the edentulous state, bucher part 1
TRANSCRIPT
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1
EDENTULOUS STATEBucher2013
Chap.1
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Etiology: heterogeneous dental diseases ,culture ,financial,attitude
Prevalance : but partially dentate
EDENTULOUS STATE
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1)Need for complete denture remain high
2)High percentage of older people be edentoulus
3)Impact of longivity on edentulism ?
4) Difficult treatment
EDENTULOUS STATE
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Periodontium: hard CT& soft CT
Principal functions: 1)support
2)positional adjustmentSecondary & dependent function: sensory perception
SUPPORT OF NATURAL DENTITION
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Quality : Mucosal vs periodontium
Quantity: max:22.96 vs 45cm²mand:12.25
denture-bearing area (basal seat) becomes smaller as ridges resorbs
mucosa :little tolerance /adaptability to denture wearing
Systemic diseases: Anemia, hypertension , diabetes , nutritional deficencies
Support for complete denture
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intermittent , rhythmic and dynamic
greatest forces : mastication & deglutiton vertically in direction tongue & circumoral musculature: lower,longer,horizontally
Physiological forces
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Increase steadily & abruptly return to zero magnitude , rise time , interval between thrust consistency , stage of chewing, dental status
Physiological forces
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function :17.5 min per daymastication(9min) < deglutition
Parafunction : (grinding , clenching,bruxism)
occlusal forces
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Natural dentition: 200 N
Complete denturers : max:60-80 N 5-6 times less
masticatory forces ~ type foodFood choice ~ tissue tolerance
Masticatory loads
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The residual ridge consists of denture-bearing mucosa, the submucosa and periosteum, and the underlying residual alveolar bone
Residual Ridge :
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Residual Ridges
Tensile compressive
Vertical & horizontal
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1)Direct effect of loss of pdl
2)Poorly understood factors
Ridge Resorption
More rapid in ant.mand Functional movement may be a major cause(unproved)
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"principles" of complete denture construction:
1)minimize the forces transmitted to the supporting structures
2) to decrease the movement of the prostheses
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physical factors
1)maximal extension of the denture base(impression)
2) maximal intimate contact (impression)
3)frequent follow up(reline)
muscular effect(neutral zone) buccinator ,orbicularis oris,intinsic&extrinsic muscles of tongue
Psychological effect salaiva
retention
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The edentulous state
Deteriorating adult dentition
Healthy adult
Developing dentition
Development & adaptation of the occlusion
16
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it has been concluded that masticatory efficiency as low as 25% is adequate for complete digestion
of foods
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Patients do not compensate for the smaller number of teeth by more prolonged or a larger number of chewing strokes
they merely swallow larger food particles
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d
Loss of teeth
diminished masticatory efficency Restrict dietary choice
Systemic effect
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• Quality of prosthetic service is related to
dentuer wearer masticatory performance
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mandibular movement of dentate & denturers is similar treatment of partially edentulous and
edentulous patients:
chewing efficiency improve masticatory muscle activity
elevator muscle activity & occlusion phase
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Chewing occurs chiefly in the premolar and molar regions
both right and left sides are used to about the same extent
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the tougher the consistency the greater is the person’s preference for using the
premolar region
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The end… Thanks for your patienceAny question? …
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