Depression and complete dentures <ul><li>Friedman et al JPD 1987 </li></ul><ul><li>Chamberlaine JPD 1985 </li></ul><ul><li...
So what are the problems treating PD patients? <ul><li>Access  </li></ul><ul><li>Compliance  </li></ul><ul><li>Moisture co...
Difficulties recording jaw relation <ul><li>Stability of bases </li></ul><ul><li>Jaw tremor </li></ul><ul><li>Recording co...
Stability of bases <ul><li>Use heat cured final bases </li></ul><ul><li>Finish upper denture and register lower on heat cu...
Occlusal scheme for complete dentures is a balanced articulation set up   In complete dentures ICP must = RCP For every ot...
Why record retruded contact position? <ul><li>It is reproducible (because it is a border position) </li></ul><ul><li>We kn...
Complete Denture Design <ul><li>Denture bearing area </li></ul><ul><li>Jaw relationship </li></ul><ul><li>Polished surface...
old new
Implants, but where is tongue space?
Implants and Parkinson’s Disease <ul><li>The implant retained UCLA-type clip bar overdenture. A solution to the mandibular...
Implants  <ul><li>Bar clip </li></ul><ul><li>Ball anchor </li></ul><ul><li>Custom made telescopic </li></ul><ul><li>Magnet...
Implants  <ul><li>For patients with PD and with limited manual dexterity, the attachment system should allow easy insertio...
RPDs in PD <ul><li>Dexterity </li></ul><ul><li>Path of insertion </li></ul><ul><li>Simplicity of design </li></ul><ul><li>...
RPDs <ul><li>For patients with PD and with limited manual dexterity, the  attachment  system should allow easy insertion a...
Overdentures <ul><li>Number of abutments </li></ul><ul><li>Hygiene  </li></ul><ul><li>Xerostomia  </li></ul><ul><li>Second...
Recommendations  <ul><li>Dentists need to be made aware of the needs of PD patients </li></ul><ul><li>Dentists should be i...
Conclusions <ul><li>Denture patients are difficult </li></ul><ul><li>Avoid edentulism </li></ul><ul><li>Consider use of ov...
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  1. 1. Depression and complete dentures <ul><li>Friedman et al JPD 1987 </li></ul><ul><li>Chamberlaine JPD 1985 </li></ul><ul><li>Pitts JPD 1985 </li></ul>
  2. 2. So what are the problems treating PD patients? <ul><li>Access </li></ul><ul><li>Compliance </li></ul><ul><li>Moisture control </li></ul><ul><li>Movement </li></ul>
  3. 3. Difficulties recording jaw relation <ul><li>Stability of bases </li></ul><ul><li>Jaw tremor </li></ul><ul><li>Recording constant rest position </li></ul><ul><li>Sealing rims </li></ul>
  4. 4. Stability of bases <ul><li>Use heat cured final bases </li></ul><ul><li>Finish upper denture and register lower on heat cured final base </li></ul><ul><li>Use existing denture modified to establish OVD and RCP </li></ul>
  5. 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. 6. Why record retruded contact position? <ul><li>It is reproducible (because it is a border position) </li></ul><ul><li>We know that patients easily accommodate to it (via neuromuscular feedback from proprioceptors in TMJ, muscles of mastication, denture bearing mucosa) </li></ul><ul><li>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 </li></ul>
  7. 7. Complete Denture Design <ul><li>Denture bearing area </li></ul><ul><li>Jaw relationship </li></ul><ul><li>Polished surfaces </li></ul><ul><li>Tooth position </li></ul>
  8. 8. old new
  9. 9. Implants, but where is tongue space?
  10. 10. Implants and Parkinson’s Disease <ul><li>The implant retained UCLA-type clip bar overdenture. A solution to the mandibular edentulous patient affected by PD </li></ul><ul><li>Allebaum et al Oral Health 1997: 87 </li></ul><ul><li>Clinical outcomes of three PD patients treated with mandibular implant overdentures. </li></ul><ul><li>Heckmann et al Clin Oral Impl Res 2000: 11 </li></ul><ul><li>Implant tissue supported, magnet retained mandibular overdentures for an edentulous patient with PD: a clinical report. </li></ul><ul><li>Chu et al J Prosthet Dent 2004: 91 </li></ul>
  11. 11. Implants <ul><li>Bar clip </li></ul><ul><li>Ball anchor </li></ul><ul><li>Custom made telescopic </li></ul><ul><li>Magnets </li></ul>
  12. 12. Implants <ul><li>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. </li></ul><ul><li>The use of overdenture retaining systems that require high levels of manual dexterity are inappropriate. </li></ul>
  13. 13. RPDs in PD <ul><li>Dexterity </li></ul><ul><li>Path of insertion </li></ul><ul><li>Simplicity of design </li></ul><ul><li>Jaw relationship </li></ul><ul><li>Maintenance </li></ul><ul><li>Xerostomia </li></ul>
  14. 14. RPDs <ul><li>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. </li></ul><ul><li>The use of overdenture retaining systems that require high levels of manual dexterity are inappropriate. </li></ul>
  15. 15. Overdentures <ul><li>Number of abutments </li></ul><ul><li>Hygiene </li></ul><ul><li>Xerostomia </li></ul><ul><li>Secondary caries </li></ul><ul><li>Root caries </li></ul><ul><li>Jaw relationship </li></ul><ul><li>Attachments what type? </li></ul>
  16. 16. Recommendations <ul><li>Dentists need to be made aware of the needs of PD patients </li></ul><ul><li>Dentists should be involved early in the management of PD patients </li></ul><ul><li>Dental health educators should establish contact with PD groups </li></ul><ul><li>Dentists should target PD groups for dental health awareness </li></ul>
  17. 17. Conclusions <ul><li>Denture patients are difficult </li></ul><ul><li>Avoid edentulism </li></ul><ul><li>Consider use of overdentures </li></ul><ul><li>Consider use of implants </li></ul><ul><li>Dental imput at time of diagnosis </li></ul><ul><li>Increase dental awareness </li></ul><ul><li>Tailor visits to suit patient needs </li></ul>

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