Removable Prosthodontics for People with Dementia
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30/11/2015 1 Removable Prosthodontics for People with Dementia Tim Friel Senior Clinical Lecturer Barts and the London School of Medicine & Dentistry What are the key issues? Will the patient cooperate enough? Can the patient consent to treatment? Will tooth replacement improve patients quality of life? Who are we treating? Adjustments to the existing denture Resorption leads to relative overextension of denture which may cause hyperplasia Adjustment of borders alone may not solve issues as occlusal table has also sunk Decision needs to be made on basis of pt cooperation Adjustment / Refurbishment may be most appropriate where a single problem is identified Strategies for refurbishment Chairside reline last up to one year – avoid irreversible changes to satisfactory denture. Laboratory reline More durable but need to consider benefit vs removing denture from patient Tissue conditioning. Useful but only as short term measure – difficult for the patient to maintain hygiene
Transcript of Removable Prosthodontics for People with Dementia
30/11/2015
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Removable Prosthodontics for People with Dementia
Tim FrielSenior Clinical Lecturer
Barts and the London School of Medicine & Dentistry
What are the key issues?
Will the patient cooperate enough?
Can the patient consent to treatment?
Will tooth replacement improve patients quality of life?
Who are we treating?
Adjustments to the existing denture
Resorption leads to relative overextension of denture which may cause hyperplasiaAdjustment of borders alone may not solve issues as occlusal table has also sunkDecision needs to be made on basis of ptcooperation
Adjustment / Refurbishment may be most appropriate where a single problem is identified
Strategies for refurbishment
Chairside reline last up to one year – avoid irreversible changes to satisfactory denture.
Laboratory reline More durable but need to consider benefit vs removing denture from patient
Tissue conditioning. Useful but only as short term measure – difficult for the patient to maintain hygiene
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Denture Adhesives
Improvement in chewing ability
Improvement in Quality of Life
When do we make new dentures?Patient cooperationFamily present Missing DenturesExisting dentures – copy technique
Case Treated by Dr Aditi Bhalla
Copying Dentures
Modifying the Denture
Copying Dentures
• Visit 1• Jaw registration and copy
impression
• Lab stage 1• Pour copy impressions, articulate
and set teeth
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Occlusal Stability Making the Occlusal Record
Copying Dentures
Visit 2Tooth try in, closed mouth impression techniqueRelates occlusal surface to impression surface under functional loading
Lab stage 2Pour master casts, articulate, wax up base, process
Confirm:C/ has not been displaced forwards OVD unchanged
Copying Dentures
Visit 3Deliver dentures, check and adjust
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Copying Partial Dentures
Copy the denture
Jaw registration with copy denture in situ
Impression of fit surface of copy in situ (closed mouth technique)
May be fewer indications for copying P/P
Copying Partial Dentures
Alginate over impression to create master cast
Denture Design
Hygienic design where possible
Plan for failure as well as success
Tooth supported where possible
Conclusions
Decision to replace missing dentures needs to be made with carers
Refurbishment of dentures may be an acceptable alternative to remake
Copying dentures (even with extensive modification) may offer the best solution
