01 Introduction

© 2004 UCLA, Ivoclar Vivadent, Inc. and ACP

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Chapter 1

Introduction

Chapter 1

Introduction

1. IntroductionPart A: Trends in removable

prosthodontic dentistry

Part B: Consequences of tooth loss


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Average Age

3847

7590

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20

40

60

80

100

1800 1900 1996 2050

Year

Average Age

Average Age

3847

7590

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20

40

60

80

100

1800 1900 1996 2050

Year

Average Age

Average lifespan has increased dramatically. We are living longer.

Average lifespanAverage lifespan

PATIENT DEMOGRAPHICS


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10

11

12

13

14

1960 1970 1980 1990

Pe

rce

nt

30

40

50

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1960 1970 1980 1990

Percent Edentulous 18+ yrs old

Percent Edentulous 65+ yrs old

Since the 1960’s there has been a dramatic decrease in the rateSince the 1960’s there has been a dramatic decrease in the rateof tooth loss in our population.of tooth loss in our population.

Trends in tooth lossTrends in tooth lossVital & Health Statistics



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Estimates of U.S. total adult & edentulous adult population

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50

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150

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350

1970 1980 1990 2000 2010 2020

Mill

ions < 18 yrs.

Adult

EdentulousAdults

However, due to the exponential growth of our population the actual number of However, due to the exponential growth of our population the actual number of edentulous patients is slightly increasing over time. Because the age at which patients edentulous patients is slightly increasing over time. Because the age at which patients are becoming edentulous is older, they may have greater adaptation difficulties.are becoming edentulous is older, they may have greater adaptation difficulties.

Vital & Health Statistics



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Estimates of U.S. total elderly (65+yrs.) & Estimates of U.S. total elderly (65+yrs.) & elderly edentulous in one or both jawselderly edentulous in one or both jaws

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10

20

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1970 1980 1990 2000 2010 2020

Dentate

One Arch

Both Arches

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By the year 2020 approximately 30 plus million elderly adults will be By the year 2020 approximately 30 plus million elderly adults will be edentulous in one or both arches. edentulous in one or both arches.

Edentulous

Vital & Health Statistics



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This chart reveals all the possible combinations of completely This chart reveals all the possible combinations of completely edentulous and partially edentulous prostheses in our present edentulous and partially edentulous prostheses in our present population.population.

Denture users in the adult populationDenture users in the adult population

Redford et al(1996) NHANES Data



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•Answers to the question, “what is your lab specialty?”

Type 1999 2002 % change

Partial Dentures 8% 24% +16%

Complete Dentures 18% 23% +5%

Orthodontics 2% 3% +1%

Implants 3% 3% 0

Full Service 16% 16% 0

Crown & Bridge 51% 49% -2%

Trends in the laboratory industryTrends in the laboratory industry

Trends in the laboratory industry are showing a significant Trends in the laboratory industry are showing a significant increase in the demand for complete and partial removable increase in the demand for complete and partial removable services. In fact the increase in removable is outpacing the services. In fact the increase in removable is outpacing the growth patterns of the other restorative areas.growth patterns of the other restorative areas.

Cornerstone Research & Marketing 2002 study of 601 laboratories



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Will there be a need for complete dentures in the Will there be a need for complete dentures in the United States in 2020? United States in 2020?

Douglas et al., J Prosthet Dent 2002Douglas et al., J Prosthet Dent 2002

• Complete dentures will increase from 33.6 million adults Complete dentures will increase from 33.6 million adults in 1991 to 37.9 million adults in 2020. The 10% decline in 1991 to 37.9 million adults in 2020. The 10% decline in edentulism experienced each decade for the past 30 in edentulism experienced each decade for the past 30 years will be more than offset by the 71% increase in the years will be more than offset by the 71% increase in the adult population older than 55 years. adult population older than 55 years.



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Future needs for fixed and removable partial dentures Future needs for fixed and removable partial dentures in the United States in the United States

Douglas et al., J Prosthet Dent 2002Douglas et al., J Prosthet Dent 2002

• The number of people in the United States who need The number of people in the United States who need complete dentures will increase over the next 20 years. complete dentures will increase over the next 20 years.

•Dental education programs and practitioners should Dental education programs and practitioners should consider the implications of these continuing patient consider the implications of these continuing patient needs.needs.



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Denture use and the technical quality of dental Denture use and the technical quality of dental prostheses among persons 18-74 years of age: prostheses among persons 18-74 years of age:

United States, 1988-1991United States, 1988-1991Redford et al., J Dent Res 1996Redford et al., J Dent Res 1996

• Analysis of prosthodontic evaluation data indicate that approximately 60% of denture users have at least one problem with the denture.



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Complete dentures in the prosthetic rehabilitation of Complete dentures in the prosthetic rehabilitation of the elderly persons; five different criteria to evaluate the elderly persons; five different criteria to evaluate

the need for replacement.the need for replacement.Nevalainen et al., J Oral Rehabil 1997Nevalainen et al., J Oral Rehabil 1997

• This study evaluated the complete dentures of 144 This study evaluated the complete dentures of 144 patients over 75 years old. They found that depending patients over 75 years old. They found that depending on the criteria used, between 10% and 80% of the on the criteria used, between 10% and 80% of the dentures were in need of replacement.dentures were in need of replacement.



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• Despite all the shortcomings edentulous patients Despite all the shortcomings edentulous patients are quite satisfied with their complete dentures, only are quite satisfied with their complete dentures, only

• 5-20% of them are not.5-20% of them are not. Van Waas, 1990Van Waas, 1990

• Denture satisfaction is influenced by various factors, Denture satisfaction is influenced by various factors, including denture quality, the denture bearing area including denture quality, the denture bearing area available, the quality of dentist-pt. interaction, previous available, the quality of dentist-pt. interaction, previous denture experience and the patients personality & denture experience and the patients personality & psychologic well beingpsychologic well being. .

Berg,Berg, 19911991

• Outcome from the patient’s point of view is only in part Outcome from the patient’s point of view is only in part related to technical aspects of the treatment modalityrelated to technical aspects of the treatment modality

Vervoorn, 1988; Van Waas, 1990Vervoorn, 1988; Van Waas, 1990



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66.7 %25.6 %

7.7 %

Fully SatisfiedModerately Satisfied

Dissatisfied

Berg E (1998); Smedley TC et al (1989); Kapur KK et al (1997)Berg E (1998); Smedley TC et al (1989); Kapur KK et al (1997)

Patient satisfaction also depends upon expectations and some Patient satisfaction also depends upon expectations and some patients may have very unrealistic expectations. For this patients may have very unrealistic expectations. For this reason it is important to guide and educate the patient.reason it is important to guide and educate the patient.



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Increase in esthetic awareness has prompted an Increase in esthetic awareness has prompted an increase in patient demand for quality removable increase in patient demand for quality removable prosthodontic restorative treatment.prosthodontic restorative treatment.

ESTHETIC AWARENESS


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Increase in esthetic awareness has prompted an Increase in esthetic awareness has prompted an increase in patient demand for quality removable increase in patient demand for quality removable prosthodontic restorative treatment.prosthodontic restorative treatment.


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Dr. Lydon Cooper…Dr. Lydon Cooper…Out of 33 million edentulous patients only 2-4% Out of 33 million edentulous patients only 2-4%

have received implant treatment.have received implant treatment.

Dr. Lydon Cooper…Dr. Lydon Cooper…Out of 33 million edentulous patients only 2-4% Out of 33 million edentulous patients only 2-4%

have received implant treatment.have received implant treatment.

IMPLANT TREATMENT


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• Denture support areaDenture support area• Neuromuscular controlNeuromuscular control• Chewing forceChewing force• Salivary flow due to medication(s)Salivary flow due to medication(s)• Healing capacityHealing capacity• Quality of denture bearing tissuesQuality of denture bearing tissues

Specific Management ProblemsSpecific Management ProblemsElderly patients require special considerations due to their Elderly patients require special considerations due to their compromised oral anatomy, medical & nutritional status, compromised oral anatomy, medical & nutritional status, reduced physiologic reserves and adaptive capacity.reduced physiologic reserves and adaptive capacity.

GERIATRIC PATIENT


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Residual Ridge Resorption (RRR)Residual Ridge Resorption (RRR)

• Physiologic levels of tension results in Physiologic levels of tension results in apposition (such as that transmitted by apposition (such as that transmitted by loading the PDL through natural dentition)loading the PDL through natural dentition)

• Non-physiologic compression (as may occur Non-physiologic compression (as may occur under denture bases) results in resorptionunder denture bases) results in resorption

CONSEQUENCES OF TOOTH LOSSCONSEQUENCES OF TOOTH LOSS


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• Atrophy of supporting Atrophy of supporting structures – Residual Ridge structures – Residual Ridge ResorptionResorption

• Maxillary loss is in vertical Maxillary loss is in vertical and palatal directionand palatal direction

• Mandibular loss is vertical and oriented Mandibular loss is vertical and oriented along cross-sectional shape of mandiblealong cross-sectional shape of mandible



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• Maxillary loss is in vertical and palatal directionMaxillary loss is in vertical and palatal direction

• Mandibular loss is vertical and oriented along Mandibular loss is vertical and oriented along cross-sectional shape of mandiblecross-sectional shape of mandible



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• Maxillary loss is in vertical and Maxillary loss is in vertical and palatal direction (0.1 mm/year palatal direction (0.1 mm/year sustained)sustained)

• Initial loss in first year greater but Initial loss in first year greater but variablevariable

• Mandibular bone Mandibular bone

resorption is 4x resorption is 4x maxillary (varies)maxillary (varies)



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Changes in Intraoral StructuresChanges in Intraoral Structures• Atrophic changes in the residual ridge leading to Atrophic changes in the residual ridge leading to

unfavorable changes in vestibular attachmentsunfavorable changes in vestibular attachments

• Atrophic changes in the mucosa compromising the bearing Atrophic changes in the mucosa compromising the bearing surfacesurface

• Loss of teeth as “fulcrums” for function and tissue supportLoss of teeth as “fulcrums” for function and tissue support• Affect quality of support and stabilityAffect quality of support and stability• Affect ability to manipulate dentures during functionAffect ability to manipulate dentures during function

Denture wearers are in a sense Denture wearers are in a sense “oral invalids“oral invalids”.”.



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Loss of Facial Support and Muscle TonusLoss of Facial Support and Muscle Tonus



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The goals of complete denture The goals of complete denture treatment are to help minimize treatment are to help minimize the affect of these functional, the affect of these functional, aesthetic and psychological aesthetic and psychological compromises.compromises.

SUMMARY… Tooth loss results inSUMMARY… Tooth loss results in• Residual Ridge Resorption (RRR)Residual Ridge Resorption (RRR)• Changes in intraoral structuresChanges in intraoral structures• Decreased masticatory function Decreased masticatory function • Loss of facial support and muscle tonusLoss of facial support and muscle tonus• Psycho-social effectsPsycho-social effects



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The technical details of denture fabrication are only one The technical details of denture fabrication are only one aspect of treatment. Of equal importance is the dentist-patient aspect of treatment. Of equal importance is the dentist-patient interactions or rapport. A dentist must understand denture interactions or rapport. A dentist must understand denture function and its limitations and be able to guide the patient function and its limitations and be able to guide the patient through the treatment and adaptation process.through the treatment and adaptation process.

Technical abilityTechnical ability

Interpersonal management skillsInterpersonal management skills

Understanding of denture Understanding of denture function and denture limitationsfunction and denture limitations

DDEENNTTIISSTT



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Elderly are not simply old adults . . . Elderly are not simply old adults . . . They vary widely in their physiologic They vary widely in their physiologic and psychosocial characteristics and and psychosocial characteristics and in the number and severity of in the number and severity of diseases that they contract.diseases that they contract.

Rowe, New England J of Medicine 1985Rowe, New England J of Medicine 1985



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Proceed to Chapter 2: History and Exam

01 Introduction

Documents

residual ridge

united states

denture users

tooth loss

complete dentures

prosthet dent

van waas

palatal direction