Prosthodontics

This department specialises in oral conditions associated with missing or deficient teeth and/or the face and jaw requiring specialist level management.

This may include the replacement of natural teeth with removable dentures and/or fixed replacement of natural teeth with crowns and bridges or implants where appropriate. It may also include facial prosthetics.

Patients have a major role in contributing to the long term success of treatment provided in this clinic. There should be a reasonable expectation that the patient will maintain their existing dentition for most of their life.

The replacement of missing teeth oral rehabilitation is driven by these clinical principles:

• All general dental care is completed
• Oral health is stable and is being maintained
• The remaining teeth have a fair to good prognosis
• Dental aesthetics to provide dignity for the patient (anterior teeth replaced)
• Sufficient numbers of teeth to provide function (shortened dental arch)

Clinical options will be proposed with consideration to the most appropriate treatment by a RDHM senior clinican.  These options will be based on the requirements to gain function, comfort, and aesthetics as they relate to dignity, wellbeing, and quality of life. To determine the most appropriate course of action a consultation will be required.

Patients should be aware that all options have some limitations and that no artificial tooth replacement can be equal to the function, comfort and appearance of healthy, undamaged teeth.

Considerations:

Some patients may not be able to maintain the standard of oral health that is needed for fixed replacement of natuural teeth, but the provision of a removable prosthesis could greatly improve their social function and restore dignity.

The possible options for tooth replacement and rehabilitation may be limited by:

1. Age – ongoing growth and development up to 21 years
2. Current habits – such as smoking, or
3. Medical conditions – such as :
   1. Uncontrolled Diabetes Mellitus
   2. Compromised immune system
   3. Had (or currently undertaking) Bisphosphonate therapy
   4. Had radiotherapy to head and neck
4. Current difficulty wearing full and partial dentures will have their denture needs assessed prior to consideration of more complex treatment

Clinical criteria:

• Patients who have lost an anterior tooth or have a tooth of poor prognosis particularly following trauma, and who otherwise, have intact arches and a sound dentition.
• Patients missing one or more teeth due to trauma, anodontia, genetic conditions, or diseases of the jaws, e.g. osteomyelitis, tumours
• Patients requiring an assessment for a fixed prosthesis to replace an anterior tooth in the aesthetic zone (13-23, 33-43)
• Patients who have had difficulty in regard to function (speaking and / or eating) and may be treated to Shorthened Dental Arch principles.
• When the provision of a conventional fixed prosthesis will beneficially protect damaged teeth
• Evidence of a collapsing occlusion affecting the Temporo-Mandibular Joint

Prerequisites to referral:

• completion of all other general dental care prior to referral
• demonstrated ability to maintain excellent oral hygiene< 15% plaque score
• a minimum of two O’Leary plaque index scores demonstrating sustained excellent oral health.
• stable periodontal health (for dentate patients)
• any need for an immediate denture is expected to be filled by the patient’s general dentist
• a capacity to attend multiple appointments, and cooperate with complex treatment
• completion of the RDHM Referral Specialist Prosthodontics form