Transition from partial to total edentulism

INTRODUCTION :

The transition from partial to total edentulism is a delicate period in the patient’s life.

And such an act cannot be undertaken without taking into consideration certain general and local factors in order to opt for one of the possible treatments:

• The transitional partial prosthesis.
• The complete dento-muco-osteo supported prosthesis.
• Immediate complete prosthesis.

1. Diagnostic elements
2. – Elements to consider before opting for a transitional partial prosthesis and postponing total edentulism:
   • The psychological factor:

• Patients fearing the loss of their last teeth.
• Significant hypersensitivity during each extraction.
• Series of incessant complaints expressed during the insertion of the first partial prosthesis.
• The anatomical factor:

• The significant degree of resorption.
• An unsightly congenital misalignment between the bone bases.
• The physiological factor:

• Erroneous positional reflexes acquired following poorly compensated tooth loss.
• The need for preprosthetic surgery.
• The pathological factor:
• The abnormal decrease in vertical dimension.
• The social factor:
• The profession of a patient playing a wind instrument.

2)- Elements to take into consideration before opting for a complete dento-muco- osteo-supported prosthesis

NB: This treatment is characterized by the conservation and use of a coronal or radicular portion of the dental organ.

This type of prosthesis is considered when;

• The operator wishes to delay bone resorption.
• The remaining teeth are dilapidated , unsightly , malpositioned with good prosthetic values.

intrinsic and extrinsic.

• The patient accepts neither visible brackets nor any possible distinction between residual teeth and artificial teeth.
• The patient refuses to see the last possibilities of anchoring a mobile prosthesis disappear.
• His psyche is ill-prepared for complete toothlessness.
• The last extractions will be the source of frustration.

3)- Elements which point towards an immediate complete prosthesis without transition:

• General condition (heart disease, rheumatic fever) requiring the elimination of any source of infection.
• Painful, loose, and extruded teeth.
• Vestibular version of the anterior teeth.
• Existence of an incorrect partial denture and the financial inability to make a transitional partial denture.
• Departure for a trip lasting several months.

2. TRANSITIONAL PARTIAL PROSTHESIS:
3. Definition :

Any prosthesis intended to ensure the transition from partial to total edentulism without affecting the patient.

2. Goals:
   • Allow paraprosthetic organs to be maintained in their physiological positions.
   • Familiarize the patient with the size of a complete prosthesis without harshness.
   • Carry out conditioning in all its forms.
   • Plan for the replacement of extracted teeth without affecting the transitional prosthesis.
   • Carry out the addition of this tooth immediately and in the same position.
   • Allowing the patient to be linked to their practitioner.
3. Practical implementation:

1. Secondary impression taking due to the difference in resilience between the fibromucosa and the periodontium: The PEI follows the same criteria as in removable total prosthesis.
2. Mounting the teeth:

The assembly must be perfectly balanced, which will facilitate the transition to the total removable prosthesis.

3. Dental extractions:

• Avulsions should be spaced out (for a real transition).
• Each extracted tooth must be instantly replaced in the same position it occupied.

4. Replacement of teeth to be extracted: is done using the following technique:

• Before extraction, an alginate impression of the arch is taken with the prosthesis in place.
• The prosthesis remains in the impression.
• The space occupied by the tooth to be extracted is filled with a resin of the appropriate shade.

5. When the last tooth is extracted:

• The replacement of the last tooth is done as before.
• But before inserting the prosthesis, the intrados which becomes total is covered with a uniform layer of delayed-setting resin.
• When this prosthesis is integrated and has achieved its objectives, the intrados is improved by the total repair of the base.

NB: This same prosthesis is used as PEI and the impression is taken with a low viscosity silicone (Light)

3. COMPLETE DENTO-MUCO-OSTEO-SUPPORTED PROSTHESIS
4. Definition :

It is a complete removable prosthesis completely covering the residual dental organs by resting

on them.

Also called “ Overdenture ”.

2. Principle:

This prosthesis is designed to rest simultaneously on osteo-mucosal tissues and on dental tissues:

• Let’s have a coronary portion .
• Let there be a root portion .
• Either a means of prosthetic anchoring .

3. Goals :

1. Psychic objectives:
   • Preserving teeth even in the root state gives the patient a feeling of physical integrity.
   • She reassures and comforts him.
2. Tissue objectives:
   • Avoid pathological changes in the fibro-mucosa. (when the support is strictly fibro-mucosal)
   • Promote osteogenesis by axial forces on residual roots.
3. Physiological objectives:

Thanks to desmodontal proprioceptors, we can benefit from:

• Permanent control of mandibular position and movements . (Determination of centric relation.)
• Directional sensitivity of the mandible.

4. Mechanical objectives:
   • Slowing down resorption ensures ridges high enough to oppose lateral movements of the prosthesis.
5. Aesthetic objectives:
   • Preservation of the anterior alveolar rim thanks to the two residual canines allows correct assembly of the incisor-canine block without unbalancing the prosthesis.  

4. Indications:
   • The patient’s age (life expectancy of a few decades).
   • Tooth mobility following an unfavorable clinical crown/root portion ratio.
5. Contraindications:
   • Lack of hygiene.
   • Patient refusing to have his last teeth reduced in height.
   • Possible lack of trust between the patient and their practitioner.
   • Poor quality residual teeth.
6. Choice of a total removable dento-muco-osteo-supported prosthesis technique:
7. PARABOLIC OR PARABOLIC-CYLINDRICAL CAPS:
   • Indications for PARABOLIC caps:

• Reduced inter-arch height.
• Choice of porcelain teeth.
• Search for contact between the prosthetic intrados and the cap limited by its convexity.
• Indications for parabolic-cylindrical caps:

• Significant inter-arch height.
• Possibility of using resin teeth.
• Search for telescopic friction between the intrados and the cylindrical part of the cap.
• Preservation of pulp vitality.
• Technique:

• The impression is taken 8-10 days after sealing.
• The individual impression tray complies with classic requirements.
• Provide a discharge area at the level of each cap and above all protect the vulnerable gingival ring.

2. MECHANICAL STABILIZATION SYSTEMS: (Attachments)
   • Axial Anchors:

• The male part is welded onto the root anchor.
• The female part is included in the prosthetic intrados.
• Indications:

• Single tooth firmly implanted.
• Residual teeth too far apart.
• Bar Anchors:

• The bar is fixed on the root anchor or on cast caps.
• The female part is included in the prosthetic intrados.
• Goals :

• Solidify the remaining teeth.
• Distribute the pressure over as many teeth as possible.
• Promote the conservation of residual teeth
• Increase retention.

4. COMPLETE DENTO-MUCO-OSTEO-SUPPORTED PROSTHESIS
   1. Definition:

Immediate prosthesis is a definitive prosthesis designed before the extraction of the remaining teeth and inserted instantly after their extraction.

2. Goals:
   • Preserve the patient’s aesthetic appearance.
   • Keep the original vertical dimension.
   • Do not alter phonation.
   • Improve the healing process.
   • Systematically use poorly filled alveoli, thus providing the prosthesis with improved stability and, for the patient, the deep tactile sensation of still chewing on their real teeth.
3. Directions:
   • Social position (artist, businessman, statesman, etc.)
   • Emotional life: the patient will always find the period of total toothlessness imposed for healing humiliating.
   • Age: The younger the patient, the more this type of restoration is necessary.
   • Special circumstances (proximity of holidays, a happy or unhappy event, etc.)
   • The integrity of anatomical and physiological structures: immediate prosthesis allows the current integrity of all muscular and joint structures to be preserved.
4. Implementation procedure

• Conservation of pre-extraction documents:

The pre-extraction elements to be recorded in our pre-prosthetic examination are as follows:

• the orientation of the existing occlusal plane.
• The intermaxillary relationship.
• Incisor and condylar trajectories.
• The shape, size, color and position of the anterior teeth.
• Extraction of posterior teeth:

• The posterior teeth are extracted first to ensure longer healing time.
• Before any procedure, a cast of both arches with all existing teeth must be taken.
• Preliminary alginate impressions:
• Before taking the alginate impression, it is recommended to fill the interdental diastemas with a heavy silicone to avoid extracting the teeth when removing the impression tray.
• Secondary prints:

Their principles of realization are not very different:

• Production of the individual impression tray with a gripping system which prefigures the volume and position of the alveolar-dental wall.
• Adjustment of the individual impression tray.
• Taking the secondary impression.

• Location and transfer of the hinge axis
• Determination of the intermaxillary relationship

• Determination of the vertical dimension of rest.
• Possible correction of the minimum phonetic space.
• Transfer to the articulator of the position of the maxilla relative to the hinge axis.
• Solidarity of the two bulges in centric relation.
• Selection and assembly of posterior teeth:
• The choice is made based on: – the incisor and condylar trajectories and the pre-extraction documents.
• Functional test:
• Control of the intermaxillary relationship.

• Construction of the complete prosthesis in the laboratory: A/ Registration of the marks on the casts:.
• The color of each tooth was chosen in advance by the practitioner in agreement with the patient and someone close to them.

B/ Polymerization:

• It is done on the model.
• The prosthesis is then duplicated.
• Extraction of the remaining teeth and placement of the prosthesis.
• Post-operative advice:

• Do not remove the prosthesis for the first 24 hours.
• Apply ice packs locally for the first few hours.
• Take a sedative before going to sleep.
• A fluid diet free from any chewing effort.

N.B: The prosthesis acts as a surgical dressing that should only be removed by the practitioner. It acts as a true hemostat by compression.

• Post-operative care and corrections:

• 2nd session ^:
• the prosthesis is removed and washed with physiological serum.
• The support surface is examined and the operator proceeds to carefully clean the alveoli.
• Occlusion control is performed. Very tight contacts will be established between the artificial teeth.
• Any retouched point on the prosthesis must be carefully polished.
• This restoration should not be considered definitive because two phenomena inevitably occur:

  A secondary resorption which progressively destroys all adhesion and stability of the prostheses.

A change in the intermaxillary relationship resulting from a shift in occlusion toward centric relation.

CONCLUSION

Transition therapy from partial to total edentulism is a key step in the integration of the future complete prosthesis .

The means implemented during this passage have the following objectives:

• Correct an aesthetic and functional defect as quickly as possible .
• Prepare the patient and their oral cavity to receive a complete removable prosthesis under favorable conditions.

BIBLIOGRAPHY

J.Lejoyeux – Treatment of partial and total edentulism (partial prosthesis). Maloine SA publisher 1980,1985.

Transition from partial to total edentulism

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Transition from partial to total edentulism