Frictional Fitting Removable Partial Denture for Patients

with Cleidocranial Dysostosis

Handré Prinsloo (PS)

In partial fulfilment of BTech: Dental Technology

Department of Dental SciencesTygerberg Campus

CPUT2007

Overview

Overview of Cleidocranial Dysostosis (CCD)Patient historyDesirable Treatment optionsSelected Treatment optionClinical historyLaboratory proceduresReferencesAcknowledgements

Overview of CCDCleidocranial Dysostosis (CCD): CCD is an inherited disorder of bone development 1-6

Characterized by absent or incomplete formed collarbone 1-6

Abnormal shape of skull with depression of sagittal suture 1-6

Characteristic facial appearance 1-6

Short stature and dental abnormalities 1-6

Affected chromosomes 6 and 18 1-6

Patient history 18 year-old female Has CCD syndrome Is asthmatic Extreme tooth abnormalities Absent collarbone Still has primary teeth

Figure 1. Radiograph of patients profile.Figure 2. Radiograph of patients frontal view.

Radiograph courtesy of Tygerberg Hospital Radiograph courtesy of Tygerberg Hospital

Desirable Treatment options

Early OrthodonticsAdvantages and Disadvantages

Acrylic OverdentureAdvantages and Disadvantages

Conventional Co-Cr applianceAdvantages and Disadvantages

Removable Partial Denture (RPD)Advantages and Disadvantages

Desirable Treatment options cont.

Motivation for not selecting these options: Early Orthodontics advantages:

No severe tooth loss due to no surgery 6, 10, 11

Some tooth arch alignment can be established 6, 10, 11

Early Orthodontics disadvantages:Treatment option is to expensive 6, 10, 11 Considerably long treatment duration 6, 10, 11

Patient was too old, impacted teeth roots have already closed, no orthodontics appliance would help 6, 10, 11

Impacted teeth where to severally impacted 6, 10, 11

Desirable Treatment options cont.

Acrylic Overdenture advantages:When dental support is lost, converting from a

overdenture to a complete denture is simple and quick 9

Longitudinal clinical maintenance of the denture improves 9

Greater the retention and stability of a overdenture, improves the masticatory effectiveness 9

Provides Stability by bone preservation 12

Retention, primary retentive areas are preserved 12

Improves chewing ability 12

Desirable Treatment options cont.

Acrylic Overdenture disadvantages:Expensive appliance 12

Bulkier appliance 12

It is a Removable Prosthesis 12

Alternatively canines must be present in the mouth 12

Forces on standing teeth be too severe 9, 12

Loading forces on remaining teeth would be too great 9, 12

Desirable Treatment options cont.

Conventional Co-Cr appliance advantages:Good stability 8

Good strength 8

Conventional Co-Cr appliance disadvantages:Loading forces on teeth would be too great 8

Would damage standing teeth 8

Can cause mandibular to break because of major extractions during surgery 8

Minimal loading forces where needed on remaining standing teeth for future treatment 8

Selected Treatment option

Removable Partial Denture:Treatment option but no clasps or rest where used 7

Reason for no clasp, to minimize the force on the fragile remaining teeth 7

Retentive elements where used to retain the partial denture 7

Use of this appliance eliminated all unnecessary forces on remaining teeth 7

Selected Treatment option

Removable Partial Denture advantages:No metal needed 7,13

Easily constructed 7,13

Inexpensive appliance 7,13

Minimal forces on teeth 7,13

Removable Partial Denture disadvantages:May fracture easily 7,13

Regular cleaning of denture 7,13

Clinical history Surgery was done on the

25/06/2007 Various teeth and impacted

teeth where extracted After surgery the patients

remaining teeth were still fragile, due to the severe surgery.The 1-1, 1-7, 2-1, 2-6, 2-7

teeth remained on the maxillary

The 3-1, 3-2, 3-6, 4-1, 4-2, 4-7 teeth remained on the mandibular

Figure 3. Maxillary model

Figure 4. Mandibular model

Photograph by H. Prinsloo

Photograph by H.Prinsloo

Laboratory procedures Impressions were taken,

bite registration and models were poured 7, 14

Special trays were fabricated on the models and 2nd impressions were taken 7, 14

Final models were poured Try-in was made and sent

to dentist 7, 14

Investing of try-in was done, standard procedure 7, 14

Figure 5. Maxillary and Mandibular special trays

Photograph by H.Prinsloo

Laboratory procedures cont.

No undercuts where blocked out because no clasps or rest was used 7, 14

Use of no clasps or rests was to minimize the loading forces on fragile teeth 7, 14

Undercuts where used for optimal stability and retention 7, 14

RPD was finished and polished, standard procedure and sent out 7, 14

Figure 6. Finished Maxillary RPD

Photograph by H.Prinsloo

Conclusion

The patient is currently wearing the frictional fitting RPD, a mandibular RPD will also be constructed. The reason for the fabrication of a RPD was because of the traumatic

surgery which left the patient with fragile teeth.

A personal recommendation would be that the patient consider a Valplast® Flexible Partials, for the reason of the fragile teeth, because it is: Biocompatible, Promotes health of remaining teeth and gums, Thin and lightweight, Virtually unbreakable, Strength without bulk, Stability, Retention and

can be added to existing partial frames.15, 16

References1. Daskalogiannakis J, Piedade L, Lindholm TC. Cleidocranial Dysplasia: 2

Generations of Management. Available:http://www.cda-adc.ca/jcda/vol%2D72/issue%2D4/337.pdfAccessed: [2007,9 June]

2. Becker A. The Orthodontic Treatment of Impacted Teeth. London: Martin Dunitz 1998

3. University of Peninsula Health System. Available: http://www.pennhealth.com/ency/article/001589.htmAccessed: [2007,15 June]

4. MerckSource. Available: http://www.mercksource.com/pp/us/cns/cns_hl_adam.jspzQzpgzEzzSzppdocszSzuszSzcnszSzcontentzSzadamzSzencyzSzarticlezSz001589zPzhtm Accessed: [2007,15 June]

5. All Refer Health. Diseases & Conditions. Available:http://health.allrefer.com/health/cleidocranial-dysostosis-info.htmlAccessed: [2007,15 June]

References cont.

6. Olszewska A. Dental treatment strategies in cleidocranial dysplasia. Department of Pediatric Dentistry, University of Medical Sciences, Paznań, Poland. 2006; 47: 199-201

7. Samant A, Martin O.J. Fabrication of immediate transitional denture for patients with fixed partial dentures. JADA. 2003; 134: 473-475.

8. Zlatarić D.K, Nemet M, Baučić I. Laboratory Fabrication Procedures of a Metal Partial Denture Framework. Acta Stomatol Croat. 2003; 37: 95-98.

9. NCBI. Pubmed. Overdenture supported by natural teeth: Analysis of clinical advantages. Available:

http://www/ ncbi.nlm.nih.gov/sites/entrez?db=pubmed&list_uids= 12874539&cmd=Retrieve&indexed+google Accessed: [2007,23 October]

10. Hsieh T.J, Pinskaya Y, Roberts W.E. Assessment of Orthodontic Treatment Outcomes: Early Treatment versus Late Treatment. Angle Orthodontist. 2005; 75: 162-170.

References cont.11. Conley R.S, Boyd S.B, Legan H.L, Jernigan C.C, Starling C, Potts C. Treatment of a

Patient with Multiple Impacted Teeth. Angle Orthodontist. 2007; 77: 735-741.

12. Najeeb Saad M.N. Overdentures. Available: www.fmd.uwo.ca/students/uwodss/year3/removable%5COverdenturesforUWO.ppt Accessed: [2007, 28 October]

13. Dental Gentle Care. Partial Denture. Available: http://www.dentalgentlecare.com/parital_denture.htm Accessed: [2007, 28 October]

14. Sowter J.B. Removable Prosthodontics Techniques Dental Laboratory Technology Manuals. Revised Ed. North Carolina: Chapel Hill. 1986: 160-227.

15. Valplast Flexible Partials. Laboratory & Technician. Available: http://www.valplast.com/labs_and_technicians.htm Accessed: [2007, 31 October]

16. Dental Masters Laboratory. Valplast The Aesthetic Flexible Partial. Available: http://www.dentalmasters.com/products/dandp/valplast.html Accessed: [2007, 31 October]

Acknowledgements

Z. Nortjie K. Cloete N. De La Course J. Wright L. Steyn P. van Zyl J.A. Morkel