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16 Cards in this Set

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risk factor

a factor that increases the probability of a disease developing in a given individual

local risk factor

those risk factors confined to the oral cavity

name some acquired local risk factors

calculus - plaque retentive & relates to pt's oral hygiene




BOP - represents both pt oral hygiene compliance & host response to bacterial challenge. Pt's w. low BOP % (<10% of surfaces) may be regarded at low risk of disease




PPD (probing pocket depth) - remaining PPD of 5mm or more following therapy represents a risk factor for tooth loss (7.7 OR)

developmental local risk factors

dental crowding/ tooth position - may lead to ^ plaque retention from compromised OH




furcation involvement - ^ risk disease progression & v prognosis.


However, many studies document a good overall prognosis for such teeth if regular supportive care is provided by a well-organised maintanence programme




bone defects - dehiscence & fenestration & risk of local recession defects




mucosal defects - high fraenal attachments may compromise OH & poss. recession defects




cervical enamel projections & enamel pearls




canine fossa - mesially on 1st PreM - floss ineffective, vision brushes better




root grooves - palatally on incisors

any restoration or prosthesis should:

minimise plaque accum.




avoid physical injury to the periodontium

overhangs/ deficiencies

follows poor matrix adaptation prior to restoration placement as a result of:




- failure to assess cervical fit after placement


- difficulty adapting matrix band when and if cervical floor is subgingival or where proximal surface is concave


- similar problems if crown margins are poor or have subgingival finishing lines

inadequate contact points

attention to matrix band adaptation is crucial




poor/ non-existant point ^ risk of food impaction & plaque retention


- also true for crown & bridgework

conservation issues - damage to perio tissues may occur when:

during cavity preparation




impression taking




as a result of faulty temporary/definitive restoration




creation of occlusal interferences

Restoration margins

imperative that any underlying perio disease is treated before placing restorations




Pt must be able to demonstrate good OH home care before finalising treatment plan




following restoration impt to inform pt of any OH changes, esp. w. crown & bridge work




cavity margins should be readily cleansable - impt to recognise that restorative materials will attract plaque, even subgingivally

subginigival margin placement

potential for:


- direct operative trauma


- facilitate subgingival plaque retention


- risk of marginal tissue recession - esp. if biological width is breached




supra-g margins minimise these risks




sub-g margins may be indicated when:


- caries, fractures or previous restorations extend sub-g


- aesthetics - e.g. if crown margins would be visible (although caution required)


- retention purposes - or alternatives may include crown lengthening surgery





perio health should be attained before perm restorations are placed because...

it is more pleasant to work in a clean mouth vs dirty




presence of calculus may hamper caries detection




inflammed tissue may bleed -> cavity prep more difficult, restoration will be compromised/discoloured/both, impression taking more difficult




failure eliminate perio disease & ensure pt can maintain high standard of home care may result in loss of tooth, irrespective of restoration placed


- esp impt in case of extensive & expensive restorations e.g. bridges




impt stabilise & correct gingival margin - esp upper ant. region when crowns planned


- e.g. replace ill-fitting crowns that have indirectly caused perio disease w. well-fitting, lab made acrylic crowns. Perio treated & when completed preparations can be modified, with margins just apical to gingival margin. Failure to do this may result in persistance of perio disease, apical migration of the gingival margin to expose the crown margin or both

reason to restore edentulous spaces

aesthetics




function




occlusal stability


- prevention of over-eruption, tilting, drifting etc

Why should oral hygiene be monitored throughout prosthetic treatment?




what should consideration also be given to?

any form of prosthesis has potential to increase plaque accum -> stresses importance of OH & stabilisation perio disease




consideration also given to:


- the shortened dental arch concept


- acid etch bridges for single missing anterior teeth


- well designed cobalt chrome tooth-borne partial dentures


- 'Every' design acrylic partial dentures

what advgs may overdentures provide?

increased retention


improved masticatory load


maintenance of alveolar bone


improved masticatory load


psychological benefits

Bridge hygiene should include

- highly motivated pt


- good OH


- no perio disease


- sup-g margins which are easily cleaned by pt


- adequate embrasues (v-shaped valleys btw adjacent teeth)


- convex fitting surface to pontic


- pontic free or just touching mucosal surface


- harmonious occlusion


- instruction of the pt in bridge hygiene

why is it impt to give specific denture/crown/bridgework OH advice?

to minimise potential detrimental effects to surrounding perio tissues