Transcript Slide 1 - Digital Knowledge

Frictional Fitting Removable
Partial Denture for Patients
with Cleidocranial
Dysostosis
Handré Prinsloo (PS)
In partial fulfilment of
BTech: Dental Technology
Department of Dental Sciences
Tygerberg Campus
CPUT
2007
Overview
Overview of Cleidocranial Dysostosis (CCD)
Patient history
Desirable Treatment options
Selected Treatment option
Clinical history
Laboratory procedures
References
Acknowledgements
Overview of CCD
Cleidocranial Dysostosis (CCD):
 CCD is an inherited disorder of bone development 1-6
 Characterized by absent or incomplete formed
collarbone 1-6
 Abnormal shape of skull with depression of sagittal
suture 1-6
 Characteristic facial appearance 1-6
 Short stature and dental abnormalities 1-6
 Affected chromosomes 6 and 18 1-6
Patient history






18 year-old female
Has CCD syndrome
Is asthmatic
Extreme tooth abnormalities
Absent collarbone
Still has primary teeth
Radiograph courtesy of Tygerberg Hospital
Figure 2. Radiograph of patients frontal view .
Radiograph courtesy of Tygerberg Hospital
Figure 1. Radiograph of patients profile.
Desirable Treatment options
 Early Orthodontics
Advantages and Disadvantages
 Acrylic Overdenture
Advantages and Disadvantages
 Conventional Co-Cr appliance
Advantages and Disadvantages
 Removable Partial Denture (RPD)
Advantages and Disadvantages
Desirable Treatment options cont.
Motivation for not selecting these options:
 Early Orthodontics advantages:
No severe tooth loss due to no surgery 6, 10, 11
Some tooth arch alignment can be established 6, 10, 11
 Early Orthodontics disadvantages:
Treatment option is to expensive 6, 10, 11
Considerably long treatment duration 6, 10, 11
Patient was too old, impacted teeth roots have already
closed, no orthodontics appliance would help 6, 10, 11
Impacted teeth where to severally impacted 6, 10, 11
Desirable Treatment options cont.
 Acrylic Overdenture advantages:
When dental support is lost, converting from a
overdenture to a complete denture is simple and
quick 9
Longitudinal clinical maintenance of the denture
improves 9
Greater the retention and stability of a overdenture,
improves the masticatory effectiveness 9
Provides Stability by bone preservation 12
Retention, primary retentive areas are preserved 12
Improves chewing ability 12
Desirable Treatment options cont.
 Acrylic Overdenture disadvantages:
Expensive appliance 12
Bulkier appliance 12
It is a Removable Prosthesis 12
Alternatively canines must be present in the mouth 12
Forces on standing teeth be too severe 9, 12
Loading forces on remaining teeth would be too
great 9, 12
Desirable Treatment options cont.
 Conventional Co-Cr appliance advantages:
Good stability 8
Good strength 8
 Conventional Co-Cr appliance disadvantages:
Loading forces on teeth would be too great 8
Would damage standing teeth 8
Can cause mandibular to break because of major
extractions during surgery 8
Minimal loading forces where needed on remaining
standing teeth for future treatment 8
Selected Treatment option
 Removable Partial Denture:
Treatment option but no clasps or rest where used 7
Reason for no clasp, to minimize the force on the
fragile remaining teeth 7
Retentive elements where used to retain the partial
denture 7
Use of this appliance eliminated all unnecessary
forces on remaining teeth 7
Selected Treatment option
 Removable Partial Denture advantages:
No metal needed 7,13
Easily constructed 7,13
Inexpensive appliance 7,13
Minimal forces on teeth 7,13
 Removable Partial Denture disadvantages:
May fracture easily 7,13
Regular cleaning of denture 7,13
Clinical history
 Surgery was done on the
25/06/2007
 Various teeth and impacted
teeth where extracted
 After surgery the patients
remaining teeth were still
fragile, due to the severe
surgery.
The 1-1, 1-7, 2-1, 2-6, 2-7
teeth remained on the
maxillary
The 3-1, 3-2, 3-6, 4-1, 4-2,
4-7 teeth remained on the
mandibular
Photograph by H.Prinsloo
Figure 3. Maxillary model
Photograph by H. Prinsloo
Figure 4. Mandibular model
Laboratory procedures
 Impressions were taken,
bite registration and models
were poured 7, 14
 Special trays were
fabricated on the models
and 2nd impressions were
taken 7, 14
 Final models were poured
 Try-in was made and sent
to dentist 7, 14
 Investing of try-in was done,
standard procedure 7, 14
Photograph by H.Prinsloo
Figure 5. Maxillary and Mandibular special trays
Laboratory procedures cont.
 No undercuts where
blocked out because no
clasps or rest was used 7, 14
 Use of no clasps or rests
was to minimize the
loading forces on fragile
teeth 7, 14
 Undercuts where used for
optimal stability and
retention 7, 14
 RPD was finished and
polished, standard
procedure and sent out 7, 14
Photograph by H.Prinsloo
Figure 6. Finished Maxillary RPD
Conclusion
The patient is currently wearing the frictional fitting RPD, a
mandibular RPD will also be constructed. The reason for
the fabrication of a RPD was because of the traumatic
surgery which left the patient with fragile teeth.
A personal recommendation would be that the patient
consider a Valplast® Flexible Partials, for the reason of the
fragile teeth, because it is: Biocompatible, Promotes health
of remaining teeth and gums, Thin and lightweight, Virtually
unbreakable, Strength without bulk, Stability, Retention and
can be added to existing partial frames.15, 16
References
1.
Daskalogiannakis J, Piedade L, Lindholm TC. Cleidocranial Dysplasia: 2
Generations of Management. Available:
http://www.cda-adc.ca/jcda/vol%2D72/issue%2D4/337.pdf
Accessed: [2007,9 June]
2.
Becker A. The Orthodontic Treatment of Impacted Teeth. London: Martin Dunitz
1998
3.
University of Peninsula Health System. Available:
http://www.pennhealth.com/ency/article/001589.htm
Accessed: [2007,15 June]
4.
MerckSource. Available:
http://www.mercksource.com/pp/us/cns/cns_hl_adam.jspzQzpgzEzzSzppdocszSz
uszSzcnszSzcontentzSzadamzSzencyzSzarticlezSz001589zPzhtm
Accessed: [2007,15 June]
5.
All Refer Health. Diseases & Conditions. Available:
http://health.allrefer.com/health/cleidocranial-dysostosis-info.html
Accessed: [2007,15 June]
References cont.
6.
Olszewska A. Dental treatment strategies in cleidocranial dysplasia. Department of
Pediatric Dentistry, University of Medical Sciences, Paznań, Poland. 2006; 47:
199-201
7.
Samant A, Martin O.J. Fabrication of immediate transitional denture for patients
with fixed partial dentures. JADA. 2003; 134: 473-475.
8.
Zlatarić D.K, Nemet M, Baučić I. Laboratory Fabrication Procedures of a Metal
Partial Denture Framework. Acta Stomatol Croat. 2003; 37: 95-98.
9.
NCBI. Pubmed. Overdenture supported by natural teeth: Analysis of clinical
advantages. Available:
http://www/ ncbi.nlm.nih.gov/sites/entrez?db=pubmed&list_uids=
12874539&cmd=Retrieve&indexed+google Accessed: [2007,23 October]
10.
Hsieh T.J, Pinskaya Y, Roberts W.E. Assessment of Orthodontic Treatment
Outcomes: Early Treatment versus Late Treatment. Angle Orthodontist. 2005; 75:
162-170.
References cont.
11.
Conley R.S, Boyd S.B, Legan H.L, Jernigan C.C, Starling C, Potts C. Treatment of a
Patient with Multiple Impacted Teeth. Angle Orthodontist. 2007; 77: 735-741.
12.
Najeeb Saad M.N. Overdentures. Available:
www.fmd.uwo.ca/students/uwodss/year3/removable%5COverdenturesforUWO.ppt
Accessed: [2007, 28 October]
13.
Dental Gentle Care. Partial Denture. Available:
http://www.dentalgentlecare.com/parital_denture.htm Accessed: [2007, 28 October]
14.
Sowter J.B. Removable Prosthodontics Techniques Dental Laboratory Technology
Manuals. Revised Ed. North Carolina: Chapel Hill. 1986: 160-227.
15.
Valplast Flexible Partials. Laboratory & Technician. Available:
http://www.valplast.com/labs_and_technicians.htm Accessed: [2007, 31 October]
16.
Dental Masters Laboratory. Valplast The Aesthetic Flexible Partial. Available:
http://www.dentalmasters.com/products/dandp/valplast.html Accessed: [2007, 31
October]
Acknowledgements







Z. Nortjie
K. Cloete
N. De La Course
J. Wright
L. Steyn
P. van Zyl
J.A. Morkel