PREVENTIVE PROSTHODONTICS
GUIDED BY PRESENTED BY
DR.D.SREENIVASULU B.CHANDRA OBULA REDDY
PROFESSOR I MDS
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CONTENTS
• Introduction
• Goals
• Different levels of Preventive prosthodontics
• Primary level of prevention
• Secondary level of prevention
• Tertiary level of prevention
• Preventive implant therapy
• Conclusion
• References
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PREVENTIVE DENTISTRY :
• It is that specialized branch of dentistry which deals with the prevention and
interpretation of the progress of all dental and oral diseases and limitation of
disabilities and provides rehabilitation.
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INTRODUCTION:
• Preventive prosthodontics refers to prosthodontic practices that help
prevention of factors adversely affecting the oro-dental facial tissues and tooth
supporting structures such as periodontium, alveolar bone, basal bone and
musculo-skeletal structures . ( GPT 10)
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GOALS :
• To delay residual ridge resorption.
• Preservation and Maintainance of remaining structures .
• To asses the need for early prosthodontic replacement of lost teeth .
• Select treatment in consultation with patient and implement it judiciously.
• Design prosthesis not interfering with normal oro-dental hygiene procedures .
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OBJECTIVES:
• patients education and motivation.
• Selecting evidence based management option / prosthetic type and design to
maintain remaining teeth and their supporting tissues in healthy state.
• Prostheses for Stabilizing and controlling the progression of specific dento-
orofacial conditions.
• Special preventive prostheses for head and neck cancer (HNC) patients
including preventive prostheses and radiation stents and carriers.
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PREVENTIVE PROSTHODONTICS CAN BE
DEALT UNDER 3 LEVELS
• Primary(intiation of disease)
• Secondary (disease progression and recurrence)
• Teritary (loss of function)
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PRIMARY LEVEL SECONDARY LEVEL TERITARY LEVEL
• DIET COUNSELLING • OCCLUSAL • IMMEDIATE DENTURES
INTERFERENCES
• MOUTH GUARDS • OVER DENTURES
• BRUXISM
• CARIES PREVENTION • PROVISIONAL
MEASURES • TFO RESTORATIONS
• RADIATION CARRIERS • PLUNGER CUSP • OBTURATORS
• SOCKET SHIELDING • OBSTRUCTIVE SLEEP • SINGLE COMPLETE
APNEA DENTURES
• SPACE MAINTAINERS
• IMPLANTS
• MAXILLOFACIAL
PROSTHESES
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PREVENTIVE PROSTHODONTICS AT PRIMARY LEVEL
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PRIMARY LEVEL
• DEFINED as action taken prior to
onset of disease which will remove
the possibilities of disease to occur.
• It is a prepathogenic phase. It
includes the steps like health
promotion and specific protection.
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PLAQUE CONTROL
• Neutralize the plaque acids
• Improve hygiene
• Introduce antimicrobials
• Stimulate Saliva
• Topical fluorides
Remineralizing strategies promoted with the use of calcium-phosphate complexes
such as ACP-CPP ( amorphous calcium phosphate – casein phosphopeptide)
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Caries preventive measures:
• In the case of the old patients due to decreased salivation, gingival
recession, root exposure, cervical abrasion, attrition, an increase risk of
the caries susceptibility is there.
• So, for these patients fluoride rinses and fluoridated tooth pastes are
recommended.
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• Correction of mal-aligned teeth and regular care for the prosthesis like
complete dentures, removable partial dentures and fixed partial dentures is
essential.
• The patient is also educated about the chewing habits, tongue postures for
better maintenance of the occlusion.
• The jaw exercises are recommended because complete edentulousness may
alter the normal muscle engrams ( masticatory muscle memory ) .
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Diet counseling
• Step 1: As certain the dental health diet score and if necessary, demonstrate the
method for keeping a food intake diary
• Step 2: explain the nutrition-periodontal relationship
• Step 3 : Assess nutritional status
• Step 4 : Prescribe a diet –improve adequacy of diet
• Emphasize foods that are particularly beneficial to periodontal tissue proteins,
vitamin C, vitamin A, folic acid, calcium, iron and zinc
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SOCKET SHIELDING
• This complicates dental
rehabilitation, especially in case of
implant treatment.
• Various Guided Bone Regeneration
(GBR) techniques like the use of filler
materials and membranes have been
used to retain the original dimension
of bone after extraction.
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• Leaving a segment of the uninflammed buccal root in place there by preserving
the natural periodontium eventually prevents bone loss.
• Welker WA and his colleagues mentioned that the mucosal coverage of roots
come under preventive prosthodontics.
• Davarpanah and Szmukler did a 2 year follow up of five patients showing that
immediately placed implants in contact with tooth fragments preserved buccal
bone without any signs of abnormal changes.
Welker WA, Jividen G J, Kramer DC. Preventive prosthodontics mucosal coverage of roots. J 16
Prosthet Dent 1978;40:619-621
SPACE MAINTAINERS
• Dental space maintainers are
designed for a specific purposes.
They may be removable, fixed or
semi-fixed.
• They are very essential in cases of
deciduous or permanent tooth loss
to prevent malposition of teeth,
supra eruption
Albati M, Showlag R, Akili A, Hanafiyyah H, Alnashri H, Aladwani W, et al. Space maintainers application,
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indication and complications. Int J Community Med Public Health. 2018;5(11):1–5
MOUTH GUARDS
• The mouth guards are indicated to prevent the
dental and dentofacial injuries in contact sports .
• The injuries such as tooth fractures, concussion,
crown root fractures, TMJ fractures, dentoalveolar
fractures, soft tissue injuries can be prevented or
minimized.
• The mouth guards with moderate resiliency
absorb the forces .
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• Types of mouth guards :
1.Stock mouthguard
2.Boil and bite
3.Custom made .
• Multiple layer mouth guards are preferred to single layer vacuum mouth
guards.
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RADIATION SHIELDS
Radiation stents/ shields are the ones which protect the
adjacent tissues from scattered and secondary radiation
during radiotherapy.
Importance of intra – oral radiotherapy stents
1.Proper projection of radiation
2.Protects healthy tissues
3.Reduces the side effects of the treatment
Increases the accuracy of the radiation source.
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Types of radiation prothesis:
• Radiation carrier
• Radiation protection / shielding
stent
• Position maintaining stent
• Tongue depressing stent
• Tissue recontouring stent
• Perioral cone positioning stent
• Tissue bollus compensator
• Dosimeter positioning stent
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REGULAR CARE OF PROSTHESES
• Patients should be encouraged to thoroughly clean their dentures with a soft
brush and non-abrasive paste or denture cleansing tablets or soaps can be used.
• Over night soaking of the prosthesis is recommended
• If the dentures are lined with soft temporary lining materials, then the inner
portion should be gently washed under cold running water with soft cotton and
the external surface can be brushed in a normal manner.
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PREVENTIVE PROSTHODONTICS AT
SECONDARY LEVEL
• It includes the early detection of the disorders and providing prompt
treatment.
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OCCLUSAL INTERFERENCE
• Occlusal interference produces
mandibular deviation during closure
to maximum intercuspation (MIC)
position or may hinder the smooth
passage to and from MIC position.
• The inference may be also be present
during latero-trusive movements and
protrusive movements.
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• If the occlusal interference cross the threshold of adaptive capacity of the
temporo-mandibular joint, muscles of mastication and neuromuscular system, it
leads to muscle hypertrophy, muscle fatigue, spasm, headaches, cranio-
mandibular dysfunction syndrome, wear facets, fractured cusps, tooth mobility.
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BRUXISM
• It has a multifactorial etiologies - stress,
anxiety,sleep apnoea, cracked tooth
syndrome, periodontitis, CNS disturbances,
and alcohol consumption.
• Bruxism leads to attrition, mobility, muscle
hypertrophy, occlusal facets, alveolar bone
loss and TMJ disorders.
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• Treatment of bruxism involves Controlling
the psychological stress , Occlusal
correction, Coronoplasty and Occlusal
splints or intraoral prosthesis
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TRAUMA FROM OCCLUSION:
• Acute TFO is due to sudden heavy forces.
Chronic TFO is due to continuous and long
duration occlusal forces, e.g. bruxism,
drifting and extrusion of the teeth.
• Primary TFO is caused due to high occlusal
forces whereas main cause of secondary
TFO is a low threshold or low resistance of
the periodontium.
• Occlusal corrections are needed for the
correction of the TFO.
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PLUNGER CUSPS
• The cusps that tend to forcibly wedge food
into interproximal embrasures of opposing teeth.
• These plunger cusp are usually the functional
cusp and sometimes palatal incline of maxillary
buccal cusp and buccal incline of lingual cusp.
• Treatment involves rounding and shortening of
the plunger cusps, and the opposing
interproximal space is protected by splinting the
adjacent teeth.
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PROVISIONAL RESTORATION
• It mainly focuses on protecting pulp and periodontal health, promoting guided
tissue healing, to achieve an acceptable emergence profile, evaluating hygiene
procedures, preventing abutment migration, providing an adequate occlusal
scheme and evaluating maxillo-mandibular relationships.
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OBSTRUCTIVE SLEEP APNEA
• The role of dentistry in sleep disorders is becoming more significant, especially
in co-managing patients with simple snoring and mild to moderate obstructive
sleep apnea.
• It is characterized by cessation of airflow through upper airway while
diaphragm movement continues. It can cause due to enlarged tonsils, enlarged
soft palate, large tongue and retrognathism.
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• This can be taken care by fabrication of
prosthetic mandibular advancement
appliances like soft palate lifters,
tongue retainers, mandibular
repositioners, snore guards etc., and
surgery to remove portions of the soft
palate and uvula
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Tertiary level prevention involves
A - Limiting the disability of the patient
B- Rehabilitation
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A.Limiting the disability of the B. In rehabilitation phase
patient • Post and core treatment
• Restoration of the teeth • Obturators
• Timing of extraction • Removable partial denture
• Preservation of occluding pairs of • Fixed partial denture
teeth • Complete dentures
• Avoidance of contact between the • Implants
teeth and the opposite edentulous • Over denture
jaw
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TIMING OF EXTRACTION
• Planned extraction of highly mutilated teeth prevents the rapid resorption of
the alveolar ridges.
• Extraction of the maxillary third molar is delayed till the middle age. As third
molars have their influence on growth of the tuberosity and help in the
development of anterioposterior alveolar ridge.
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Preservation of Occluding Pair of Teeth
• preservation of an incomplete dentition with a minimum of occluding pairs of
teeth in combination with a partial denture is preferable than the total tooth
extraction.
Dua P, Singh JP, Aghi A. Aesthetic and functional rehabilitation of acase of mutilated dentition and loss
of vertical dimensions. J IndianProsthodont Soc. 2011;11(3):189–94. doi:10.1007/s13191-011-0088- 36
3.
Interim Denture/Treatment Denture
• The treatment dentures acts as space maintainers, prevent the
migration/drifting, prevent the supra eruption and prevent the contact between
the teeth, alveolar ridge, restore the function, esthetics, restore the muscular
tonicity, restore the vertical height, jaw health and avoids the abnormal jaw
habits.
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POST & CORE TREATMENT
• post and core crown is a type of dental restoration required where there is an inadequate
amount of sound tooth tissue remaining to retain a conventional crown.
• A post is cemented into a prepared root canal, which retains a core restoration, which retains
the final crown.
• The role of the post is firstly to retain a core restoration and crown, and secondly to redistribute
stresses down onto the root, thereby reducing the risk of coronal fracture
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IMMEDIATE DENTURE
• If the dentition is very compromised and indicated for
total tooth extraction, then immediate dentures are
planned to promote better healing, protect the blood
clot and aid early healing and promote better ridge
form.
• Immediate dentures also prevent the facial
musculature from collapsing, provide a guide for the
vertical dimension, esthetic, easy adaptation to the
dentures and provide psychological comfort. 39
Single Complete Denture
• When the teeth are completely absent in any one
of the arch, the fabrication of a single complete
denture is highly recommended to prevent the
contact of the teeth and alveolar ridge, to restore
function, vertical dimension, esthetics and
prevent the development of parafunctional habits.
Scott BJ, Hunter RV. Creating complete dentures that are stable in function. Dent Update
2008;35:259‑62, 265.
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Mucosal Coverage Of Roots
• A clinical procedure that involves covering exposed tooth roots with mucosa
to preserve the alveolar ridge. ( some procedures include - sub epithelial
connective tissue graft, GTR..etc)
• Retaining the vital roots retarded the resorption of the residual ridges under
complete dentures.
• These retained vital roots serve as natural implants which are ideal and
anchored by periodontal ligaments.
Welker WA, Jividen GJ, Kramer DC. Preventive prosthodontics--mucosal coverage of roots. J Prosthet
Dent. 1978 Dec;40(6):619-21. doi: 10.1016/0022-3913(78)90056-2. PMID: 281517. 41
• In a 4‑year‑study, Renner et al. showed that 50% of roots, used as overdenture
abutments remained immobile. In addition, 25% of roots that were initially
mobile became less mobile. Hence, they suggested, that teeth that are generally
compromised can be used for overdentures after root canal therapy and
decoronation.
Renner RP, Gomes BC, Shakun ML, Baer PN, Davis RK, Camp P.
Four‑year longitudinal study of the periodontal health status of 42
overdenture patients. J Prosthet Dent 1984;51:593‑8.
Overdentures
• This can be advantageous in terms of conserving
the natural teeth, reducing the rate of residual
ridge resorption, proprioceptive feedback by
existing periodontal ligaments and thus
controlling the occlusive forces and preventing
the rapid residual ridge resorption
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• Arora et al reported over denture with attachments as a boon to
preventive prosthodontics.
• They act as shock absorbers and stress redirectors as well as provide
good retention.
Arora A, Upadhayaya V, Goyal I, Chowdry A. Attachments : Boon to preventive 44
prosthodontics: Two case reports. J Dent Res Rev 2014;1:152-6
• Some authors concluded that mucosal coverage of roots as a means of
preservation of the residual alveolar ridge is a sound clinical method for those
patients where the overdenture is not possible, and instead of complete
extractions. They feel that the undisturbed root attached to the alveolar bone by
the periodontal ligament is the “perfect” implant.
Lovdal A, Schei O, Werhaug J, Arno A. Tooth mobility and alveolar
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bone resorption as a function of occlusal stress and oral hygiene. Acta Odontol
• Semi precision attachment has exceptional feature of being a removable
prosthesis with improved esthetics, less postoperative adjustments, functional
stability and better patient comfort.
• They are mostly indicated in long edentulous spans, distal extension bases and
nonparallel abutments.
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FIXED PARTIAL DENTURE
• The preparation should be conservative .
• use partial coverage rather than full coverage .
• convergence angle between the axial walls should be minimum.
• occlusal reduction should follow the anatomic planes.
• The adjacent teeth and surrounding tissues should be protected .
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• keeping the gingival margin supra gingivally or in area easily cleansed by the
patient.
• Resin retained FPD : The main advantage is that they are conservative in tooth
preparation does not compromise the abutment tooth.
• Pontic –
modified ridge lap in the anterior region & maxillary posterior region
Sanitory pontic in the mandibular posterior region
Open embrasure adjacent to abutment tooth allow space for inter proximal
tissue and access for oral hygiene.
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• Supra gingival margin should place in a non esthetic area.
• Equi gingival margin have more impact on the periodontium & subgingival
margin having greatest biologic risk.
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OBTURATOR
• Obturator is a prosthesis used to close a congenital or acquired tissue
opening, primarily of the hard palate and contiguous alveolar tissues.
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• Interim obturator is given after the removal of
the surgical packing.
• The interim obturator is retained up to 3
months with repeated checking and relining
with the tissue conditioner, followed by
definitive obturator.
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PREVENTIVE IMPLANT THERAPY
• Preventive dentistry is mainly concerned with caries and periodontal disease
and little, or no attention is paid to the prevention of alveolar bone loss.
• Studies have shown that mandibular ridge shows a slower resorption pattern
when it is loaded by implants supported prosthesis rather than a conventional
mucosa supported dentures.
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Kalk et al. proposed the resorption stages of the residual ridges which are used
in preventive implantlogy.
• Preventive stage I : Anatomic situation after tooth extraction. Further
resorption can be prevented by implantation of the bone substituents. e.g. a non
resorbable hydroxyl appetite.
• Preventive stage II : After the initial resorption has occurred. In this case,
further resorption can be prevented by placing cylindrical endosteal implants to
maintain adequate width and height .
• Preventive stage III : Knife edged ridge. Bone removal is necessary for implant
placement.
• Preventive stage IV : Severe resorption of the alveolar ridge has taken place.
only basal bone is present. Implants are placed directly into the basal bone to
prevent total loss of function of the arches.
Kalk W, Denissen HW, Kayser AF. Preventive goals in oral implantology. Int Dent. 1993;43(5):483–91. 53
CONCLUSION
• Potential problems can be avoided & resolved by properly instituting preventive
prosthodontic measures according to the degree or level of prevention needed
to correct it.
• Every extra minute spent in a thorough clinical evaluation eliminates future
prosthodontic problems.
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REFERENCES
• Singh R, Singh J, Gambhir RS, Bhinder KS. Preventive aspect of prosthodontics: An overview.
European Journal of Prosthodontics. 2015 Jan 1;3(1):10.
• Lakshmi US, SrinivasaRao R, Rajesh A, Anusha C, Reddy RR. " Prevention Better Than Cure" In
Prosthodontics-A Review.
• Morrow, R. M., Feldmann, E. E., Rudd, K. D., & Trovillion, H. M. (1969). Tooth-supported complete
dentures: An approach to preventive prosthodontics. The Journal of Prosthetic Dentistry, 21(5),
513– 522. doi:10.1016/0022-3913(69)90073-0
• Palaskar J, Mody ZS, Mohile SS, Wankhade JH, Korde SR. Different types of radiation prosthesis
to minimise radiation side effects. Int J Curr Res. 2016;8:33575-8. 45
• Welker WA, Jividen G J, Kramer DC. Preventive prosthodontics- mucosal coverage of roots. J
Prosthet Dent 1978;40:619-621
• Arora A, Upadhayaya V, Goyal I, Chowdry A. Attachments : Boon to preventive prosthodontics:
Two case reports. J Dent Res Rev 2014;1:152-6
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