AQ

Chapter 30 - Care of Prosthesis (Vocabulary Flashcards)

Fixed Prostheses

  • Fixed prostheses are non-removable once seated and include:
    • Fixed partial denture (bridge)
    • Implant-supported complete denture
  • Fixed partial dentures (FPDs) are fabricated from various materials and affixed to teeth or implants.
  • Types of FPDs:
    • Natural tooth–supported
    • Implant-supported
  • Criteria for fixed partial dentures (FPDs): stability, esthetics, occlusion, and preservation of tooth structure; require adequate tooth/implant abutments and support.

Natural Tooth–Supported Fixed Partial Denture (FPD)

  • Replaces missing teeth by attaching artificial teeth to existing teeth (abutments).
  • Abutments act as pillars to support the FPD (bridge).
  • Process generally involves:
    • Attaching dental crowns to existing teeth on either side of the gap (abutments)
    • Using dental adhesive to secure crowns
    • Securing false teeth to crowns with a porcelain bridge
  • Also known as a traditional fixed bridge when spanning a gap with crowns

Traditional Dental Bridge

  • Traditional bridge is the most common type.
  • Composed of crowns on adjacent teeth with a pontic (false tooth) bridging the gap.
  • Benefits: strength due to crown support.
  • Downsides: requires modification of two adjacent teeth (preparation to receive crowns).

Cantilever Dental Bridges

  • Uses a single anchor tooth (one abutment).
  • Not commonly used, often placed toward the front of the mouth; not advised for the back of the mouth due to excessive loading on one tooth.
  • If safely placed, can save time and money, but cases are limited

Maryland Bonded Bridges

  • Also called Maryland bridges.
  • Structure similar to traditional bridges but anchors are a framework bonded to the back of adjacent teeth rather than full crowns.
  • Conservative and often more affordable; strength depends on adhesive and framework.
  • Potential issue: tooth discoloration with some metal frameworks

Implant-Supported Bridges (FPD)

  • Bridges anchored by dental implants, not relying on adjacent teeth.
  • Can span large gaps with multiple missing teeth.
  • Strength and durability of implants restore function.
  • Trade-off: more invasive placement and a longer recovery period

Removable Prostheses

  • Removable Prosthetic Options:
    • Removable Partial Denture (RPD)
    • Complete Denture
    • Overdenture (a complete denture supported by roots/implants and soft tissue)
    • Obturator
  • Indications depend on patient’s candidacy for fixed options (bridges/implants)

Removable Partial Denture (RPD)

  • Replaces one or more teeth but not all; can be removed.
  • Primary denture base rests on oral mucosa.
  • Framework usually metal (chrome cobalt) with:
    • Clasps (retainers) and rests to stabilize
    • Abutment teeth or implants as anchors
    • Major connector and denture base
  • RPD may be tooth-borne, implant-borne, tissue-borne, or a combination
  • Base materials include plastic acrylic resin; teeth may be porcelain, plastic resin, or metal
  • RPD components include: cingulum rest, occlusal rest, retainer (clasp), denture teeth, major connector, denture base

Complete Denture and Overdenture

  • Complete Denture: replaces all teeth in an arch; components include base, impression surface, polished surface, occlusal surface, and teeth.
  • Complete Overdenture: a complete denture supported by retained natural teeth and/or implants and soft tissue of the residual alveolar ridge.
    • Root-supported overdenture
    • Implant-supported overdenture
  • Purpose of overdenture:
    • Preserve bone to improve denture retention
    • Allow remaining teeth to bear occlusal loads, reducing stress on edentulous areas
    • Improve stability, retention, tactile and proprioceptive feedback via the periodontal ligament when roots are retained

Obturators

  • A maxillofacial prosthesis used to close, cover, or maintain the integrity of the oral and nasal compartments.
  • Indications include congenital, acquired, or developmental disease processes (cancer, cleft palate, osteoradionecrosis of the palate)
  • Related literature examples include rehabilitation of surgically resected soft palate with velopharyngeal obturators

Consequences of Not Replacing Missing Teeth

  • Replacement may not be indicated if function can be achieved with remaining teeth
  • Common non-replacement scenarios: third molars; second molars with no opposing teeth; teeth extracted for orthodontic purposes
  • Consequences of non-replacement:
    • Migration of adjacent teeth (tilting/rotation) leading to periodontal problems and biofilm control difficulties; misdirected occlusal forces
    • Migration of opposing teeth (supereruption)
    • Increased stress on remaining teeth leading to fractures or loss
    • Loss of occlusal vertical dimension (overclosure) and potential temporomandibular joint disorders
    • Loss of vertical dimension may promote pooling of saliva, increasing risk of angular cheilitis

Denture Care and Maintenance

  • Complete and partial denture care includes debris/biofilm control and maintenance:
    • Debris removal and biofilm control on abutment teeth (if present) and prosthesis
    • Preventive agents as needed (fluoride, CHX)
    • Regular cleaning and protection of fixed prostheses (see figures and Box references for procedures)
  • Denture cleaning cautions:
    • Do not soak dentures in sodium hypochlorite bleach for periods exceeding 10 minutes; may damage dentures
    • Dentures should be immersed in water when not in the mouth to avoid warping
  • Ultrasonic cleaning is used as an adjunct but note avoid damaging materials; see program videos and demonstrations

Procedures for Cleaning Dentures

  • Brushing method (Box 30-2):
    • Spread towel/mat in sink; partial water in sink
    • Grasp denture securely without squeezing
    • Use warm water, nonabrasive cleanser; brush all areas, with special attention to impression surfaces and anterior interior surfaces
    • Rinse to remove cleanser
    • Visually inspect for biofilm and debris
  • Immersion method (Box 30-3):
    • Place denture in a covered plastic container with warm water
    • Follow manufacturer’s dilution/time for cleanser; ensure completely submerged
    • Rinse and brush after immersion; rinse away loosened debris
    • Empty and clean container daily; prepare fresh solution to prevent contamination

Patient Self-Care for RPDs

  • Guidelines for biofilm removal around abutments and implants
  • Educate patients on proper use and cleaning of removable prosthesis
  • Cleaning procedures include: rinsing, mechanical cleansing, and chemical cleansers (see Box 30-3)
  • Figure references show denture brush and clasp brush (Box 30-2/30-3 imagery)

Complete Denture Care and Maintenance Procedures

  • General education prior to denture placement and for new denture wearers
  • Denture cleaning and care recommendations, including adhesives if used
  • Rebase vs relining: relining reshapes the denture underside to improve fit; reline is added to the intaglio surface to improve tissue contact when fit changes over time
  • Relining may be needed periodically due to changes in the jawbone or gums

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 (abrasive)
  • Do keep up with dental appointments
  • Don’t forget the overnight soak
  • Keep dentures in a shape suitable for biting or resting position

Denture-Induced Oral Mucosal Lesions (OMLs)

  • Factors contributing to denture-induced OMLs
  • Types include:
    • Traumatic ulcers (denture irritation) — see Fig. 30-11
    • Denture stomatitis (oral thrush) — see Fig. 30-12
    • Angular cheilitis — see Fig. 30-13
    • Tissue hyperplasia — see Fig. 30-14

Traumatic Ulcer and Denture Stomatitis

  • Denture stomatitis is a yeast infection (Candida) causing inflammation and redness; not contagious; affects gums/palate
  • Treatment often starts with antifungal medications (lozenges or ointments): examples include Nystatin and miconazole
  • Chlorhexidine mouthwash can be effective against fungal infections

Angular Cheilitis and Epulis Fissuratum

  • Angular cheilitis: cracking/irritation at the corners of the mouth; causes include nutritional deficiencies (e.g., vitamin B, iron, zinc)
  • Epulis fissuratum: painless, tumor-like growth on gums/alleolar mucosa due to chronic irritation from ill-fitting appliances or plaque/calculus

Documentation and Clinical Records

  • Documentation is essential for implant and partial denture care (Box 30-5 and related content)
  • Example documentation structure (S-A-O-A-P: Subjective, Assessment, Plan, etc.)
  • Example: partial denture case
    • S: Patient with loose partial denture
    • O: Intraoral findings; tissue status; probing depths; biofilm; calculus
    • A: Assessment of instability and inflammation
    • P: Plan for RPD cleaning, relining/replacement as needed, patient education, schedule follow-up
  • Box 30-5 example demonstrates documentation style for partial dentures

Implants and Implant Prosthetics

  • Chapter 31 overview: The Patient with Dental Implants

Patient Selection and Evaluation

  • Key factors for success:
    • Systemic health and medical history
    • Local factors: periodontal disease, soft-tissue architecture, implant-site anatomy
    • Patient compliance with oral hygiene and maintenance
  • Evaluation for placement includes:
    • Medical/psychological evaluation
    • Comprehensive dental examination
    • Patient expectations and motivation
    • Habits/conditions increasing risk of failure
    • Diagnostic aids preparation
  • Good implant candidate characteristics:
    • Overall good health
    • Healthy gums
    • Sufficient bone to anchor implants
    • Commitment to meticulous home care (brushing/flossing)
  • Contraindications include systemic conditions with poor control, smoking, poorly controlled diabetes, immunocompromised states, bruxism (may require night splint), and growing individuals under ~15–16 years old

Implant Failure Risk Factors

  • Risk factors for implant failure include:
    • Heavy smoking
    • Alcohol abuse
    • Active periodontal disease
    • Immuno-compromised states (steroids, autoimmune diseases, irradiation)
    • Bruxism
  • These factors can impair healing and osseointegration and may necessitate alternative treatments

Post-Restoration Evaluation and Maintenance

  • After osseointegration and restoration completion, periodic evaluation includes:
    • Radiographs
    • Occlusal evaluation
    • Peri-implant tissue health and probing
    • Self-care adequacy
    • Patient comfort

Peri-Implant Preventive Care (1 of 2)

  • Care for natural teeth and for implant biofilm management
  • Planning a disease-control program related to the chosen prosthesis
  • Monitoring prosthesis fit

Peri-Implant Preventive Care (2 of 2)

  • Maintenance of implant-supported restorations
  • Use of antimicrobial agents and appropriate products (toothpaste, mouthwash, fluoride measures for caries control)

Continuing Care and Implant Success

  • Basic criteria for implant success (see Fig. 31-7 for probing an implant)
  • Frequency and content of continuing care appointments
  • Recommending selective radiographs
  • Periodontal assessment and dental biofilm control
  • Instrumentation with implant-safe tools

Cleaning and Care of Implants

  • Cleaning implants is similar to natural teeth but requires gentler approaches:
    • Use soft-bristled toothbrush and low-abrasive toothpaste to protect soft tissue and crown
    • Titanium is commonly used due to biocompatibility and corrosion resistance
  • Ultrasonics caution:
    • Avoid ultrasonic scalers on implants as tips can scratch titanium; consider plastic sleeve covers to reduce damage during cleaning

Probing and Assessment Around Implants

  • Probing around implants can be uncomfortable and may risk trauma to peri-implant tissue
  • Use plastic (TPS or WHO 621) probes:
    • More flexible than metal probes
    • Less contamination/damage risk to implant surface
    • May provide better adaptation to abutment-suprastructure junction

Classification of Peri-Implant Disease

  • Peri-implant mucositis: reversible; diagnostic criteria and non-surgical/surgical treatment options
  • Peri-implantitis: inflammation with progressive bone loss around implant
    • Diagnostic criteria
    • Treatments include non-surgical and surgical approaches; new approaches discussed in evolving literature

Management of Peri-Implant Mucositis

  • Short-term home care: 0.12% chlorhexidine gluconate mouthrinse
  • Office-based management: chlorhexidine gel applications; professional debridement with implant-safe instruments and subgingival air-polishing as appropriate
  • Frequency: may require short-interval visits (e.g., every 3–4 months) to resolve mucositis

Documentation for Implants

  • Example Box 31-1: Continuing care documentation after implant seating
    • S: Patient presents for continuing care 3 months after final seating of implant prosthesis; no chief complaint
    • O: Intraoral health within normal limits; peri-implant soft tissue healthy; biofilm score < 10%; radiographs normal; no mobility; no calculus on implant
    • A: Peri-implant tissue healthy and well-integrated
    • P: Reinforce cleaning, periodontal debridement with implant-safe instruments; plan for three-month continuing care; copy report to surgeon and general dentist

Factors to Teach the Patient (Implants)

  • How implants preserve and maintain bone
  • How to care for implants
  • How implant health depends on daily self-care
  • Role of biofilm in peri-implant disease
  • When to call the office for concerns around the implant
  • Relationship between history of periodontitis and increased risk of peri-implantitis
  • Need for ongoing professional maintenance and radiographs

Key Referencing Concepts and Numerical Details

  • Box and figure references denote standard teaching diagrams and stepwise procedures (e.g., Figure 30-1, Figure 30-4, Figure 31-7)
  • Probing around implants: typically use implant-safe probing techniques with plastic tips; depth measurements monitored during maintenance
  • Prophylaxis and biofilm control are integral to both fixed and removable prostheses maintenance
  • Important numbers:
    • Probing depths discussed in examples: 3 \text{ mm} or less (with some values up to 4 \text{ mm} in certain areas)
    • Biofilm score goal: <10\% for peri-implant assessment
    • Chlorhexidine regimen for mucositis management: 0.12\% solution
    • Maintenance intervals often cited as 3\text{–}4\text{ months} for peri-implant professionals

Real-World Relevance and Practical Implications

  • Replacement options should be tailored to patient’s biological status, esthetic desires, and financial considerations
  • Overdentures provide bone preservation benefits and improved proprioception due to retained roots or implants
  • Denture marking supports forensic identification and patient safety in care facilities; legal variances exist across jurisdictions
  • Proper cleaning protocols reduce microbiological risks, prevent mucosal lesions, and extend denture life
  • Implant maintenance requires patient commitment to daily care and frequent professional follow-up; neglect increases risk of peri-implant disease and implant failure

Foundational and Ethical Considerations

  • Ethical obligation to educate patients about maintenance, realistic expectations, and potential risks/complications
  • Informed consent should cover surgical/invasive aspects of implants and ability to restore function
  • Forensic and identification value of denture marking highlights patient safety and public health considerations

Summary of Key Procedures and Box References

  • Box 30-1: Types of oral prostheses (Fixed vs Removable)
  • Box 30-2: Procedure for Cleaning Denture by Brushing
  • Box 30-3: Procedure for Cleaning a Denture by Immersion
  • Box 30-4: Method to remove denture
  • Box 30-5: Example Documentation: Partial Denture
  • Box 31-1: Example Documentation: Patient with Implants
  • Figures referenced for specific prosthesis types (as noted in text)

Quick Reference Checklist

  • Assess patient’s suitability for fixed vs removable prosthesis; consider implants when appropriate
  • Evaluate abutment teeth/implants and occlusion before selecting an FPD or implant bridge
  • If using an RPD, ensure metal framework suitability and proper clasp/rest configuration
  • Consider overdenture benefits for bone preservation and proprioception
  • For obturators, recognize indications and orofacial structural needs
  • Educate patients on denture hygiene, including brushing/immersion protocols and avoidance of long bleach exposure
  • Screen for denture-induced lesions; treat stomatitis and angular cheilitis promptly
  • In implant care, emphasize peri-implant maintenance, mucositis vs peri-implantitis, and appropriate use of implant-safe instruments
  • Document thoroughly using standardized formats (S-O-A-P) and share with the dental team