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Rem Pros pt. 2 (Root-Over Denture (Advantages:
Reduced RRR, Improved…
Rem Pros pt. 2
Root-Over Denture
Advantages:
Reduced RRR, Improved stability/retention, Improved proprioception, psychological benefits
Disadvantages:
Additional tx costs/time, weakened denture base, abutment susceptibility to biological issues, increased maintenance and recall
Patient Selection:
- Avoid pts w/ hx of dental neglect, lack of motivation and poor oral hygiene
- Root caries and perio issues w/ abutments are common therefore pt selection is critical
Abutment Selection:
- Perio eval (pocketing, mobility, gingival attachment)
- Chemical and Hygiene protection (fluoride)
-
Indications:
- Consider in pts who are indicated for full clearance
- when remaining teeth are inadequate for FPD or RPD
- Single Complete Denture Cases
- Severe tooth wear
Complete Dentures
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Stability, Support,& Retention
Retention:
Boarder/post dam seal, w/ intimate tissue contact
- influence by = frena, tongue position
Stability:
Mdb (ridge height, FOM, lingual flange, tongue position)
Mx (ridge height, supporting areas, mobile/flabby areas)
Support:
Mx (hard palate, others ie ridge tuberosity)
Mdb (buccal shelf, retro-molar pad, other ridge
Occulsal Wax rims
Purpose:
- Means of transferring facebow record
- Aid in anterior tooth placement
- Orientation of occlusal plane
- Lip and cheek support
- Determines VDO
W/ lips at rest, wax should project 1-2mm below the lip line
Mx Occlusal Rim = Use fox plane & Ala-tragus line
Mdb Occlusal Rim = ridge crest and retromolar pad (1-2mm above)
= They are both then checked using RVD, OVD & Freeway Space
Occlusal Set-Up
Denture Occlusion Scheme:
- Neutrocentric [non-balanced]
= centralization of forces which act on the basal seat when the mdb and mx are in centric + neutralization of inclines
Adv:
- Requires less precise records
- :check:Friable/ resorbed mdb ridge
- :check: reduced oral dexterity or neuro impairment
Disadv:
- Least aesthetic of the occlusal schemes
- impaired masticatory efficiency (poor bolus penetration)
- reduced stability of denture (non-balanced)
Contacts:
- centric, flattened teeth w/ freedom to contact anywhere
- eccentric, lateral; balancing side disoccludes, protrusion; the posterior teeth disocclude
Goals of Complete Denture Occlusion
Minimise trauma to the supporting structures
Preserve remaining structures
Enhance stability of the dentures
Facilitate aesthetics and speech
Restore mastication efficiency to a reasonable level
Five Factors Affecting Occlusal Balance (Hanau's Quint)
1) Condylar Inclination
2) Incisal Guidance
3) Occlusal Plane Inclination
4) Compensating Curve
5) Cuspal Inclination
nb: we can alter 2, 4, 5 w/ dentures
Denture Occlusion Scheme:
- Bilateral Balanced
= Simultaneous, bilateral, anterior and posterior occlusal contact of the teeth during centric and eccentric function
Contacts:
- (for minimal occl balance) there must be three points of contact, the more contacts the better the balance
- Ideally all teeth are in contact during lateral and protrusion movements
Adv:
- Simultaneous contacts improve stability/retention of denture during mastication, swallowing and speech
- Can be incorporated into lingualised scheme for improved aesthetics and bolus penetration
- Good for bruxism cases
Disadv:
- Difficult to achieve in mouths w/ excessive OB
(nb lingualsed can help this)
- May encourage lateral/protrusive grinding habit
Types of Denture Teeth:
- Anatomic
- semi-Anatomic
(22-degree cusp incline)
- Lingualized
(aesthetic, freedom of monoplane, minimizes tipping)
- Monoplane/non-Anatomic
(can achieve bilateral balance w/ balancing ramps, then will have 3-points at least)
Single Complete Dentures
(opposing natural, fixed or RPDs)
Single Denture Syndrome
= A cycle or ill-fitting dentures leading to discomfort/damage/RRR, leading to relining and contd. dissatisfaction
Morphological Changes
RRR pattern, a horizontal discrepancy between arches
Adverse Tx Outcomes:
Natural Tooth wear, denture base fracture
Mandibular Single Dentures
- often compromised, implant assistance usually indicated
- Why were the Mx teeth lost first?
(ie Mx F/- are comparatively more successful)
Implications:
Opposing natural teeth = occlusion, tooth form
Fixed Pros = compatibility of denture teeth, occlusal surfaces