Frictional Fitting Removable Partial Denture for Patients with

Frictional Fitting Removable Partial Denture for Patients with Cleidocranial Dysostosis Handré Prinsloo (PS) In partial fulfilment of BTech: Dental Technology Department of Dental Sciences Tygerberg Campus CPUT 2007

Overview Ø Overview of Cleidocranial Dysostosis (CCD) Ø Patient history Ø Desirable Treatment options Ø Selected Treatment option Ø Clinical history Ø Laboratory procedures Ø References Ø Acknowledgements

Overview of CCD Cleidocranial Dysostosis (CCD): Ø CCD is an inherited disorder of bone development 1 -6 Ø Characterized by absent or incomplete formed collarbone 1 -6 Ø Abnormal shape of skull with depression of sagittal suture 1 -6 Ø Characteristic facial appearance 1 -6 Ø Short stature and dental abnormalities 1 -6 Ø Affected chromosomes 6 and 18 1 -6

Patient history Ø Ø Ø 18 year-old female Has CCD syndrome Is asthmatic Extreme tooth abnormalities Absent collarbone Still has primary teeth Radiograph courtesy of Tygerberg Hospital Figure 2. Radiograph of patients frontal view. Radiograph courtesy of Tygerberg Hospital Figure 1. Radiograph of patients profile.

Desirable Treatment options Ø Early Orthodontics ÄAdvantages and Disadvantages Ø Acrylic Overdenture ÄAdvantages and Disadvantages Ø Conventional Co-Cr appliance ÄAdvantages and Disadvantages Ø Removable Partial Denture (RPD) ÄAdvantages and Disadvantages

Desirable Treatment options cont. Motivation for not selecting these options: Ø Early Orthodontics advantages: ÄNo severe tooth loss due to no surgery 6, 10, 11 ÄSome tooth arch alignment can be established 6, 10, 11 Ø Early Orthodontics disadvantages: ÄTreatment option is to expensive 6, 10, 11 ÄConsiderably long treatment duration 6, 10, 11 ÄPatient was too old, impacted teeth roots have already closed, no orthodontics appliance would help 6, 10, 11 ÄImpacted teeth where to severally impacted 6, 10, 11

Desirable Treatment options cont. Ø Acrylic Overdenture advantages: ÄWhen dental support is lost, converting from a overdenture to a complete denture is simple and quick 9 ÄLongitudinal clinical maintenance of the denture improves 9 ÄGreater the retention and stability of a overdenture, improves the masticatory effectiveness 9 ÄProvides Stability by bone preservation 12 ÄRetention, primary retentive areas are preserved 12 ÄImproves chewing ability 12

Desirable Treatment options cont. Ø Acrylic Overdenture disadvantages: ÄExpensive appliance 12 ÄBulkier appliance 12 ÄIt is a Removable Prosthesis 12 ÄAlternatively canines must be present in the mouth 12 ÄForces on standing teeth be too severe 9, 12 ÄLoading forces on remaining teeth would be too great 9, 12

Desirable Treatment options cont. Ø Conventional Co-Cr appliance advantages: ÄGood stability 8 ÄGood strength 8 Ø Conventional Co-Cr appliance disadvantages: ÄLoading forces on teeth would be too great 8 ÄWould damage standing teeth 8 ÄCan cause mandibular to break because of major extractions during surgery 8 ÄMinimal loading forces where needed on remaining standing teeth for future treatment 8

Selected Treatment option Ø Removable Partial Denture: ÄTreatment option but no clasps or rest where used 7 ÄReason for no clasp, to minimize the force on the fragile remaining teeth 7 ÄRetentive elements where used to retain the partial denture 7 ÄUse of this appliance eliminated all unnecessary forces on remaining teeth 7

Selected Treatment option Ø Removable Partial Denture advantages: ÄNo metal needed 7, 13 ÄEasily constructed 7, 13 ÄInexpensive appliance 7, 13 ÄMinimal forces on teeth 7, 13 Ø Removable Partial Denture disadvantages: ÄMay fracture easily 7, 13 ÄRegular cleaning of denture 7, 13

Clinical history Ø Surgery was done on the 25/06/2007 Ø Various teeth and impacted teeth where extracted Ø After surgery the patients remaining teeth were still fragile, due to the severe surgery. ÄThe 1 -1, 1 -7, 2 -1, 2 -6, 2 -7 teeth remained on the maxillary ÄThe 3 -1, 3 -2, 3 -6, 4 -1, 4 -2, 4 -7 teeth remained on the mandibular Photograph by H. Prinsloo Figure 3. Maxillary model Photograph by H. Prinsloo Figure 4. Mandibular model

Laboratory procedures Ø Impressions were taken, bite registration and models were poured 7, 14 Ø Special trays were fabricated on the models and 2 nd impressions were taken 7, 14 Ø Final models were poured Ø Try-in was made and sent to dentist 7, 14 Ø Investing of try-in was done, standard procedure 7, 14 Photograph by H. Prinsloo Figure 5. Maxillary and Mandibular special trays

Laboratory procedures cont. Ø No undercuts where blocked out because no clasps or rest was used 7, 14 Ø Use of no clasps or rests was to minimize the loading forces on fragile teeth 7, 14 Ø Undercuts where used for optimal stability and retention 7, 14 Ø RPD was finished and polished, standard procedure and sent out 7, 14 Photograph by H. Prinsloo Figure 6. Finished Maxillary RPD

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

References 1. Daskalogiannakis J, Piedade L, Lindholm TC. Cleidocranial Dysplasia: 2 Generations of Management. Available: http: //www. cda-adc. ca/jcda/vol%2 D 72/issue%2 D 4/337. pdf Accessed: [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. htm Accessed: [2007, 15 June] 4. Merck. Source. Available: http: //www. mercksource. com/pp/us/cns_hl_adam. jspz. Qzpgz. Ezz. Szppdocsz. Sz usz. Szcnsz. Szcontentz. Szadamz. Szencyz. Szarticlez. Sz 001589 z. Pzhtm Accessed: [2007, 15 June] 5. All Refer Health. Diseases & Conditions. Available: http: //health. allrefer. com/health/cleidocranial-dysostosis-info. html Accessed: [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/year 3/removable%5 COverdenturesfor. UWO. 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 Ø Ø Ø Ø Z. Nortjie K. Cloete N. De La Course J. Wright L. Steyn P. van Zyl J. A. Morkel