclei of dense chromatin,

together with other nuclei surrounded by loose chromatin. In the excretory ducts, of

note, was the increase in ductal diameter, the stasis of the secretory material with

desquamated cells, and epithelial atrophy, immunohistochemically heterogeneous for

cytokeratins (13,14, 20, 21).

With respect to its function there have been described, other than the flow

disturbances, modifications of the salivary biochemistry in type 2 diabetic patients:

disturbances in the glucose concentration, total protein count, albumin, lisozymes,

peroxidase, electrolytes (sodium, potassium, chloride, phosphorus, magnesium,

calcium), amylase, IgA, and in its buffer capability. Although these findings have not

been related by all the studies. Therefore Ben-Aryeh et al. (22) studied 35 type 2

diabetics and they compared them with a control group. The results of this study

found increased levels of glucose, total protein, and potassium, normal levels of

amylase, IgA and sodium and a reduced salivary flow, not finding any correlation

between blood and salivary glucose levels.

Dodds et al. (23) studied the effects of metabolic control in salivary flow, protein

concentration, and salivary amylase activity in type 2 diabetics, finding a reduced

salivary amylase activity, but no significant difference in the protein concentration or

in the salivary flow. Reuterving et al. (24) studied the influence of the degree of

severity of diabetes in the salivary flow and in the glucose concentration in 11 patients

with type 1 and 2 diabetes, not finding any significant difference in pH, buffer

capacity, total proteins, electrolytes, lysozymes, peroxidases, or metabolic control.

They concluded that the degree of metabolic control doesn’t have a great influence in

salivary composition, except in the salivary concentration of glucose. Forbat et al.

(25) measured the concentration of blood and salivary glucose in 31 patients with type

2 diabetes mellitus. They concluded that salivary glucose levels don’t reflect blood

glucose levels.

In type 1 and 2 diabetic patients it has also been tried to correlate salivary

composition with the presence of oral pathology, finding dental caries in 100% of

diabetic patients and an overall increase in periodontal disease (26-28).

The objectives of our study were: to compare the biochemical findings in the saliva in

a sample group of diabetics against the saliva of a control group; to establish if the

salivary biochemical disturbances are related with metabolic control; to determine if

the variables of the oral and periodontal findings are related with the salivary

biochemical disturbances; and to establish the usefulness of measuring the salivary

biochemistry of type 2 diabetes mellitus patients, as an optional parameter to evaluate

the metabolic state.

Cara pemeriksaan laju aliran saliva?

5. Kemungkinan penyebab mukosa yang tipis?

As bone loses width, then height, then width, and then height again, the attached

gingiva gradually decreases. A thin attached tissue usually lies over the advanced

atrophic mandible or is absent entirely. The gingiva is prone to abrasions caused by

the overlaying prosthesis. In addition, unfavorable high muscle attachments and

hypermobile tissue often complicate the situation. The thickness of the mucosa

on the atrophic ridge also is related to the presence of systemic disease and

physiologic changes accompanying aging. Conditions such as hypertension, diabetes,

anemia, and nutritional disorders have a deleterious effect on the vascular supply and

soft tissue quality under removable prostheses. These disorders result in a decreased

oxygen tension to the basal cells of the epithelium. Surface cell loss occurs at the

same rate, but the cell formation at the basal layer is slowed. As a result, thickness of

the surface tissues gradually decreases. Therefore sore spots and uncomfortable

removable prostheses result.

6. Jelaskan penyebab lidah yang berukuran relative lebih besar!

The tongue of the patient with edentulous ridges often enlarges to accommodate the

increase in space formerly occupied by teeth. At the same time, the tongue is used to

limit the movements of the removable prostheses and takes a more active role in the

mastication process. As a result, the removable prosthesis decreases in stability. The

decrease in neuromuscular control, often associated with aging, further compounds

the problems of traditional removable prosthodontics. The ability to wear a denture

successfully may be largely a learned, skilled performance. The aged patient who

recently became edentulous may lack the motor skills needed to accommodate to the

new conditions.

7. Jelaskan pengaruh saliva yang sedikit dan kental terhadap pemakaian GTP!

Saliva & Complete Denture Prosthodontics

The role of saliva in maintaining the overall wellbeing of the oral cavity in dentate

individuals is well documented. In edentulous subjects, who have lost all their teeth

and are dependent upon artificial prosthesis to carry out the basic oral functions of

mastication, the presence of appropriate quantity and quality of saliva becomes even

more critical.

Optimal salivary flow and consistency plays an important role not only in the denture

fabrication process but also in the maintenance of integrity of the prosthesis. In

patients who present with an excessive secretion of saliva, proper impression making

becomes difficult. Also, the minor palatal glands are known to secrete saliva rich in

mucins. The presence of such highly mucous saliva may distort the impression

material and prevent the ideal reproduction of posterior portion of the palate in the

impression.9

Saliva also plays a very important role in preserving denture integrity by keeping the

denture surfaces clean and in maintaining proper oral hygiene by physically washing

away food and other debris from the soft tissues and from the polished surface of the

prosthesis. The lubrication provided by saliva in dentate subjects is equally important

in the edentulous as this makes the surface of the dentures more compatible with the

movements of the lips, cheek and tongue. Salivary glycoproteins facilitate the

movement of soft tissues during speech, mastication and swallowing of food.

Denture retention is also to a large extent dependent upon saliva. Retention in

complete denture prosthodontics is defined as the quality inherent in the prosthesis

which resists the forces of dislodgement along the path of insertion.10 Successful

rehabilitation of edentulous patients with complete dentures is largely contributed to

by satisfactory denture retention. Two important factors that contribute to retention of

complete dentures include the establishment of an accurate and intimate fit of the

denture base to the mucosa and the achievement of a proper peripheral seal. 11 The

physical factors that contribute to denture retention include Adhesion, Cohesion,

Interfacial surface tension, Atmospheric pressure, Capillary attraction and Gravity. An

optimal flow, consistency and volume of saliva is considered to be a major factor in

enabling these physical factors to act in unison and aid in denture retention. 11 -13

The adhesive action of the thin film of saliva between the denture base and the

underlying soft tissues is considered to be one of the principal factors that aids in

denture retention. Such adhesive action of saliva is achieved through ionic forces

between charged salivary glycoproteins and surface epithelium on one side and

denture base acrylic resin on the other.13 This thin film of saliva also acts as a

lubricant and cushion between the denture base and oral tissues and tends to reduce

friction. Also, the cohesive forces within the

layers of saliva present between the denture base and mucosa aid in maintaining the

integrity of interposed fluids and aids in retention. The presence of a thin film of

saliva also provides interfacial surface tension and resists the separation between the

denture surface and the mucosa.

Not just the quantity, but also the flow rate, quality & consistency of saliva influence

denture stability and tolerance. The presence of thick ropey saliva may compromise

maxillary denture retention by creating a negative hydrostatic pressure in the area

anterior to the posterior palatal seal leading to downward dislodgement of the denture.

The normal salivary flow rate is about 1ml/min. Optimum quantity of saliva of

medium viscosity at this rate lubricates the mucosa and assists in denture retention.

An inadequate salivary flow may have a profound effect on denture retention and

stability and also tends to make mastication and deglutition difficult. Loss of the

mechanical protective influence of saliva on the denture supporting tissues would

predispose them to irritation. Also, the antibacterial action provided by saliva would

be proportionally reduced making the denture bearing oral tissues more susceptible to

infection.14

Considering the highly significant role played by saliva in successful complete

denture rehabilitation, it is imperative for the prosthodontist to give due attention to

the quantity and quality of saliva during the fabrication of complete dentures. Hypo-

salivation and associated xerostomia is a common finding in the elderly. The effect of

age on salivary secretion and flow has been a matter of great debate. However, it is

now believed that aging does not directly reduce salivary flow per se; a number of

factors associated with aging may however do so. 5, 15 The geriatric prosthodontic

patient may be under some sort of medications that tend to affect salivary function.

These include drugs such as sedatives, anti-hypertensives, anti-depressants and anti-

histaminics. Any systemic factors such as alcoholism, depression and the presence of

diseases such as uncontrolled diabetes, pernicious anaemia, rheumatoid arthritis,

Vitamin A & Vitamin-B deficiency and Sjogren’s syndrome are also known to have a

profoundly negative influence on salivary secretion. Patients who have undergone

radiotherapy in the head and neck region also present with xerostomia due to the

associated destruction of salivary glands.15-16 Any such systemic diseases must be

identified prior to denture fabrication and due consultation should be sought from the

physician. If the patient is under any medication that tends to cause hypo-salivation,

consultation should also be sought to substitute these drugs with others that have

lesser adverse effects.17

In patients with xerostomia in whom some residual salivary capacity remains,

stimulation of salivary glands may be induced by the by the frequent snacking and by

the use of lemonades, lozenges and sugar free gums like xylitol. 17 Sialogogues such

as pilocarpine may also be prescribed in an attempt to stimulate salivary secretion.18

In severe cases where the salivary glands cannot be stimulated to produce sufficient

saliva, salivary substitutes 12,13,17 may be used. These substitutes range from readily

available compounds such as milk to the commercially available substitutes such as

artificial saliva (which may be mucin or carboxymethyl cellulose based), Salinum

(containing Linseed oil), Luborant (based on lactose peroxidase) and others.

Glandosane is a salivary substitute with an acid pH indicated specifically in denture

wearers.

Another approach to providing optimal lubrication in complete denture patients is the

use of saliva delivery systems in the form of oral lubricating devices or reservoir

dentures. The clinician may either fabricate new reservoir dentures for the patient or

may add reservoirs to the existing dentures. An important concern is the size, shape

and location of the reservoir. The commonly preferred sites for adding reservoir is the

palate in the maxillary denture and interior of the mandibular complete denture.

13,19-20

The prosthodontist’s role does not end just at denture fabrication and delivery. An

important concern for prosthodontic patients who have recently received new dentures

is the discomfort associated with a significant increase in salivary secretion. The

prosthodontist should explain to the patient that the new dentures are perceived as

foreign objects, stimulating the salivary glands to produce excessive saliva, which

necessitates frequent deglutition. Such an increase in salivary flow is however a

transient natural response of the oral tissues and tends to diminish over time. During

this period, the patient should also be advised to avoid compulsive rinsing & spitting

as it is unsettles the denture. Also, following the delivery of complete dentures in

patients with xerostomia, it is important to advise the patient to use the dentures for

shorter periods of time and to consume soft and moist foods which would be tolerated

better by the oral mucosa.8 Such patients should also be advised to have frequent sips

of water17 and should be followed up regularly to assess and suitably treat any form

of mucosal ulceration or denture stomatitis.

8. Jelaskan pengaruh mukosa yang tipis terhadap pemakaian GTP!

The dentures are surrounded by the cheeks and lips, which are covered by lining

mucosa. This mucosa moves in intimate contact with the dentures during the

functioning of the related facial and masticatory muscles. The lining mucosa of the

lips and cheeks and floor of the mouth is relatively thin and easily traumatized. It is

also the site of a variety of pathoses. The lingual and palatal surfaces of the dentures

are in intimate contact with the tongue and its specialized mucosa. The specialized

mucosa covering the tongue is often regarded as a possible “window” on systemic

disorders—arguably an overstatement, but still a relevant consideration. All these

tissues must be examined in detail for individual anatomy and for abnormalities,

irregularities, and pathoses. The term masticatory mucosa has been applied to the

mucosa covering the residual alveolar ridges and palate. It is usually attached to the

underlying periosteum; however, when it is not, denture instability can be a problem.

The area of attachment diminishes with ridge resorption, which is more severe in the

mandible. A total loss of attachment is often first seen above the mandibular

symphysis and can be demonstrated by tensing the lower lip, which causes the floor

of the mouth to move.

Diagnosis of abnormalities of the mucosa requires the recall of the normal

appearance. Shape, color, and texture are significant characteristics. Some variations

occur fre-

quently with no significance and are therefore accepted as normal. These include

Fordyce’s granules in the buccal fat pads and varicosities in the floor of the mouth of

elderly patients. Initially, knowledge of normal appearance is learned from anatomy

texts and the study of surface anatomy. However, the required mental picture becomes

well developed only through careful examination of many healthy mouths.

The color of the mucosa reveals much about its health. The differences in appearance

between a healthy, pink mucosa and red, inflamed tissue will be apparent. The

cause of any inflammation must be determined.

Abrasions, cuts, or other sore spots may be found in any location under the basal seats

of the existing dentures or at the borders. They may be the result of overextended or

even underextended borders (Fig. 5-4). Incorrect occlusion is also a major source of

tissue trauma. Sharp or overextended denture borders produce red lines of inflamma-

tion or ulcerations. Evidence of cheek biting appears at the level of the occlusal plane

and often presents as a white scar tissue line indicating a mucosa that has been

traumatized and is now healing. Sometimes soreness results from something as simple

as a small fruit seed lodged under the denture. At the time of the examination, the

causes should be determined to allow correction before impressions are recorded.

9. Jelaskan pengaruh lidah yang besar terhadap pemakaian GTP !

The tongue plays an important role in determining denture success or failure, with its

size and activity being the main concerns. The tongue will expand into any edentulous

space(s) by a reorientation of its intrinsic musculature and become habitually active

within its extended boundaries. The introduction of a new denture will then be met

with dislodging competition from the tongue. An edentulous patient who has not been

wearing a mandibular denture often uses the tongue as an antagonist for the maxillary

arch during mastication. In these situations, the tongue can become enlarged (see

Figs. 5-2 and 5-3) and also very strong, making prosthetic treatment and subsequent

denture use challenging for the dentist and the patient, respectively.

Examination of the floor of the mouth includes examination of deep sublingual

structures. The surface contours are important but can change as a result of underlying

activity. Contraction of the mylohyoid muscles raises the floor of the mouth. This will

dislodge a complete denture made from an impression that did not record the position

of the floor of the mouth with the mylohyoid muscles in a contracted state. The visual

examination also requires that the depths of mucosal folds be exposed to make sure

that hidden lesions are not missed

Tongue position and coordination are significant in functioning with a mandibular

denture. Normally, the tongue should be expected to rest in a relaxed position on

the lingual flanges, which, if properly contoured, will allow the tongue to help retain

the denture. A retruded tongue position deprives the patient of a border seal for the

lingual flange in the sublingual crescent; it also may produce dislodging forces on the

distal regions of the lingual flanges. On the other hand, a habit of protruding the

tongue tends to dislodge a lower complete denture by raising the floor of the mouth

and, in so doing, lifting the lingual flanges. Attempts at tongue retraining may not be

very successful but will at least make patients aware of the problem and help them to

understand encountered adverse effects.

10. Jelaskan biomekanik dukungan gigitiruan penuh berdasarkan hasil pemeriksaan intra

oral pada pasien tersebut!

The basic challenge in the treatment of edentulous patients lies in the differences

between the ways natural teeth and their artificial replacements are supported. The

previous section emphasized the superbly evolved quantitative and

qualitative aspects of periodontal ligament support for a functioning dentition. This

has an approximate area of 45 cm 2 in each arch, viscoelastic properties, sophisticated

sensory mechanisms, and the potential for bone remodeling to cope with the diverse

directions, magnitudes, and frequencies of occlusal loading. In contradistinction, the

tissues pressed into service to support complete dentures are inherently unsuited to

this role.

MUCOSAL SUPPORT AND

MASTICATORY LOADS

The mean area of mucosa available for denture support has been calculated to be

22.96 cm 2 in the edentulous maxillae and approximately 12.25 cm 2 in an edentulous

mandible. These figures, particularly in the mandible, are in dramatic contrast to the

45-cm 2 area of periodontal ligament available in each dental arch (see Fig. 1-3). It

also must be remembered that the denture-bearing area (basal seat) becomes

progressively smaller as the residual ridges resorb.

Furthermore, the mucosa itself demonstrates little tolerance or adaptability to denture

wearing, a disadvantage worsened by the presence of systemic diseases such as

anemia, hypertension, or diabetes, as well as nutritional deficiencies.

Indeed, any disturbance of the normal metabolic processes may lower the upper limit

of mucosal tolerance and initiate inflammation. Reported masticatory forces using

complete dentures are much smaller than those produced by the natural dentition,

which is of the order of 200 N. Although maximum forces of 60 to 80 N have been

reported for complete dentures, the average loads are probably much less than these.

Indeed maximal bite forces appear to be five to six times less for complete denture

wearers than for persons with natural teeth. Moreover, the forces required for

mastication vary with the type of food being chewed. Patients with prostheses

frequently limit the loading of supporting tissues by selecting foods that do not

require masticatory effort that exceeds their tissue tolerance.

THE RESIDUAL RIDGES

The residual ridge consists of denture-bearing mucosa, the submucosa and

periosteum, and the underlying bone. When the alveolar process is made edentulous,

the alveoli that contained the roots of the teeth become filled with new bone, forming

the residual alveolar processes. These become the residual ridges and are the

foundation for dentures, a role for which they are ill-suited.

The loss of teeth and their periodontal support results in the removal of an important

sensory mechanism and a change in the loading pattern of the alveolar bone

from tensile to compressive with forces being predominantly vertical as well as

horizontal. The edentulous ridge also has a considerably smaller surface area than that

of the preceding periodontal ligaments, and the denture supporting tissues

demonstrate very little adaptation to their new functional requirements. This is in

marked contrast to the frequently remarkable adaptive range of the dentate

masticatory system. Following teeth loss, the alveolar ridge is subject to

ongoing resorption, which results in its gradual reduction and virtual disappearance

(Fig. 1-4). This process apparently occurs at an exponentially reducing rate and is

typically most rapid in the anterior mandible. The loss of bone does not occur evenly

over the surface of the ridges, and so with time, their shapes and size become altered.

The rate of bone resorption also varies markedly from person to person and is not

predictable at an individual level. Little is known about which factors are most

important for the observed variations Two concepts have been advanced concerning

the inevitable loss of residual bone: one contends that as a direct consequence of loss

of the periodontal structures, the latter’s organizational influence on adjacent bone is

altered and variable progressive bone reduction occurs. The other maintains that

residual bone loss is not an inevitable consequence of tooth removal but depends on a

series of poorly understood factors.

Clinical experience strongly suggests a definite relationship between the presence of a

healthy periodontal ligament and the maintained integrity of alveolar bone (Fig. 1-5).

This accounts for a strong professional commitment to the preservation and protection

of any remaining teeth to minimize or avoid advanced residual ridge reduction. The

tissue support for complete dentures is conspicuously limited in both its adaptive

ability and inherent capability of simulating the roles of the periodontium. These

disadvantages are compounded by the movement of complete dentures in relation to

the underlying bone during function. This is related to the resiliency of the supporting

mucosa and the inherent instability of the dentures during functional and

parafunctional movements. Because these recurrent movements and the forces that

produce them can cause damage to the supporting tissues, almost all “principles” of

complete denture construction have been formulated so as to minimize them.

Although unproven, it is tempting to conclude that the recurrent functional

movements of removable prostheses may be a major factor contributing to residual

ridge reduction.

Two physical factors are involved in denture retention that are under the control of the

dentist and are technique driven. One is the optimal extension of the denture base;

the other is the maximally intimate contact of the denture base to its basal seat.

Muscular factors can be used to increase the retention (and stability) of dentures. The

actions of the buccinator, the orbicularis oris, and the intrinsic and extrinsic muscles

of the tongue can be harnessed by the dentist to achieve this with appropriate

impression techniques. Furthermore, the design of the labial, buccal, and lingual

polished surfaces of the dentures and the forms of the dental arches must be

considered when balancing the forces generated by the tongue and the perioral

musculature. As the form and size of the denture-supporting tissues (the basal seat)

change, harnessing muscular forces in complete denture design becomes particularly

important for denture retention.

Wearing dentures may have an adverse psychological effect on some patients, and the

nervous stimuli that result may influence salivary secretions and thereby adversely

affect retention. Eventually, most patients seem to acquire an ability to retain their

dentures by means of oral muscle control. This muscular stabilization of the

prostheses is probably also accompanied by a reduction in the physical

forces used in retaining the dentures. Clearly, the physical forces of retention can be

improved and reestablished, up to a point, by careful and frequent attention to the

status of the dentures. Periodic inspection, including relining procedures, will help

prolong the usefulness of the prostheses.

11. Bagaimana prognosa perawatan prostodonsia pada pasien tersebut berdasarkan

karakter pasien?

Dari riwayat diketahui bahwa pasien bukanlah sosok yang patuh, hal ini

terbukti dari:

o Seluruh gigi telah dicabut

o Mukosa tipis

o Saliva sedikit

o Lidah relative besar

Tanda-tanda tersebut menunjukkan bahwa pasien tidak dalam kondisi

mengontrol kadar gula dalam darah tidak kooperatif

Pasien tidak kooperatif + keadaan intraoral yang tidak baik untuk stabilitas

GT

Prognosis kurang baik

12. Bagaimana teknik komunikasi yang tepat untuk pasien tersebut?

Interpretive

-D & P berdiskusi alternatif penanganan

Seni mendengar dan mendengar aktif komunikasi 2 arah

Empati umpan balik untuk memastikan bahwa pasien sudah paham

Langkah-langkah:

o GATHER

Greet

Memberi salam ramah

Ask

Nada yang menunjukkan minat dan keramahan

Kata yang dapat dimengerti

Ajukan pertanyaan dan tunggu responnya

Gunakan open question

Tell

Memberi informasi secara jelas pasien mengerti

Help

Bantuan ketika pasien sulit menentukan keputusan

Explain

Penjelasan atas keputusan yang dipilih pasien

Return

Beri kesempatan kepada pasien untuk datng kembali