Depression and complete dentures

1
Depression and complete dentures

• Friedman et al JPD 1987
• Chamberlaine JPD 1985
• Pitts JPD 1985

2
So what are the problems treating PD patients?

• Access
• Compliance
• Moisture control
• Movement

3
Difficulties recording jaw relation

• Stability of bases
• Jaw tremor
• Recording constant rest position
• Sealing rims

4
Stability of bases

• Use heat cured final bases
• Finish upper denture and register lower on heat
  cured final base
• Use existing denture modified to establish OVD
  and RCP

5
Occlusal scheme for complete dentures is a
balanced articulation set up  In complete
dentures ICP must RCP For every other possible
occlusal relationship there must be bilateral or
anterior and posterior simultaneous
contact   Balanced occlusion a static
relationship The bilateral, simultaneous,
anterior, and posterior occlusal contact of
teeth  Balanced articulation a dynamic
relationship  The bilateral, simultaneous,
anterior, and posterior occlusal contact of teeth
during the movement from one balanced occlusion
to another with the maximum of points in sliding
contact.
6
Why record retruded contact position?

• It is reproducible (because it is a border
  position)
• We know that patients easily accommodate to it
  (via neuromuscular feedback from proprioceptors
  in TMJ, muscles of mastication, denture bearing
  mucosa)
• In order to set up a balanced articulation we
  must record the most posterior position
  achievable as the average value articulator
  cannot reproduce backwards movements

7
Complete Denture Design

• Denture bearing area
• Jaw relationship
• Polished surfaces
• Tooth position

8
old
new
9
Implants, but where is tongue space?
10
Implants and Parkinsons Disease

• The implant retained UCLA-type clip bar
  overdenture. A solution to the mandibular
  edentulous patient affected by PD
• Allebaum et al Oral Health 1997 87
• Clinical outcomes of three PD patients treated
  with mandibular implant overdentures.
• Heckmann et al Clin Oral Impl Res 2000 11
• Implant tissue supported, magnet retained
  mandibular overdentures for an edentulous patient
  with PD a clinical report.
• Chu et al J Prosthet Dent 2004 91

11
Implants

• Bar clip
• Ball anchor
• Custom made telescopic
• Magnets

12
Implants

• For patients with PD and with limited manual
  dexterity, the attachment system should allow
  easy insertion and removal of the prosthesis and
  cleansability around implant abutments.
• The use of overdenture retaining systems that
  require high levels of manual dexterity are
  inappropriate.

13
RPDs in PD

• Dexterity
• Path of insertion
• Simplicity of design
• Jaw relationship
• Maintenance
• Xerostomia

14
RPDs

• For patients with PD and with limited manual
  dexterity, the attachment system should allow
  easy insertion and removal of the prosthesis and
  cleansability around implant abutments.
• The use of overdenture retaining systems that
  require high levels of manual dexterity are
  inappropriate.

15
Overdentures

• Number of abutments
• Hygiene
• Xerostomia
• Secondary caries
• Root caries
• Jaw relationship
• Attachments what type?

16
Recommendations

• Dentists need to be made aware of the needs of PD
  patients
• Dentists should be involved early in the
  management of PD patients
• Dental health educators should establish contact
  with PD groups
• Dentists should target PD groups for dental
  health awareness

17
Conclusions

• Denture patients are difficult
• Avoid edentulism
• Consider use of overdentures
• Consider use of implants
• Dental imput at time of diagnosis
• Increase dental awareness
• Tailor visits to suit patient needs