PATIENT FACTORS & THE FAILURE OF RESTORATIONS

what are (the groups of) risk factors that increase the risk of a disease from recurring or that increase the risk of a treatment failing

• systemic conditions that impact on oral health

• inherited or acquired oral conditions

• habits or behaviours

list systemic conditions impacting on oral health/ operative treatment

• cardiovascular disease

• diabetes mellitus

• epilepsy

• autoimmune conditions

• chemotherapy/ radiotherapy

• anti-coagulant and anti-platelet drugs

• anti-resorptive drugs/ bone metabolism drugs

how does cardiovascular disease impact on oral health/ operative treatment

• CVD and drugs used to manage it impact on periodontitis, LA selection, prescription of antibiotics

• there is increasing evidence that CVD may impact on oral soft and hard tissue healing

how does diabetes mellitus impact on oral health/ operative treatment

• well established risk factor for periodontitis

• drugs used to manage DM can lead to dry mouth which increases caries risk

how does epilepsy impact on oral health/ operative treatment

• epilepsy and management can lead to gingival enlargement

• seizures can lead to significant stress on dental tissues and increases risk of trauma i.e. tooth fractures and luxations

how do autoimmune conditions impact on oral health/ operative treatment

• some can cause dry mouth e.g. Sjogren’s syndrome

how does chemotherapy/ radiotherapy impact on oral health/ operative treatment

• can cause dry mouth if in head/ neck region

• chemotherapy can lead to oral sores and timing of procedures

how do anti-coagulant and anti-platelets drugs impact on oral health/ operative treatment

• impact on treatment planning with extractions being contraindicated in most situations

how do anti-resorptive drugs/ bone metabolism drugs impact on oral health/ operative treatment

• e.g. bisphosphonates, Denosumab

• extractions are contraindicated in most situations

what needs to be taken into consideration when planning complex restorations

if it can be cleaned well by the patient - adapt OH appliances to patient

what condition is shown in this photo

amelogenesis imperfecta

what condition is shown in this photo

outline amelogenesis imperfecta

• INHERITED/ HEREDITARY CONDITION

• commonly presents with pitted and discoloured enamel

• pain and sensitivity

• affects all teeth in mouth so management typically involves full mouth restorations and often full coverage crowns from a young age

outline dentinogenesis imperfecta

• INHERITED/ HEREDITARY CONDITION

• discolouration of all teeth

• all teeth appear to be significantly worn down

• patients with more severe forms will typically wear dentures from a very young age

give examples of developmental oral conditions

• fluorosis

• molar incisor hypomineralisation (limited to first permanent molar teeth and incisors)

what occlusal factors impacts on treatment planning

• anterior open bite

• cross bites

• heavy occlusal contacts

give examples of acquired diseases and conditions (after a tooth is fully erupted )

• history of periodontal disease: gingival recession, loss of alveolar bone support, aesthetics

• history of dental caries: increasing caries risk, restored teeth, impact on recall period

• previous dental treatment: quality, complexity of maintenance and replacement

• tooth surface loss: erosion, abrasion, attrition

what are the common causes of acquired diseases and conditions after a tooth is fully erupted

acquired diseases and conditions are typically the result of 3 common diseases of the tooth and surrounding structures:

• caries

• periodontitis

• TSL

what are two general groups of patient factors that can cause restorations to fail

• diet: cariogenic or erosive

• lifestyle: impact on OH measures, smoking

how do restorations fail

• secondary caries/ CARS

• failure of restorative material

• cracks and fractures

• loss of vitality

outline secondary caries/ CARS

• CARS = Caries Around a Restoration or Sealant

• failure to eliminate underlying disease

• continuation of the original disease

• new episode of caries

outline failure of the restorative material

• material thickness?

• wear and tear?

• occlusion?

outline cracks and fractures

• cracks and fractures lead to loss of restoration or replacement of restoration

what can severe cases of cracks lead to

extraction

outline loss of vitality and its solution

• pulp necrosis may occur after a previous deep lesion has been managed and restored or recurrent carious lesion may begin around an existing restoration

• usual solution for loss of pulp vitality: RCT

what effect does the operator have on the longevity of restorations

• assessment

• diagnosis and prognosis

• prevention

• cavity preparation

• restoration placement and finishing

• maintenance