Next generation of elderly adults are committed to high level of oral health.
They consider their teeth important for their self-image and the ability to enjoy eating.
They will be able to pay considerable amount to have missing teeth replaced by FPD rather than RPD.
Patients prefer a fixed restoration
More comfortable when chewing.
Difficulty in accommodating to major change in oral status. (From natural to RPD)
Adaptation problems.
General Treatment Considerations
No definitive prosthetic treatment should be started bfore a comprehensive treatment plan has been made.
Treatment plan is based on detailed medical and dental history and thorough clinical examination.
Treatment with fixed prostheses normally should not be carried out if oral hygiene can not be controlled.
Control of gingival inflammation, due to persistent poor oral hygiene, is crucial to successful Fixed Prosthodontic Care in older adults
Periodontal Consideration and Attachment Loss
There is no evidence that periodontal disease progresses more rapidly in older people than in young adults. It is essential that periodontitis is treated prior to the placement of FPD.
There must be a continuous maintenance program adapted to patient’s ability to maintain plaque control. Gingival recession have technical consequences when treating patients with FPD.
Avoid devitalization of pulp.
Limit tooth prep by using a narrow chamfer preparation that includes only the crown of the abutment tooth and not the root.
In gingival recession of an Endodontically treated posterior tooth with caries, the best option for treatment is cast restoration that extends to the gingival margin of tooth. Another consequence is open spaces created gingival to the contact areas of the teeth.
Endodontic Considerations and Foundations for Restorations
Tooth vitality of abutments should be maintained.
For building up cores, the use of friction retained self-threading pins may not be appropriate in older patients because their dentin is less elastic in comparison to younger teeth.
In endodontically treated teeth it is recommended that a minimum of 1 mm sound dentin should be preserved around the perimeter of the post. Diameter of the post should be less than one third the diameter of the root. Tooth prep should be extended gingivally and include at least 1 to 2 mm of the cervical dentin.
Existing Restorations and the Integrity of Residual Tooth Structure
Older dentition has experienced extensive treatment over the years.
There’s an increase risk of fractures. To prevent fracture, it is wise to use full crowns that encompass the entire tooth to prevent fracture.
Heavy contacts on closing or excursive movements of mandible may fracture already weakened teeth. Occlusion on natural and restored surfaces msut show multiple even contacts between posterior teeth when the px closes.
Treatment of Patients with Occusal Tooth Wear
Treatment options:
Observation with no treatment.
Change of possible predisposing factors.
Treatment with an occlusal splint.
Prostho treatment.
Restoration of Worn Tooth Surfaces Comprises:
Composite resin restoration
RPD
Overdentures
Inlays
Crowns
FPD
The goal is to obtain maximum retention and stability of the restoration while removing minimum tooth substance. Whenever possible worn tooth surfaces should be restored by metal.
Restoration of Posterior Tooth Loss with Fixed Partial Dentures
FPD for patients with shortened dental arch and the need for additional prostho molar support:
Cantilever FPD
Implant Supported FPD
Cross Arch Fixed Partial Dentures
Cantilever Cross-arch FPD yields good results if:
Perio health has been established and can be maintained in the remaining dentition. Bridgework is designed to preclude undue stress concentration in suporting structures. Treatment with cross arch cantilever FPD has limited indicatiuons in older adults.
Cross Arch Fixed Partial Dentures
It is mainly restricted to previous periodontitis patients who exhibit good cooperation with regard to oral hygiene.
Small Unilateral Fixed Partial Dentures
Small unilateral or bilateral extension FPD were originally conceived for treatment of older patients who were edentulous in maxilla and had fewer than 10 teeth in mandible.
Purposes:
To create at least a premolar occlusion
To provide functional stability of maxillary denture.
To protect the anterior part of maxillary ridge from excessive load or resorption
Tooth prep was kept to minimum and performed according to the following principles:
Margins are placed as far as possible from gingiva.
Minimal grinding was done.
Retention was secured whenever possible by three to four parallel pin preparations per tooth.
Implant Supported Fixed Partial Dentures
Advantages
Enhanced comfort and function
Greater confidence
Reduced dependence on denture wearing skills
Factors when replacing posterior teeth with an Implant Supported Fixed Partial Denture.
1. Posterior placement of implants of adequate lngth may be inhibited by anatomic features such as location of mandibular Canal.
2. If there are natural teeth in the opposite jaw, sufficient space may not be available for the abutments or to provide sufficient rigidity of the fixed partial denture.
3. Occlusal forces are difficult to control when the natural teeth in the opposite jaw have severe attachment loss.
Implant Supported Fixed Partial Dentures
4. Significantly more complications are found in prostheses supported by molar-premolar implants than in prostheses supported by implants in only premolar sites. (according to Parein, 1997)
5. Posterior maxillary implants have decreased survival rate compared with mandibular implants.
6. Most technical and biologic complications occur in prostheses supported by only two implants, compared to those supported by three or more implants.
Replacement of Anterior Teeth
Treatment modalities depend on:
The general dental and periodontal situation
The degree to which abutments are intact
Residual ridge resorption
Occlusion
Oral hygiene
Patient demand
Metal Ceramic Full-Crown Fixed Partial Dentures
Indicated when the abutments need restoration with full crowns and good long term result is required.
This situation is relatively frequent in elderly patients who have had caries throughout life but who maintained their natural dentition by restorative therapy.
Metal-Ceramic Partial Crown Fixed Partial Dentures
Partial crowns used as retainers
Complex preparation – occlusal, mesial, distal groove pin preparation and removal of tooth substance
Incisal surface should be covered with gold
If the reconstruction fails it is usually necessary to make new restoration based on full crowns.
Resin Bounded Partial Dentures
Attaching pontics via plate to the unprep or minimally prepared lingual surfaces.
Bonding is made with composite resin.
Resin Bounded Partial Dentures
Rochette
Retained by a metal plate with undercut perforations through which composite resin can flow.
Maryland
No perforations. Etched electrolytically with strong acid. Mesiolingual and distolingual of abutment must be prepared to be circumscribe by 180 degrees.
Fiber Reinforced Composite Resin Fixed Partial Dentures
Steps
Basal part of the pontic is built up with composite resin
Basal part of the pontic is bonded to the abutment teeth with fibers and composite resin
The pontic is again built up with composite resin and polished.
Reference
Jorgensen E: Prosthodontics for the elderly, Quintessence Publishing Illinois 1999
0 Comments.