Dental Prosthetic Options

Dental Prosthetic OptionsS.N.IntroductionProsthetic preferences to knock back a missing tooth fall into two main categories repair prostheses and extractable prostheses.When choosing the suitable interference pickaxe to re post a missing speed incisor, multiple variables involving the patient wishes, expectations, dentist skills and training, cost of interposition, and clinical findings should be interpreted into consideration (Al-Quran et al., 2011). These factors forget have a strong influence on the short and long terms success of the treatment selected.Based on the conservation of neighbouring teething and annual ill luck order, alveolar consonant sets are the treatment of choice to replace a missing primaeval upper jaw incisor, followed by formulaic connects, and removal partial dentures (Pjetursson Lang, 2008).Facial return in coition to jump onCraniofacial development is a day-and-night process that starts intra-uterine and has sh aver different rates amid males and females (Brahim, 2005) .Skeletal maturation in males is inform to be reached at the mount up of 20, while females reach the maturation phase earlier, at the age of 17-18 years (Heij et al., 2006).Therefore, it has been recommended, when selecting the prosthetic option to replace a missing tooth, to compute the patients age into consideration. Dental Implants should be avoided until the cessation of natter development mentioned earlier (Daftary et al., 2013) or after the end of the growth fountain (Heij et al., 2006).If dental embeds are utilise before the vertical maturation is reached, it volition not grow vertically with the alveolar rise and will be submerged at different levels depending at the patients age when the sets were inserted (Brahim, 2005).Dental harm and the surrounding threadsIn most scenarios, it is rare that a single incisor will be traumatized with no damage on attached incisors, surrounding deck out, or fruity tissues. If any damag e sustained to neighbouring teeth, the office and prognosis of these teeth should be assessed, as it will have a strong impact on the selection of the definitive treatment option.traumatic avulsion of teeth, account for 0.5% 3% of all dentoalveolar trauma, and it is associated with damage to the alveolar drum, specially the buccal plate (Andreasen, 1970).After tooth extraction, reduction of the alveolar os summit meeting and breadth can be as lavishly as 50% in the outgrowth year (Schropp L, 2004) with the highest amount of bone loss within the first three months (Pietrokovski Massler, 1967).Bone loss is not even amongst the buccal and palatalised bone plates, with to a greater extent than bone loss in the buccal plate (Pietrokovski Massler, 1967) and bone width than height (Van Der Weijden et al., 2009).There are several(prenominal) treatment options that could be used for replacing a lost maxillary central incisorRemovable Partial Denture (RPD)RPD have the advantages o f minimal clinical skills required, minimal chair time, and preservation of neighbouring teeth. On the other hand, the patient triumph is low, with a sense of insecurity, high risk of accidental breakage, and loss.Still, RPD is the quickest, cheapest repla cement option of a missing incisor, and usually used as a short treatment until healing is complete and bone remodelling is minimal.Resin Retained refractory duads (RRB)Resin retained bridges share the advantage of obliterable dentures of having minimal effect on abutment teeth with no risk of pulpal blot and the reversible nature of the prostheses. It is too relatively of low cost and unobjectionable esthetic result (metal frame could be masked by dark cement on expense of translucency).The commonest ruin associated with RRB is frequent debonding of 20% over 5 years (Pjetursson et al., 2008) which could cause social embarrassment to the patient.The patient could overly be given an Essex Type retainer with a single tooth in the gap as an emergency prosthesis until recementation of the resin retained bridge is done.RRB could be used as a final prosthetic option but to a greater extent often is used as an interim government note as it could be reversed at any time, with 87.7% 5 years prognosis (Pjetursson et al., 2008)If the prosthesis is planned to be a temporary option, Rochette theatrical role wings are made with holes to facilitate frequent removal.Conventional BridgeThis is an irreversible treatment, replacing the missing tooth with a 2 or 3 units conventional bridge. These offer superior retention and aesthetics over RRB by the mean of spacious coverage of the abutment teeth. The main drawback is the need to reduce the give-up the ghost tooth structure of the abutments with 20% risk of nerve damage and high dental caries risk. The reduction of tooth structure is more for porcelain fused to metal or full ceramic/Zirconia crowns than full crown which is a requirement in the anterior aesthet ic zone.According to previous studies, if the adjacent teeth are severed, or in need of being crowned, the conventional bridge is to be preferred (Annual failure rate 1.14%) (Pjetursson Lang, 2008).The success rate is reported to be 90 % for 10 years and 72% for 15 years (Pjetursson et al., 2008) and (Burke Lucarotti, 2012).Endosseous dental implantsWhen considering the success rate, dental implants are reported to have the highest documented pick rate of 94% for 5 years (Attard Zarb, 2003) and 89% over 15 years (Pjetursson et al., 2008).Dental Implants have numerous advantages over the antecedently mentioned treatment options.Comparing dental implants to other fixed treatment modalities, there is no danger of pulpable damage of adjacent teeth, as no abutment teeth provision is involved. Implants also facilitate the patients daily spontaneous hygienics routines nearly the prosthesis, since there are no connectors between the prostheses and abutment teeth, making flossing poss ible.Furthermore, the alimentation and regular follow ups by the dentist is easier for dental implants. Removing a conventional bridge is a challenging task compared to screw retained implant supported crowns which could be removed and re-inserted multiple times when required (not applicable to cemented crowns).For implant supported redresss in the anterior maxillary region, a little patient assessment, implant site assessment, and proper treatment planning is the gravestone for a roaring restoration. The planning should be derived from the restorative point of involve not guided by the availability of bone. The following points should be guardedly assessedLip position at rest and make a faceThe patients aesthetic expectations should be coupled with the upper lip position at rest and when smiling.In most cases, 2 mm of the incisal edge of the central incisors should show at rest, and it could be every 100% of all the incisors (high smile line), more than 75% visible (medium smile line), or (low smile line) wake less than 75% of the incisors.With low smile line lip position, the aesthetic challenges are lower, and the emphasis on soft tissue contouring and papilla diversity is also lower (Tjan et al., 1984).If the patients expectations are high while having high smile line, patient education should take place prior to implant treatment as the implant treatment could be deemed a failure if did not meet the patients aesthetic requirements despite been successful in every other aspect.Attached gingiva and surrounding soft tissueThe attached gingiva could have thick, moderate, or thin architecture. thickheaded gingiva is more common than the thin biotype it appears as a more stippled, flat fibrous band of attached mucosa, masking the underlying skeletal contours. It is associated with higher resistance to recession, better soft tissue contouring, and resistance to peri-implant disease. On the other hand, thin gingival biotypes are found in 15% of popul ation (Tjan et al., 1984) and it is a thinner mucosal layer with the bony scalloping presentation through it. This type is more prone to exposure of the implant and conciliatory the aesthetic result (Tjan et al., 1984).The thin biotype has been associated with long triangular teeth and more incisally positioned fill points, while the thick biotype is associated with shorter, square crowns with more apically positioned contact points (hence, more papillary regeneration).Implant size usedImplant size has a direct effect on the emergence profile of the coronal restoration and aesthetics. Natural existing teeth and easy bone are helping factors when selecting the right implant diameter, while implant length should provide a safety withdrawnness to the surrounding anatomical structures.The implant diameter should kick 1.5 mm between implant and neighbouring teeth (and 3mm between adjacent implant fixtures) (Jivraj Chee, 2006).The gingival biotype also should not be overlooked when selecting the fixture diameter, for illustration if wider implants are used with thin gingival biotype, the risk of recession is higher (Rodriguez Rosenstiel, 2012).Implant positionFor the most aesthetic emergence profile, implants should be set 1.5 mm 2 mm from the adjacent tooth, 3mm 4mm apical to CEJ (Jivraj Chee, 2006), and ideally should be placed under the proposed cingulum of the coronal restoration.A diagnostic wax up and a prefabricated surgical stent are of very important in decision making the crown and implant positions, and evaluating the amount of bony defect and the need for bone imbed. Transfaring the surgical stent into the patients mouth will allow the visualization of the amount of incisor show and smile lines.The implant position and angulation will say the abutment type and the retention method used for the restoration (screw or cement retained).Available bone quality and quantityBone density has been sort by Lekholm and Zarb (1985) into 4 categories Homogenous compact bone,Thick cortical bone around dense trabecular bone,Dense trabecular bone cover by thin cortical bone,Very thin cortex wrap minimal density trabeculae.Types 3 and 4 are associated with more failure rates, and are more found in the maxilla. Therefore, under -preparation of the osteotomy site could be done to gain higher initial stability.Branemark et al 1977 defined ossteointegeration as direct structural and functional connection between living bone and load carrying implant. Implant fixture should be in direct contact with healthy bone in three dimensions. Therefore, the amount of available bone required around any dental implant is 1.5 mm buccally and palatally, 3 mm between adjacent implants and at least 1.5mm -2mm between implants and adjacent teeth (Misch, 2008) and (Rodriguez Rosenstiel, 2012).If buccal bone width is not sufficient, a smaller diameter implant that will be functionally and esthetically sound could be selected. It will also allow slight pa latal positioning (Rodriguez Rosenstiel, 2012). Bone grafting/augmentation procedure could be done to add up the bone thickness (Esposito et al., 2009) and bone could be sourced fromPatients own bone (Autogenous graft) commonly could be harvested from calvarian bone, iliac crest, mandibular ramus or chin. This provides highest reported success rates (Esposito et al., 2009).Different human bone (Allograft) usually from cadaveric bone. Bone undergoes special treatment to be deproteinized and freezed (Esposito et al., 2009).Animal sources (Xenograft) usually overawe or pigs.Synthetic materials (Alloplast) artificial graft material which could be used solely or in conjunction with autogenous grafts (Esposito et al., 2009).Bone regeneration membranes these are used to act as a barrier between the superficial soft tissue and the grafted bone or material to proceed ingrowth of the fibrous tissue and allow pure bone development. These membranes could be either natural or synthetic, reso rbable or non- resporbable.If block bone graft is used, it should be allowed to heal for minimum 3 months before implant placement, while bone augmentation with alloplastic materials and membranes could be done simultaneously (Esposito et al., 2009).It is worth mentioning that porcine- derived bone and membranes may not be acceptable by some patients based on their apparitional beliefs and a specific consent should be obtained.The bone height will also impact the papilla formation, together with the crown shape and level of contact points the papilla regeneration is favourable is square crown, broad apical contact points, and when the distance is around 4-5 mm between bone crest and contact points (Rodriguez Rosenstiel, 2012) and (Tarnow et al., 2003). upright piano bone augmentation has been shown to be unpredictable (Esposito et al., 2009) and the patient should be aware of the sable triangles (lack of papilla) if vertical bone is deficient (Tarnow et al., 2003).ConclusionBased on the previously discussed factors and the evidence available, dental implant would be the treatment of choice if the neighbouring teeth are of good prognosis and the aesthetic results are realistic. It is safe to place an implant in 20 years old male, as the growth of the jaws is complete. A diagnostic wax up and stent could be made to value the aesthetics, and available bone. A 4.5 mm buccal width is not plenteous to place a suitable size implant in a suitable bony envelope, so a block done graft for will be needed before the implant placement. If the source of the trauma was sports related and likely to occur again, a mouth guard should be worn to protect the implant and teeth during activity.BibliographyAbt, E.C.A.B.W.H.V., 2012. Interventions for replacing missing teeth partially absent dentition. Cochrane database of systematic check outs (Online), (2).Al-Quran, Firas F., A.-G.R. N, A.-Z.B., 2011. Single-tooth replacement factors affecting different prosthetic treatment m odalities. BMC Oral Health, 11(1), p.34.Andreasen, J.O., 1970. Etiology and pathogenesis of traumatic dental injuries A clinical study of 1,298 cases. 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