Influencing factors on treatment planning partial edentulousness

Dr.Katalin KárolyházySemmelweis University Budapest, Department of prosthodonticsDirector:Med. Habil. Dr.Hermann Péter2018.

INTRODUCTION

Treatment plan is created individually:

- personal datas ( age, sex,job, social background, kooperating abilities, requirements )

- general health

-dental anamnezis:intraoral ,extraoral examination, xray , study cast.

Introduction

The principles of primary prevention, secondary prevention, and tertier

prevention should be kept, as well as the general rule of „nil nocere”.

The treatment plan is basically defined by the position

and number

of teeth on the same dental arch

Definition of treatment plan I.: - 1 missing tooth: demaging the functional

integrity of the masticatory system : implantation as well

- 6, or 5 :--- decreasing chewig ability - 3 :--- involvment of more abutment in

bridge design

- 1:---esthetical problem.

-3 missing teeth in one block: -4,5,6:---still bridge design

(Schillingburg) -6,7,8:---one end of the dental arch is

edentulous, cantilever bridge.

Definition of treatment plan I.: -4 missing teeth in one block:

-3 és 8are present:---fix denture is possible (Fábián és Fejérdy).

-4 upper incisors are missing---all premolars should be involved for a fix denture

-6 upper front teeth are missing:

-all remaining praemolars and molars should be involved for a fix denture

Definition of treatment plan II.:

-all molars and premolars missing : -

szigmatizmus laterális

-7 missing teeth in one block:---RPD

-number of remaining teeth are 1or 2 (szubtotal):

--- close to each other:class 2A/1 telescopic retention

--- far to each other:class 3.resilient dental support,telescopic retention

Modifying factors of treatment plan I.:

Tooth : ---form

---size

---axial position

Modifying factors of treatment plan II.:

1.Loadability depends on the root surface area :

root: - number - length -cross section -periodontal health

Modifying factors of treatment plan II.:

Teeth of I-st rate : upper:1,3,6,7; lower: 3,6,7

Teeth of II-nd rate: upper and lower 4,5

Teeth of III-rd rate: lower:1,2

Changing values: wisdom and the periodontally demaged teeth

Modifying factors of treatment plan II.:

2. Prothetical value depends on the position of the teeth (molars, canine, incisor)

3.Prothetical value depends on the height of the tooth (shoulder preparation of the lower teeth is rarely possible).

Modifying factors of treatment plan II.

1. Periodontal diseases and decreasing number of teeth might reduce loadability.

Splinting can be necessary.

Splinting can be in one plain, or in more, maximum 5, that is circular splinting.

Lehmann topographical classification : splinting is transzversal, sagittal, trigonal, cirkular.

Modifying factors of treatment plan III.

Shape and form of the edentulous ridge vestibular curve of the fix denture.

The function of the connector part is different in the upper and in the lower arch.

Great defects of the soft tissues allowes only the planning of a removable partial denture.

Modifying factors of treatment planning IV. Dysgnathy can deeply change the treatment

plan of partial edentulousness. Most frequently occure the great overjet

and overbite.

Crossbite(progénia). Extended bridge

Prognathy: constructing an upper front bridge is quite different as compared in the eugnath dentition.

Modifying factors of treatment planningV.

Biting forces are depending on the antagonistic dental arch. Natural teeth (500N), or RPD or complete denture (50N).

Important in splinting and cantilever bridge design.

Modifying factors of treatment planning VI. Parafunctional movements, that are different from the physiological movements

ofthe mandible: - occlusal parafunctio

---orofacialis parafunctio

Characteristics:-automatical movements -overloading the remaining teeth -retention of RPD and complete denture is difficult -more abutment teeth are necessary for fix denture.

It can be caused by : -emotion, -neuropathy It can be caused by: -dysgnathy -parodontopathy

Modifying factors of treatment planning VII. Sex of the patient: - caries incidencia is lower in females slower tooth loss esthetical point of view is important. more prosthodontics Age of the patient: -young patient don’t wear RPD -elderly patient : systemyc diseases are more common

tooth attrition, bone resorption more often, immunsystem decreases,

• biting forces decreases,

esthetics become important again between 60-70 a financial possibilities tightening Job of patient : -Stability of denture is important. -actors , sportsman

Modifying factors of treatment planning VIII

General health of the patient

1.Cardiovascular diseases: ischaemia, hypertonia

Dental treatment:• without stressz and pain, early afternoon• aspiration of anesthesia• orthostatic hypotensio( in hypertonia)• • elektiv dental treatment :6month after the myocardial infarct• antihypertensiv medicines has orofacial side effect• antibiotc treatment is necessary in arteficial heart valve

•2.Blood forming system: anaemia: lack of kooperation, chronical inflammation • coagulopathy: extractio after stopping anticoagulant

therapy• •

Modifying factors of treatment planning. VIII.

3.Endokrinológical diseases: Diabetes:-predisposing for candida infections -longer healing period -xerostomia -progrediatig parodontitis---overdenture Osteoporosis:-frequently appearing parodontopathy -frequent tooth loss riziko factors:age, sex, nutrition, smoking, genetiks 4.Secretion disorder: Renal disease: -chrónical form is frequent in elderly -xerostomia -coagulopathy-----extractio -dental treatment after the day of dializis -antibiotical profilaxis in tansplanted patients

Modifying factors of treatmant planning VIII.5.Respiratory diseases: -chronical bronchitis:treatment in

sitting position

6.Gastro-intestinal diseases: -ulcus ----reconstructing chewing abilities -regurgitáció---- dental erosion7.Arthritis: -osteoarthrosis:---rare dental treatment -arteficial hip implantation:----antibiotical profilaxis8.Infectious diseases: -HIV, TBC, Hepatitis: ---separately treated

Modifying factors of treatment plan VIII.

9.Neurological disorder:

Stroke:-preceded by TIA:

--treatment in sitting position:becouse of paretic swallowing reflex mechanism

---elektiv dental treatment after 6 months

---n.facialis és n.hypoglossus paresis:wearing a complete denture is difficult

---oralhygiene: elektrical toothbrush

Parkinson syndrom:

head tremor:---CO és CR definition is difficult

hand tremor:---insertion and removing prosthodontics are difficult

Myastenia Gravis:muscle involution, Co definition is difficult

Modifying factors of treatmant planning VIII.

Epilepsy:

-heterogén disease:--there is a guideline for dental treatment----hydantoin hyperplasia is rare-----the CBZ and Valproát therapy might cause

thrombocytopaenia, that should be taken into consideration when tooth extraction.

-I. class : 70%treated well (seizure free) with antiepileptikum , therefore dental treatment is the same as for the healthy population.

-II. class : simplex and komplex parciális seizures (oralis automatizms, tonic-clonic seizures in massticatory muscles) 1-2 GM/ year.

-prefering fix denture.

-retention of RPD is casted clasp or ball retention.

Modifying factors of treatment planning VIII.

Epilepsy:

--III. class :frequent GM seizures ( 3-4 times monthly)

-fix denture is preferable

-Bolt attachment can let removement of RPD in active consciousness.

-The baseplate of RPD and complete denture are strengten by metal net.

-IV.class :sever mental disorder, no proshodontic treatment only emergency.

Modifying factors of treatment planning VIII.10.Allergical diseases:-antibiotikumok, -metals -acrylicModifying factors of treatment planning IX. Oralhygiéne: -RPD is preferable -no 3/4, 4/5 crown or inlay. -in male it is worse -bad socio economic background -smokers-more calculus -pneumóniabecouse of the aspired bacteria

into the respiratory system

In summary the treatment plan is basically defined by the number and position of teeth, and it is modified by several circumstances.

Personal requirements and socio-economic background should be taken into consideration as creating individual treatment plan.

Thank you for you’r attention!