AQ

CH30,31 Care of Prosthesis and Implants – Comprehensive Study Notes (Ch

Box 30-1: Types of Oral Prostheses

  • Fixed

    • Fixed partial denture

    • Implant-supported complete denture

  • Removable

    • Removable partial denture

    • Natural tooth supported

    • Implant supported

    • Complete denture

    • Overdenture

    • Obturator

Purpose of Wearing Fixed/Removable Prosthesis

  • Benefits of replacing missing teeth with dentures

  • Replacement options

  • See Box 30-1, Types of oral prostheses

  • Dental hygienist’s role

  • Consequences of not replacing missing teeth

  • When replacement is not indicated

Box 30-1: Types of Oral Prostheses (Recap)

  • Fixed: Fixed partial denture; Implant-supported complete denture

  • Removable: Removable partial denture; Natural tooth supported; Implant supported; Complete denture; Overdenture; Obturator

Benefits of Wearing Fixed or Removable Prosthesis

  • Replace missing teeth and adjacent structures

  • Teeth presence has an esthetic role

  • Restore facial contour, including lip support and temporomandibular joint position

  • Provide function

  • Enhance ability to eat a variety of healthy foods (e.g., chewy meat, fresh vegetables/fruits)

  • Promote proper speech and enunciation

What is an Obturator?

  • A maxillofacial prosthesis used to close, cover, or maintain the integrity of the oral and nasal compartments

  • Indicated for congenital, acquired, or developmental disease processes (e.g., cancer, cleft palate, osteoradionecrosis of the palate)

Palatal Defect and Corresponding Obturator

  • References: Ahmed B (2015) Rehabilitation of Surgically Resected Soft Palate with Interim Velopharyngeal Obturator. Int J Oral Craniofac Sci 1(2): 031-033. DOI: 10.17352/2455-4634.000006

Fixed Partial Denture Prostheses

  • Description

    • Fixed partial dentures (bridges): see Figure 30-1

    • Fabricated from various materials

    • Affixed to tooth or implants; not removable

  • Types of fixed partial dentures

    • Natural tooth supported

    • Implant supported

  • Criteria for fixed partial dentures

    • Adequate abutment teeth or implants

    • Sufficient space and aesthetics

    • Cariogenic/periodontal risk considered

Natural Tooth-Supported Fixed Partial Denture (FPD)

  • Definition: Bridge attaching artificial teeth to existing teeth (abutments)

  • Process involves:
    1) Attaching dental crowns to the existing teeth on either side of the gap
    2) Using a special dental adhesive to hold the crowns in place
    3) Securing false teeth to the crowns with a porcelain bridge

  • Abutments serve as pillars to support the FPD

Traditional Dental Bridge

  • Most common type of dental bridge

  • Constructed from one dental crown adhered to both adjacent teeth with a pontic in between

  • Anchor points provided by crowns; pontic bridges the gap

  • Main benefit: strength

  • Downside: requires modification of the two adjacent teeth

Cantilever Dental Bridges

  • Structure deviates from traditional bridges; uses a single anchor tooth

  • Not commonly used

  • Not advised for posterior (back) mouth due to excessive strain on a single tooth

  • When safely placed, can save time and money

Maryland Bonded Bridges

  • Uses the same bridge structure but anchors with a metal or porcelain framework instead of crowns on adjacent teeth

  • Conservative and more affordable alternative to traditional bridges

  • Strength depends on adhesive; metal frameworks can cause tooth discoloration

Implant-Supported Bridges

  • Bridge anchored in place with dental implants

  • Does not require adjacent teeth

  • Can span large gaps with multiple missing teeth

  • Implants provide strength, durability, and restoration of normal function

  • More invasive placement procedure and longer recovery period

Removable Partial Denture (RPD)

  • Indication: when patient is not a candidate for fixed bridge or implant

  • Replaces one or more teeth but not all; denture base rests on oral mucosa

Removable Partial Denture Prostheses (RPD) – Details (1 of 2)

  • Description

    • Replaces one or more teeth but not all; can be removed

  • Types of removable partial dentures (see Figure 30-2, RPD)

  • Usually has a stable metal framework (chrome-cobalt)

  • Framework engages abutment teeth or abutment implants with a wide variety of clasp assemblies and rest seats or precision attachments

Removable Partial Denture Prostheses (RPD) – Details (2 of 2)

  • May derive all support from teeth or be partially tooth-borne, partially implant-borne, or partially tissue-borne

  • Base is made of plastic acrylic resin

  • Teeth are made of porcelain, plastic resin, or metal

RPD Components

  • Cingulum rest

  • Occlusal rest

  • Retainer (clasp)

  • Denture teeth

  • Major connector

  • Denture base

Consequences of Not Replacing Missing Teeth

  • Replacement may not be indicated if remaining teeth suffice for function (examples of non-replacement):

    • Third molars

    • Second molars extracted with no opposing teeth

    • Teeth extracted for orthodontic purposes

  • Consequences include:

    • Migration of adjacent teeth (tilting/rotation) leading to future replacement challenges and periodontal problems due to biofilm control difficulties and misdirected occlusal forces

    • Migration of opposing teeth (supereruption)

    • Increased function/stress on remaining teeth (risk of fractures and loss)

    • Loss of occlusal vertical dimension (overclosure) and potential TMD involvement

    • Loss of vertical dimension can promote pooling of saliva and fungal growth (angular cheilitis at mouth corners)

Complete Denture Prosthesis Components

  • Base

  • Impression surface

  • Polished surface

  • Occlusal surface

  • Teeth

Complete Denture: Impression and Border Details

  • Inner impression surface (denture border for maxillary)

  • Polished outer surface

  • Occlusal surface

  • Mandibular denture border

Complete Overdenture Prostheses

  • Definition: A complete denture supported by retained natural teeth and/or implants and soft tissue of the residual alveolar ridge

  • Types:

    • Root-supported overdenture

    • Implant-supported overdenture

  • See Figure 30-4 for illustration

Overdenture: Purpose and Benefits

  • Helps preserve bone, improving denture retention

  • Allows remaining teeth to bear occlusal pressures, reducing load on edentulous areas

  • Improves stability and retention of the denture

  • Improves tactile and proprioceptive senses by maintaining periodontal ligaments

Denture Marking for Identification

  • Criteria for an adequate marking system

  • Inclusion methods for marking

  • Surface markers

  • Information to include on a surface marker

  • Marking is required by law in some countries and in many US states

  • Forensic dentistry use: dentition is a means of identification in disasters, trauma, etc.

  • Dentures in long-term care facilities must be marked with identifying information

Professional Care Procedures for Fixed Prostheses

  • Guidelines:

    • Debris removal

    • Biofilm removal from abutment teeth

    • Preventive agents

    • Prescription fluoride and chlorhexidine (CHX) as needed

    • Care of the fixed prosthesis (see Figs. 30-6, 30-7, 30-8)

Cleaning Dentures (General Guidance)

  • Do not soak dentures in sodium hypochlorite bleach or products containing sodium hypochlorite for periods > 10 minutes; may damage dentures

  • Immerse dentures in water after cleaning when not replaced in the mouth to prevent warping

Ultrasonic Cleaning (Overview)

  • Ultrasonic cleaner usage demonstrated or discussed in related material

  • Video/interactive prompts referenced (e.g., “Ultrasonic Cleaner – Watch video”)

Patient Self-Care: Removable Partial Prostheses (RPDs)

  • Guidelines:

    • Biofilm removal for abutment teeth and implants

    • Education on proper use of removable prosthesis

    • Cleaning the prosthesis (Figures 30-9, 30-10; Box 30-2)

    • Rinsing

    • Mechanical denture cleansing

    • Chemical denture cleansers (Box 30-3)

Denture Cleaning Procedures: Brushing (Box 30-2)

1) Spread a towel, washcloth, or rubber mat over the sink; partially fill with water
2) Grasp denture securely but not tightly to avoid breakage
3) Use warm water, nonabrasive cleanser; brush all areas; special brush adaptations for anterior inner surfaces
4) Rinse under running water; remove cleanser from grooves
5) Visually inspect for biofilm

Denture Cleaning Procedures: Immersion (Box 30-3)

  • Place denture in a plastic container with fitted cover

  • Use warm water for rinsing and mixing cleanser; hot water can distort resin

  • Follow manufacturer's instructions for dilution and immersion time

  • Ensure denture is submerged; cover container

  • After removal, rinse and brush to remove debris and chemicals

  • Empty and clean container daily; prepare fresh solution

Professional Care Procedures: Complete Dentures

  • Denture deposits to consider: mucin and food debris; denture pellicle and biofilm; calculus; stains

  • Removal of denture (see Box 30-4, Method to remove denture)

  • Care of dentures during intraoral procedures

Patient Self-Care: Complete Denture Procedure (Overview)

  • General education before denture placement

  • Education for new denture wearer

  • Denture cleaning and care recommendations

  • Denture adhesives information

  • Reline or rebase of denture (definition of reline)

    • A denture reline reshapes the underside to improve fit/comfort by adding material to the denture interior

    • Relines may be needed periodically due to bone/gum changes

Do’s and Don’ts of Denture Cleaning

  • Do rinse dentures throughout the day

  • Don’t leave denture adhesive in place

  • Do remove dentures before cleaning

  • Don’t use whitening toothpaste (abrasives)

  • Do keep up with dental appointments

  • Don’t forget the overnight soak

  • Keep dentures in biting shape

  • Denture paste generally recommended

Cleaning Dentures Explained (Overview)

  • Emphasizes proper cleaning techniques and rationale

Denture-Induced Oral Mucosal Lesions (OMLs)

  • Contributing factors for denture-induced OMLs

  • Types of denture-induced OMLs:

    • Denture-induced irritation (traumatic ulcers)

    • Denture stomatitis

    • Angular cheilitis

    • Tissue hyperplasia

Traumatic Ulcer and Denture Stomatitis

  • Denture stomatitis (oral thrush) = yeast infection causing inflammation/redness

  • Candida fungus common in mouth

  • Not contagious; affects gums and palate

  • First-line therapy: antifungal medications (lozenges or ointments)

    • Examples: Nystatin, miconazole

  • Chlorhexidine mouthwash can be effective against fungal infections

Angular Cheilitis and Epulis Fissaratum

  • Angular cheilitis: cracking/irritation at corners of mouth; causes include nutritional deficiencies (e.g., vitamins B, iron, zinc)

  • Epulis (epulis fissuratum): painless, tumor-like growth on gums or alveolar mucosa; caused by chronic irritants (plaque, calculus, trapped food, trauma, ill-fitting appliances)

Documentation (Box 30-5): Partial Denture

  • Example patient: S-A 63-year-old female; chief complaint about looseness

  • Observations (O): Slight edematous tissue mesial to #6 and #11; redness on palate where RPD rests; probing depths 3 mm or less (4 mm at mesial facial #6 and #11); tissue erythema; moderate biofilm; stains/calculus

  • Assessment (A): III - fitting, unstable RPD with calculus contributing to inflammation and trauma risk

  • Plan (P): RPD cleaning and storage instructions; clean daily; remove nightly to rest mucosa; keep denture soaking when out at night; demonstrated proper technique; provided new toothbrush and clasp brush; advised ADA-recommended cleaner; next steps: dentist for RPD evaluation and possible reline or replacement; signed by RDH

Implants: Chapter 31 Overview

  • Chapter focus: The Patient with Dental Implants

Patient Selection for Implants

  • Key factors for implant success:

    • Systemic health

    • Medical history

    • Absolute contraindications

    • Local factors

    • Periodontal disease status

    • Patient compliance

    • Soft-tissue architecture

    • Architecture of implant site

Evaluation for Implant Placement

  • Collaborative process among: dentist/specialist placing implant, general dentist/prosthodontist, dental hygienist, dental lab tech, and patient

  • Pre-placement evaluation components:

    • Medical and psychological evaluation

    • Comprehensive dental examination

    • Patient expectations and motivation

    • Oral self-care abilities

    • Habits/conditions increasing implant failure risk

    • Preparation of diagnostic aids

The Implant Patient: Candidate Profile and Contraindications

  • Ideal candidate: overall good health, healthy gums, adequate bone to anchor implants, commitment to daily care

  • Absolute/relative contraindications: smoking, uncontrolled chronic diseases or systemic problems, poorly controlled diabetes (healing issues)

  • Age note: implants not recommended before skeletal growth completion (roughly under 15–16 years old)

Implant Failure and Risk Factors

  • Circumstances increasing risk of failure:

    • Heavy smoking

    • Alcohol abuse

    • Active periodontal disease (must be treated prior to implants)

    • Immunocompromised status (steroids, autoimmune disease, radiation therapy)

    • Bruxism (night-time splint can be used)

  • Implants generally suitable for most healthy individuals with good hygiene; few absolute contraindications

Post-Restoration Evaluation of Implants

  • After osseointegration and restoration: periodic evaluation includes

    • Radiographs

    • Occlusal evaluation

    • Peri-implant tissue health

    • Peri-implant probing

    • Self-care adequacy

    • Patient comfort

Peri-Implant Preventive Care (Overview)

  • Focus areas:

    • Care of natural teeth and implant biofilm

    • Planning disease control programs related to treatment and prosthesis types

    • Monitoring prosthesis fit

  • Maintenance of implant-supported restorations

  • Antimicrobial use, toothpaste choices, mouthwash, and fluoride measures for caries control

Continuing Care for Implants

  • Basic criteria for implant success;

  • Schedule and frequency of continuing care appointments

  • Review of health history, vital signs, and intra/extraoral exam

  • Selective radiographs

  • Periodontal assessment and dental biofilm control

  • Instrumentation appropriate for implants

Cleaning Dental Implants

  • Cleaning parallels natural teeth but requires soft-bristled toothbrush and low-abrasive toothpaste to protect gums and crown

  • Titanium implants: durable, biocompatible, corrosion-resistant material

Implant Care Considerations

  • Ultrasonics: avoid using ultrasonic scalers on implants due to risk of scratching titanium surfaces

  • Plastic sleeve covers available to prevent scratching during instrumentation

Probing an Implant

  • Implant probing is more uncomfortable than tooth probing and carries risk of trauma to peri-implant tissue

  • Use a plastic probe (e.g., TPS or WHO 621) for flexibility, minimal contamination, and accuracy around abutment-suprastructure junction

Classification of Peri-Implant Disease

  • Peri-implant mucositis: reversible; diagnostic criteria; treatment

  • Peri-implantitis: inflammation around implants with progressive bone loss; diagnostic criteria; treatment options (nonsurgical and surgical; new approaches)

Peri-Implantitis

  • Definition: pathological condition around implants with inflammation and bone loss

Management of Peri-Implant Mucositis

  • Short-term home care: 0.12% chlorhexidine gluconate mouthrinse

  • Office care: chlorhexidine gel application; professional peri-implant debridement with implant-safe instruments or subgingival air-polishing

  • Maintenance: may require more frequent visits (3–4 months) to resolve mucositis

Documentation: Implants (Box 31-1)

  • Example continuing care note format:

    • S (subjective): patient present for continuing care 3 months after final seating of implant prosthesis; no chief complaint

    • O (objective): intraoral/exam findings; peri-implant soft tissue healthy; biofilm score; radiographs within normal limits; no mobility

    • A (assessment): periapical implant healthy and well-integrated

    • P (plan): reinforce implant cleaning procedures; follow-up in 3 months; communicate with surgeon and general dentist

    • Signed: RDH

Factors to Teach the Patient (Implants) – Part 1

  • How implants preserve and maintain bone

  • How to care for implants

  • Long-term success depends on daily self-care

  • Role of biofilm in peri-implant disease

  • When to call the office for concerns around the implant

Factors to Teach the Patient (Implants) – Part 2

  • History of periodontitis increases risk of peri-implantitis

  • Emphasis on complex and dedicated daily oral self-care

  • Need for frequent ongoing professional maintenance care, including radiographs

Box 31-1 Example Documentation: Patient with Implants (Summary)

  • Example continuing care documentation format focusing on peri-implant health and maintenance; use standardized fields for consistency