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03 Review Complete Dentures for AGD 6 19 2015.Pptx Successful Outcomes in Successful Outcomes in Contemporary Removable Prosthodontics: Complete Denture Prosthodontics Clinical Complete Dentures •! Introduction & Demographics •! Occlusal Schemes for CD’s Mark Dellinges, DDS, FACP, MA •! Diagnosis & Treatment •! Proper Sequence of Clinical 6/19/2015 Planning Appointments •! Impression Techniques & •! Abbreviated Sequence for CD ! Materials Fabrication •! Digital Denture Tooth •! Developments in CAD/CAM Selection Dentures Review of Clinical and Laboratory Procedures for Complete Denture Success Complete Denture Prosthodontics Depends on 3 Factors •! Accurate diagnosis and execution of the required technical procedures •! Meeting or exceeding the patient’s desires and expectations •! Establishing good doctor-patient communications that results in patient confidence “Dr. Charles Goodacre, Dean – Loma Linda University” Demographics: Average Lifespan Demographics: Trends in Tooth Loss 14 60 Average Age Percent Edentulous Percent Edentulous 13 100 90 18+ yrs old 65+ yrs old 75 50 80 12 60 47 40 38 Percent 40 Average Age 11 20 10 30 0 1960 1970 1980 1990 1960 1970 1980 1990 1800 1900 1996 2050 Year 1 Demographics: Demographics: Estimates of U.S. total adult and edentulous Estimates of U.S. total elderly (65+yrs.) adult population and elderly edentulous in one or both jaws 350 60 300 50 250 Dentate < 18 yrs. 40 200 30 Millions Millions 150 Adult Millions Millions One Arch 20 100 Edentulous Edentulous 10 50 Adults Both Arches 0 0 1970 1980 1990 2000 2010 2020 1970 1980 1990 2000 2010 2020 Demographics: Demographics: Denture users in the adult population Will there be a need for complete dentures in the United States in 2020? Douglas et al., J Prosthet Dent 2002 Complete dentures for all age groups from 25 to 85 years of age will increase from 33.6 million adults in 1991 to 37.9 million adults in 2020. The 10% decline in edentulism Redford et al(1996) NHANES Data experienced each decade for the past 30 years will be more than offset by the 79% increase in the adult population older than 55 years. Demographics: Demographics: Denture use and the technical quality of Complete dentures in the prosthetic dental prostheses among persons 18-74 rehabilitation of the elderly persons; five years of age: United States, 1988-1991 different criteria to evaluate the need Redford et al., J Dent Res 1996 for replacement. Nevalainen et al., J Oral Rehabil 1997 !!Analysis of prosthodontic evaluation data indicate that approximately 60% of denture users have at least one This study evaluated the complete dentures of 144 patients problem with the denture. over 75 years old. They found that depending on the criteria used, between 10% and 80% of the dentures were in need of replacement. 2 Demographics: Demographics: Summary Trends in the laboratory industry Marcus, P.A. et. al. Complete Edent- Answers to the question, “what is your lab specialty?” ulism and Denture Use for Elders Type 1999 2002 % change in New England. Partial Dentures 8% 24% +16% J. Prosthet. Dent.76:260, 1996 Complete Dentures 18% 23% +5% Orthodontics 2% 3% +1% Implants 3% 3% 0 “Treatment of edentulous patients will continue to Full Service 16% 16% 0 be a challenge for the dental profession; therefore, Crown & Bridge 51% 49% -2% dental schools must provide adequate dental edu- cation and training in complete denture prostho- dontics for the foreseeable future.” Demographics: Summary Demographics: Dissatisfied Future needs for fixed and removable 7.7 % partial dentures in the United States Douglas et al., J Prosthet Dent 2002 Moderately Fully Satisfied Satisfied !! The number of people in the United States who need 66.7 % complete dentures will increase over the next 20 years. 25.6 % !! Dental education programs and practitioners should consider the implications of these continuing patient needs. Berg E (1998); Smedley TC et al (1989); Kapur KK et al (1997) Demographics: 1st Clinical Appointment !!Despite all the shortcomings edentulous patients -Baseline & Preliminary Impressions are quite satisfied with their complete dentures, only 5-20% of them are not. Van Waas, 1990 !!Denture satisfaction is influenced by various factors, including denture quality, the denture bearing area available, the quality of dentist-patient interaction, previous denture experience and the patients personality & psychologic well being. Berg, 1991 !!Outcome from the patient’s point of view is only in part related to technical aspects of the treatment modality Vervoorn, 1988; Van Waas, 1990 3 1st Clinical Appointment -Baseline Evaluation •! Denture History •! Clinical Findings "! retention "! stability "! support Successful Complete Dentures = Retention-resistance to vertical Optimizing Retention, Stability & Support dislodging forces Retention Stability Support Misc. Findings •! Immediate Retention •! Peripheral Seal •! Residual Ridge •! Condition of •! Interarch Space -palatal seal area Height & Contour Existing Dentures •! Tongue Size –! Intimate Tissue Contact -tongue position •! Residual Ridge •! Size of Jaws •! Lip Mobility & -border tissue attach. Relationships •! Soft tissues Length –! Peripheral (border) Seal -functional mobility of •! Residual Ridge •! Max. or Mand. Tori •! Anterior Max. the floor of the mouth Parallelism •! Palatal Vault Form Ridge Prominence –! Atmospheric Pressure -facial muscle tone •! Radiographs •! Salivary Flow -character of saliva -amount of saliva Retention-resistance to vertical dislodging forces •! Immediate Retention –! Intimate Tissue Contact –! Peripheral (border) Seal –! Atmospheric Pressure •! Long Term Retention –! Neuromuscular Control 4 Retention-resistance to vertical Retention-resistance to vertical dislodging forces dislodging forces "! Peripheral Seal "! Peripheral Seal -palatal seal area -palatal seal area -tongue position -tongue position -border tissue attach. -border tissue attach. -functional mobility of -functional mobility of the floor of the mouth the floor of the mouth -facial muscle tone -facial muscle tone "! Salivary Flow "! Salivary Flow -character of saliva -character of saliva -amount of saliva -amount of saliva Retention-resistance to vertical Retention-resistance to vertical dislodging forces dislodging forces "! Peripheral Seal "! Peripheral Seal -palatal seal area -palatal seal area -tongue position -tongue position -border tissue attach. -border tissue attach. -functional mobility of -functional mobility of the floor of the mouth the floor of the mouth -facial muscle tone -facial muscle tone "! Salivary Flow "! Salivary Flow -character of saliva -character of saliva -amount of saliva -amount of saliva Retention-resistance to vertical Retention-resistance to vertical dislodging forces dislodging forces "! Peripheral Seal "! Peripheral Seal -palatal seal area -palatal seal area -tongue position -tongue position -border tissue attach. -border tissue attach. -functional mobility of -functional mobility of the floor of the mouth the floor of the mouth -facial muscle tone -facial muscle tone "! Salivary Flow "! Salivary Flow -character of saliva -character of saliva -amount of saliva -amount of saliva 5 Retention-resistance to vertical Retention-resistance to vertical dislodging forces dislodging forces "! Peripheral Seal "! Peripheral Seal -palatal seal area -palatal seal area -tongue position -tongue position -border tissue attach. -border tissue attach. -functional mobility of -functional mobility of the floor of the mouth the floor of the mouth -facial muscle tone -facial muscle tone "! Salivary Flow "! Salivary Flow -character of saliva -character of saliva -amount of saliva -amount of saliva Stability-resistance to lateral forces Stability-resistance to lateral forces "! Residual Ridge "! Residual Ridge Height & Contour Height & Contour "! Residual Ridge "! Residual Ridge Relationships Relationships " Residual Ridge no ridge fair ridge good ridge " Residual Ridge ! ! Class II Class III Class I Parallelism Parallelism Support-resistance to vertical Stability-resistance to lateral forces seating forces "! Residual Ridge "! Condition of Height & Contour Existing Dentures "! Residual Ridge "! Size of Jaws Relationships "! Soft tissues "! Residual Ridge "! Max. or Mand. Tori Parallelism "! Palatal Vault Form 6 Support-resistance to vertical Support-resistance to vertical seating forces seating forces "! Condition of "! Condition of Existing Dentures Existing Dentures " " ! Size of Jaws ! Size of Jaws normal blanched hyperemic "! Soft tissues "! Soft tissues "! Max. or Mand. Tori "! Max. or Mand. Tori "! Palatal Vault Form "! Palatal Vault Form hyperplastic spongy taut Support-resistance to vertical Support-resistance to vertical seating forces seating forces "! Condition of "! Condition of Existing Dentures Existing Dentures "! Size of Jaws "! Size of Jaws "! Soft tissues "! Soft tissues "! Max. or Mand. Tori "! Max. or Mand. Tori “V”-shaped steep "! Palatal Vault Form "! Palatal Vault Form shallow average Miscellaneous Findings Miscellaneous Findings "! Interarch Space "! Interarch Space "! Tongue Size "! Tongue Size "! Lip Mobility & "! Lip Mobility & Length Length "! Anterior Max. "! Anterior Max. Ridge Prominence Ridge Prominence "! Radiographs "! Radiographs 7 Miscellaneous Findings Miscellaneous Findings "! Interarch Space "! Interarch Space "! Tongue Size "! Tongue Size "! Lip Mobility & "! Lip Mobility & Length Length "! Anterior Max. "! Anterior Max. Ridge Prominence Ridge Prominence "! Radiographs "! Radiographs Old Denture W/O Denture Flangeless Denture Miscellaneous Findings "! Interarch
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