Download presentation
1
Tooth Loss and Prosthetic Appliances
REF: Prosthodontics. Principles and Management Strategies.1996, Owall, Kayser and Carlsson, Chap. 3, pp Samar Al Saleh
2
Tooth – type and function
Aesthetic units Occlusal units Samar Al Saleh
3
Functional classification of the 28 teeth or 14 pairs of antagonistic units
Location Name Number Anterior area Aesthetic units 6 Premolar area Occlusal units 4 Molar area 4 (81) Total Functional units 14 (181) 1 in premolar equivalents. Samar Al Saleh
4
Healthy or Physiological Occlusion
Absence of pathologic manifestations Satisfactory function Variability in form and function Adaptive capacity Samar Al Saleh
5
Functional assessment of the different tooth types
Anteriors Premolars Molars Biting + - Chewing Speech Aesthetics Stability of: TMJ Dental arch + = Prime involvement; - = No, or secondary involvement. (Stuart and Stallard,1960) Samar Al Saleh
6
Can anterior teeth and premolars compensate for the function of the molars? (shortened dental arch)
Samar Al Saleh
7
Schematic representation of the aetiology of an impaired dentition
Samar Al Saleh
8
Natural history of the dentition in high-risk groups
Healthy dentition Minor changes (intact occlusion) Major changes (impaired occlusion) Edentulousness (lost occlusion) Loss of alveolar bone Samar Al Saleh
9
Biological and functional aspect of tooth loss
Samar Al Saleh
10
Changes following tooth loss Pathological condition
Adaptation or Pathological condition Samar Al Saleh
11
Spontaneous closure of open space in a 32-year-old man after loss of tooth 11 at the age of 12 years due to trauma Samar Al Saleh
12
Effects of tooth loss on the remaining dentition
Samar Al Saleh
13
Radiographs of a 52-year-old woman (1992) showing structural and functional stability of an extreme shortened dental arch (8 occluding units) after 20 years (a) and 28 years of function (b). Samar Al Saleh
14
Local factors influence the consequences of tooth loss
Location of the lost tooth Number of the lost teeth Intercuspation Periodontal condition Position of the tongue Samar Al Saleh
15
Systemic factors influence the consequences of tooth loss
Age Adaptive capacity General resistance Neuromuscular tolerance Psychological condition Samar Al Saleh
16
Sequelae of tooth loss Migration Unilateral chewing Alveolar bone loss
Occlusal interference Loss of proximal contact Overloading of anteriors Loss of VD TMD Samar Al Saleh
17
General Pattern of Tooth Loss
Molars then premolars. Lastly the lower anteriors. Samar Al Saleh
18
Possible migration after loss of tooth 36
Samar Al Saleh
19
(a) (b) (a) A new occlusal balance was established after loss of teeth 46 and 47 at the age of 22 years in a 28-year-old woman (1971), followed during 11 years. (b) alveolar bone height in 1971 and 1984. Samar Al Saleh
20
Loss in the anterior region
Disturbed aesthetics Disturbed speech Affected psychosocial function Samar Al Saleh
21
Patterns in partial edentulism
Eichners classification (no. of remaining occlusal supporting zones) Simple classification of impaired dentitions Uncomplicated Complicated Partial edentulism Tooth boundspace Shortened dental arch Samar Al Saleh
22
The Eichner Index, based on supporting zones of antagonist contacts in premolar and molar regions (Helldén et al., 1989) A1 A2 A3 B1 B2 B3 B4 C1 C2 C3 Samar Al Saleh
23
Uncomplicated tooth-bound space in the left mandible
Complicated tooth-bound space, showing migration of remaining teeth Samar Al Saleh
24
Uncomplicated shortened dental arch
Complicated shortened dental arch: migration of remaining teeth, loss of vertical dimension and dislocation of condyle Samar Al Saleh
25
Compensation of tooth loss
Chewing where most occlusal contact More chewing strokes Swallowing of larger particles Samar Al Saleh
26
Migration in tooth bound spaces
Distally located teeth drift and tip mesially Mesially located teeth drift and tip distally Extrusion with no opposing contact Samar Al Saleh
27
Migration Premature contact and interferences Adaptation
Pathological condition (TMD) (close in new position) Samar Al Saleh
28
Shortened dental arches
Premolar dental arch Extreme shortened dental arch Samar Al Saleh
29
Complicated shortened dental arch: migration of remaining teeth, loss of vertical dimension and dislocation of condyle Samar Al Saleh
30
Masticatory function measuring
Objectively Chewing test (masticatory performance) MP (no. of occlusal units ability) Subjectively Questionnaire or interview (masticatory) 10 occluding pairs will be sufficient Samar Al Saleh
31
Schematic representation of the relationship between masticatory function and dental arch length (expressed in occlusal units) 1 = Masticatory ability (perceived ease of chewing) 2 = Masticatory performance A = Area of sufficient masticatory function B = Turning range C = Area of insufficient masticatory function Samar Al Saleh
32
Stability of premolar dental arch
Occlusal contact in IP Overbite Interdental spacing Attrition and alveolar bone support Samar Al Saleh
33
Effect of periodontal problems on shortened dental arches
Samar Al Saleh
34
Oral comfort Absence of pain Satisfactory masticatory ability
Acceptable aesthetics Samar Al Saleh
35
Relationship between oral function and shortened dental arches
1 = Contact between anterior teeth in IP 2 = Alveolar bone height 3 = Interdental contact between anterior teeth; absence of mandibular dysfunction 4 = Chewing capacity 5 = Aesthetics A = Area of sufficient and function (adaptation) B = Turning range C = Area of insufficient oral function Samar Al Saleh
36
Dental arch support and TMJ
? Posterior tooth loss TMJ osteoarthrosis Samar Al Saleh
37
Implications for prosthetic treatment
28 tooth syndrome Over treatment Samar Al Saleh
38
To maintain a healthy natural functioning dentition for life
Dental Care Aim To maintain a healthy natural functioning dentition for life Samar Al Saleh
39
“The exact number of teeth each individual need, can not be ascertained by the dental profession.”
“If patient manage well with any number of teeth, then there is no reason to recommend prosthetic appliances.” Samar Al Saleh
40
Oral Function Level Optimal Sub-optimal Minimal Samar Al Saleh
41
Required oral functional level in relation to age, expressed as the minimum number of occluding pairs of teeth (arch length)1 Age (years) Functional level Occluding pairs 20 – 50 I: Optimal 12 40 – 80 II: Suboptimal 10 (SDA) 70 – 100 III: Minimal 8 (ESDA) 1 SDA = Shortened dental arch; EDSA = Extreme shortened dental arch Samar Al Saleh
42
The Shortened Dental Arch Concept
Samar Al Saleh
43
The occlusal preservation target in high-risk groups
I = Complete dental arch (optimal function) II = Shortened dental arch (suboptimal function) III = Extreme shortened dental arch (minimal function) A = High-risk factors (caries, pockets) B = Limiting factors (restricted finances) C = Patient factors (poor general health) The occlusal preservation target in high-risk groups Samar Al Saleh
44
The prosthetic treatment target in high risk groups
The prosthetic treatment target in high risk groups. The number of teeth to be restored is dictated by the needed functional level. Samar Al Saleh
45
Teeth should be replaced for
Aesthetics Functional comfort Occlusal stability Samar Al Saleh
46
Lecture No.2 Pre-edentulism
Ref: Prosthodontics. Principles and Management Strategies. 1996, Owall, Kayser and Carlsson, Chap. 4, pp Samar Al Saleh
47
Natural history of the dentition in high-risk groups
Healthy dentition Minor changes (intact occlusion) Major changes (impaired occlusion) Edentulousness (lost occlusion) Loss of alveolar bone Samar Al Saleh
48
The traditional restorative approach in prosthetic dentistry
Samar Al Saleh
49
Pre-edentulous situation
Just a few (non-strategic) teeth are left with poor prognosis. The distribution of the remaining teeth in the dental arches is often unfavorable oral function cannot be performed adequately. Samar Al Saleh
50
Preventive prosthetic treatment for the pre-edentulous patient
= Postponing of tooth extraction to prevent bone loss Samar Al Saleh
51
Principles of preventive prosthetic treatment for the pre-edentulous patient
Treatment planning and timing of tooth extraction Shortening the dental arch with preservation of occluding pairs of teeth Use of an overdenture Samar Al Saleh
52
Treatment planning and timing of tooth extraction
Condition of residual tooth Age Postponement of extraction delays the reduction of the alveolar ridge Extraction of teeth with severe periodontitis (targeted extraction) less bone resorption Samar Al Saleh
53
Shortening the dental arch with preservation of occluding pairs of teeth
Free-end RPD X shortened dental arch If no remaining occluding pairs the remaining teeth will cause damage to opposing edentulous jaw Preventive implantology Samar Al Saleh
54
Due to the removal of the antagonistic tooth in the mandible, the solitary maxillary tooth has caused bone loss in the mandible Samar Al Saleh
55
(a) An example of a patient with a dental situation with no occluding pairs of teeth (natural versus artificial teeth) and severe alveolar bone resorption of the edentulous maxilla. (b) The teeth in the mandible are functionally “locked”. Every movement of the jaw causes the lower teeth to damage the edentulous maxilla via the upper denture. Samar Al Saleh
56
A dentate maxilla opposing an edentulous mandible should always be avoided. A situation of natural teeth versus artificial teeth has led to severe alveolar bone loss of the mandible Samar Al Saleh
57
Use of an (immediate) overdenture
Preservation of the alveolar ridge Preserving lower canines Samar Al Saleh
58
(a) Orthopantomogram of a 45-year-old female patient (1987) with an edentulous maxilla and periodontal disease in the mandible. In spite of the poor periodontal condition, it was decided to make a complete immediate overdenture in the lower jaw, while retaining four abutment teeth. (b) The situation 6 years after treatment (1993). Good oral hygiene and plaque control using chlorhexidine (Hibigel®). Samar Al Saleh
59
Schematic summary of the treatment planning by a pre-edentulous patient with a residual mutilated dentition motivation, instruction treatment of periodontium and caries “targeted” extractions removable partial (immediate) denture recall Samar Al Saleh
60
(a) In a 61-year-old woman with poor oral hygiene, a complete immediate overdenture, while retaining both lower canines, was inserted in 1986. (b) In the clinical situation more than 7 years later (1993), oral hygiene is good, resulting in a healthy periodontium and hardly any alveolar bone loss. Samar Al Saleh
61
Assessment of the pre-edentulous dentition for overdentulous treatment
Caries Periodontal considerations Prosthetic consideration Samar Al Saleh
62
Extensive and active caries
Samar Al Saleh
63
Periodontal consideration
Mobility Type of bone loss Extraction, subgingival curettage Samar Al Saleh
64
Samar Al Saleh
65
Endodontic Consideration
Single rooted canal and apical radiolucency Successful endo treated tooth Samar Al Saleh
66
Prosthetic Considerations
Samar Al Saleh
67
If the vertical jaw relationship shows sufficient denture space, abutment teeth which are (more or less) opposing should be retained Samar Al Saleh
68
Prosthetic considerations in the selection of abutment teeth
If possible always If opposing teeth are present in the mandible in order to avoid “natural vs artificial teeth” Samar Al Saleh
69
Location of the abutment teeth
Samar Al Saleh
70
The division of the jaw into four zones to facilitate the selection of abutment teeth
Samar Al Saleh
71
Examples of the distribution of abutment teeth within the dental arch
Samar Al Saleh
72
Canines as an overdenture abutments
Longest teeth Strategic position Oval-shaped root Easy endo treatment Samar Al Saleh
73
(b) In the clinical situation more than 7 years later (1993), oral hygiene is good, resulting in a healthy periodontium and hardly any alveolar bone loss. Samar Al Saleh
74
Distribution of abutment teeth over the upper and lower jaw
Situations in which teeth oppose an edentulous part of the jaw should be avoided. Samar Al Saleh
75
Many pre-edentulous situations between the lower and upper jaw are undesirable from a prosthetic point of view (green in illustration). The figure indicates which dental situations offer a good starting point for making an overdenture. Samar Al Saleh
76
A “targeted extraction strategy”, possibly combined with the making of an overdenture, enables the balance of forces between the dental arches to be restored. (NB The use of dental implants makes other combinations possible) Samar Al Saleh
77
Dental implants as abutment teeth for overdentures
(a) The use of implants in the lower jaw restores the balance between the dental arches. (b) Reduction of tooth material in the lower jaw can be avoided by inserting implants in the upper jaw. Samar Al Saleh
78
The main goal in “preventive prosthodontics” is the preservation of oral function for life. Dental implants can effectively “reverse” complete edentulousness and restore oral function Samar Al Saleh
79
Submerged roots and submucosal implants
Root of fractured teeth Filling the socket with biocompatible material Samar Al Saleh
80
Orthopantomogram of a patient with submucosal implants (calcium hydroxyapatite), inserted immediately after extraction. Samar Al Saleh
81
Depending on the individual rate of resorption, the upper surface of the submucosal implants will sooner or later protrude above the level of the jawbone with dehiscence of the mucosa. Samar Al Saleh
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.