Unimaxillary edentulism
Introduction :
The complete single-maxillary removable prosthesis remains a clinical possibility that practitioners often find themselves confronted with.
The combinations are numerous, the toothed arch can be the maxillary or mandibular arch, be totally or partially toothed, The most frequent situation is that of the edentulous maxillary arch, opposed to a partially toothed mandibular arch in the anterior region.
Problems
*perception: Periodontal proprioception directly regulates the intensity,
the duration, direction of muscle contractions and participates in the control of mandibular movements
* Compared to natural teeth, the resorption of edentulous sectors is strongly accentuated.
* Intra-arch imbalance: At the level of the dentate arch, the remaining teeth may present malpositions such as egressions, versions. clinical conditions which significantly complicate the therapy
. These egressions can in fact exceed the
occlusal plane.
Unimaxillary edentulism
Clinical examination
The edentulous arch : qualities of the ridges, the presence or absence of firm tissues,
With or without resorption.
The dental arch : analysis of the intrinsic value of the teeth, supplemented by a radiographic examination.
analysis of the level and orientation of the occlusal plane. At the level of the oral cavity, the position of the occlusal plane is evaluated according to anatomical landmarks.
Occlusal analysis on articulator
It concerns the level and orientation of the occlusal plane, the vertical dimension of occlusion and the interridge relationships.
This clinical phase requires that the models be mounted in an articulator, in centered relation.
Previously, an occlusion model is made at the level of the edentulous arch, and at the level of the antagonist arch if the latter is partially edentulous.
Analysis of the occlusal plane
The manual cap or the one mounted on an articulator
Pre-prosthetic phases: reestablishment of the occlusal plane in the mouth: transfer the modifications to the mouth either by additive or subtractive techniques.
Prosthetic phase: the actual treatment can be undertaken.
Recording of a functional impression at the level of the edentulous arch, and of a precise impression at the level of the antagonist arch.
Recording of intermaxillary relationships in centric relation, obtaining indentations at the level of the rim.
The choice of teeth
The presence of natural teeth provides very valuable assistance in choosing their color, dimensions and morphology.
In the posterior sectors, porcelain teeth are indicated: when they are opposed to unabraded natural teeth, to ceramic crowns,
Resin teeth are indicated: when the antagonist teeth are abraded, revealing the dentine, in the presence of a reduced prosthetic space.
At the level of the anterior upper teeth, resin teeth are often indicated because they allow the creation of a lingual concavity.
The occlusal concept
The presence of a total removable prosthesis most often requires the establishment of an occlusal scheme of the bilaterally balanced occlusion type.
This requires the establishment of stable occlusal contacts in centric relation at the premolar and molar sectors, and the elimination of anterior contacts. Indeed, these contacts destabilize the prosthesis, promoting anterior resorption and leading to posterior tilting.
Mounting the teeth
The problem arises when it comes to an edentulous maxillary arch facing a toothed mandibular arch. The prosthesis is destabilized by particular dental relationships: at the anterior level,
the incisal guide and in the lateral sectors, the inter-ridge relationships.
For this, it is advisable at the previous level to achieve a very reduced or zero recovery.
Subsequently, a normocclusion assembly is preferred,
A reverse or crossed assembly can only be indicated in cases of strong vestibular position of the mandibular teeth.
Conclusion
The future of unimaxillary prostheses is largely linked to the control exercised by the practitioner over the maintenance of the balance obtained during the prosthetic phase.
Instability always sets in insidiously.
It results, firstly, from the alteration of the distribution of occlusal contacts . Secondly, the occlusal imbalance promotes resorption phenomena, sometimes prosthetic fracture.
For this reason, the placement of implants is the “ideal” solution.
Unimaxillary edentulism
Cracked teeth can be healed with modern techniques.
Gum disease can be prevented with proper brushing.
Dental implants integrate with the bone for a long-lasting solution.
Yellowed teeth can be brightened with professional whitening.
Dental X-rays reveal problems that are invisible to the naked eye.
Sensitive teeth benefit from specific toothpastes.
A diet low in sugar protects against cavities.