Preventive Prosthodontics Dr Srivatsa G

IPS Bengaluru Branch

&
DAPMRV Dental College

Master class in Prosthodontics: 3rd – 4th, Feb 2018

Topic- Preventive Prosthodontics

By- Dr Srivatsa.G, Professor & Principal, KLE

Questions asked in the examination on / related to, the topic

1. Preventive Prosthodontics- 7 marks
2. Preventive Prosthodontics- 100 marks
3. Discuss the importance of Preventive Prosthodontics- 20 marks
4. Discuss Over dentures with regard to the philosophy of Preventive Prosthodontics- 7 marks
5. Over dentures- in achieving preservation- 20 marks

FLOW CHART

Introduction
Preventive dentistry
Prosthodontics- Definition and goals
Preventive Prosthodontics
- Rationale
- Definition
Different ways of achieving preventive prosthodontic goals
o Patient education and motivation
o Optimum prosthetic type and design to maintain the remaining structures
o Prostheses for preventing and controlling the progression of specific dento-
orofacial conditions
o Special preventive prosthesis for head and neck cancer patients
Principles of prevention as applicable to the branches of prosthodontics.
o Preventive philosophy in complete denture prosthodontics
 Role of impression in prevention
 Role of occlusion in preservation and prevention in complete denture
 Role of overdenture in prevention
o Removable partial denture and its design as related to maintenance of tissue
health
o Preventive philosophy in fixed Prosthodontics including implants
Levels of Preventive Prosthodontics
o Primary- Pre pathogenic phase
o Secondary – Early detection and prompt treatment
o Tertiary- Disability limitation and rehabilitation
 Treatment for patients with highly mutilated dentition
 Interim and immediate dentures

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 Over dentures
 Implant dentures
 Maxillofacial Prostheses
Conclusion
References

Introduction

Partial or total loss of natural teeth and their replacement with prostheses necessitates the patient
to adapt to the new and progressively changing situation in many respects. The loss of teeth can
lead to functional and psychosocial problems and needs to be restored.

Dr. M. M. DeVan [1952] philosophy of giving more importance to preserving what already
exists than to replacing what is missing will always remain unchallenged or never disapproved.
This has been the primary goal of preventive prosthodontics. Mandel stated, “All the dental
procedures must be considered not only in terms of dealing past or present disease, but in terms of
preventing future diseases as well”. Today with greater stress on preventive measures, the dental
profession has expanded this preventive concept into prosthodontics.

Preventive dentistry is defined as procedures employed in practice of dentistry and community

dental health programs, which prevent the occurrence of oral diseases and oral abnormalities.
There are many forms of preventive dentistry, such as daily brushing, 6 monthly routine dental
checkups, oral prophylaxis, pit and fissure sealant application, preventive orthodontic treatment
etc. These practices are designed to ensure that teeth and the surrounding tissues are healthy and
the oral hygiene maintenance is easier for the patient. This ensures long lasting, functionally
effective and esthetically favorable oral environment.

Prosthodontics is the branch of dentistry pertaining to the restoration and maintenance of oral
function, comfort, appearance and health of the patient by the restoration of the natural teeth
and/or the replacement of missing teeth and craniofacial tissues with biocompatible artificial
substitutes.
An understanding of the goals of Prosthodontics obviously means that preventive prosthodontics
refers to the actions taken to prevent the factors, which affect the normal oral function, comfort,
health, appearance and general health of the patient.

Preventive Prosthodontics- Definition and Rationale

Preventive prosthodontics emphasizes the importance of any procedure that can delay or
eliminate future prosthodontic problems as well as those that will make future and subsequent
treatments easier.

Preventive prosthodontics refers to prosthodontic practices that help prevention of the factors
adversely affecting the oro-dento-facial tissues and structures including the tooth supporting
structures such as periodontium, alveolar bone, basal bone and surrounding musculo-skeletal

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structures like muscles of mastication, facial expression, temporomandibular joint (TMJ), jaw
bones, salivary glands and the tissues in the head and neck region.

It means to say that the most effective prosthodontic prophylaxis should be aimed at prevention
of causes leading to tooth extractions mainly dental caries and periodontal diseases. In many
clinical conditions presented by patients, even the structurally compromised teeth and / or their
roots need to be utilized, for the support of non-conventional prostheses.

Once the teeth are lost, we are obligated to deal with the consequences of teeth loss like residual
alveolar bone resorption, loss of proprioception, loss of muscular tonicity and efficiency,
abnormal habits etc. Further, any fixed and removable Prosthodontic replacement of missing
teeth must be centered to not only restore the lost function but also to maintain the remaining
oro-dental tissues in healthy state. They should prevent further damage to the components of the
masticatory system.

It is also the duty of a prosthodontist to act as a member of the multidisciplinary team in helping
patients treated by other specialists with various therapeutic modalities to prevent damage /
contain the effect of those therapies not only to the area but to avoid adverse effects to the
adjacent and distant healthy tissues.

These various preventive prosthodontic considerations and services aim to minimize the adverse
effects on the remaining oro-dental tissues as well as reduce residual ridge resorption (RRR),
maintain the prostheses in terms of fit and occlusal relations as well as make future treatment by
concerned fairly easier. All such prosthodontic approaches and practices in fact could be
collectively described as preventive prosthodontics.

Different ways of achieving preventive prosthodontic goals

The preventive prosthodontics measures and services can be given in many ways.

Patient education and motivation

We as dental care professionals are obliged not only to provide patient-centered therapies but
also educate our patients of the relevant influencing behavior to facilitate better management and
control of oro-dental problems.
In this regard, patient’s own involvement is of paramount importance for both health promotion
and disease prevention. Reinforcing good behaviors’ and preventing those that are adverse will
surely maintain good oral health. The patient's role and involvement in the care of the natural
teeth as well as the prosthesis is of central and often of crucial importance.

Role of nutrition in the prevention of oral diseases:

Nutrition is defined as the science of food, the nutrients, and other substances therein, their
actions, interactions and the process by which the organism ingests, digests, absorbs, transports,
utilizes and excretes food substance.
The essential nutrients are proteins, fat, carbohydrates, vitamins and water. Denture tolerance is
improved with a higher intake of protein. Several authors have concluded that there is a positive
correlation between low calcium intake, calcium phosphorous imbalance and more severe ridge

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resorption. Correction of the errors in many of the systemic factors will reduce the alveolar bone
resorption.

Certain nutritional strategies are appropriate for protecting geriatric patients from the effects of
postmenopausal (type I) osteoporosis and senile (type II) osteoporosis. It is suggested that
calcium, vitamin D supplements and trace elements like boron, magnesium and manganese
should be included in the diet.

Optimum prosthetic type and design to maintain the remaining structures

Irrespective of the type of prosthodontic option chosen for a patient, the aspect of prevention in
the prosthetic reconstruction must always be a prime consideration. This is achieved with the
formulation of treatment plan that is acceptable to the patient and involving the minimally
invasive and needed treatment.
The execution of the treatment plan should give due consideration to the pre-prosthetic
preparation of the orodental tissues and designing the prosthesis in a way that it does not
interfere with the normal hygiene procedures in the oral cavity.
The prosthesis must not overload teeth and the bearing tissue. The basic gnathological principles
in designing the occlusal surfaces of artificial teeth must be considered for avoiding traumatic
occlusal forces from the prosthodontic restorations placed in the oral cavity.

When replacing missing teeth to restore their lost function, we must design tissue-friendly fixed
and removable prostheses for our patients. The prostheses must stabilize periodontal condition of
the remaining dentition and prevent residual alveolar bone loss and yet remain long functioning.

Partial edentulism need to be treated cautiously, judiciously and appropriately. It is not evident or
urgent to replace all missing teeth. Primarily, only the edentulism that leads to functional
disturbance in the form of having difficulties in chewing, eating and speaking or which affects
the person negatively within the perspectives of esthetics or psychosocial disadvantages is to be
replaced.

For patients with very few missing teeth, whenever possible, it is a good practice to offer them
conventional tooth-supported fixed partial dental prosthesis or an implant-supported crown/
bridge.

When treated with removable partial dentures, the use of various types of attachments can prove
very beneficial in selected cases. The attachments can redirect occlusal forces away from weak
supporting abutments and on to soft tissue, or towards stronger abutments and away from soft
tissues. They act as shock absorbers and stress redirectors as well as provide good retention.

Every effort possible should be made by the prosthodontist to prevent completely edentulous
situation in any patient. Denture pressure on the residual ridge causes bone to be resorbed.
Whenever treated with a conventional removable complete dental prosthesis, maximum
emphasis should be given to the preservation of the underlying tissues.

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The benefit of the tooth-supported complete over-denture therapy is very well documented and
accepted mode of teeth replacement. When the tensile forces are received by bone, additional
bone is formed. Such stresses occur only when occlusal forces are transmitted to the alveolus by
the periodontal ligament. This principle has been used in overdentures in an attempt to preserve
alveolar bone by retained part of teeth, non-vital or vital roots and submerged roots that
contribute support.

The beneficial role of immediate denture therapy and incorporating provisional restorations in
the prosthodontic treatment plan is well recognized.

For people who are completely edentulous in the mandible, an implant supported over denture
should be the minimum standard of care. Also, in edentulous patients, If possible and affordable
an implant supported fixed prosthesis can be the treatment of choice.

Prostheses for preventing and controlling the progression of specific dento- orofacial
conditions

There are several specific conditions that make the patients vulnerable to both systemic and local
intraoral pathologies. These conditions not only need to be early and properly diagnosed within
the perspectives of etiology involved but they also need to be managed with the provision of
appropriate and non-invasive treatment modalities in a step-wise multi-disciplinary team
approach. The prosthodontist in this regard can play a vital preventive role in the management of
patients with such conditions.

One such common condition prevalent in adult population is the pain and dysfunction in the oro-
facial region. The consequences for the individual are varied degrees of discomfort, in relation to
basic functions such as eating, chewing and speaking, in social relations as well as negative
effect on their quality of life. In these patients, it is recommended to primarily restrict treatment
that is reversible such as individual counseling or behavioural treatments.

In case further intervention is needed, it is recommended to provide occlusal appliances and

various forms of mobilizing exercises which during a limited period of time can be combined
with non-steroidal anti-inflammatory drugs (NSAIDs). Prosthodontic splints and appliances that
can stabilize and reposition mandible can prove very helpful in patients with acute orofacial pain
and in patients suffering from sleep disorders and conditions.

In other instances like active sport players with high risk for tooth fractures and in patients who
clench and brux teeth leading to tooth surface loss, behavioural therapy, education and appliance
therapy can be very beneficial in preventing damage to teeth and associated supporting
structures.

Special preventive prosthesis for head and neck cancer patients

In patients with head and neck cancer (HNC), resection and excision of the tumour and of the
adjacent tissue is a commonly used surgical option. In many such cases, when surgical
reconstruction is not possible, prosthodontic rehabilitation approaches are used. To facilitate

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satisfactory rehabilitation with maxillofacial prostheses, it is important that proper planning be

made prior to surgery in consultation with a prosthodontist.
Prosthodontists can help avoiding and preventing future prostheses wearing related difficulties
and in ensuring long term health of the supporting tissues in this regard. The provision of
immediate and interim oburator prosthesis facilitate tissue healing and adaptation of tissue and
avoidance of tissue contraction and thus can avoid many prosthesis related complications.

Tissue irradiation during radiotherapy, when not controlled to the required site, can incur very
damaging and debilitating effect on the functioning and health of those tissues. Thus, it is very
important to contain and carry radiation to the actual site and to prevent damage to the adjacent
tissues. Prosthodontists can supply and provide various types of radiation prostheses and stents in
these cases.

Principles of prevention as applicable to the branches of prosthodontics.

Preventive philosophy in complete denture prosthodontics

Role of impression in prevention

Several authors have advocated that dentures made from rest impressions will remain serviceable
for a longer period time than dentures fabricated from impression made during displacement.
The stresses are applied only during function and are intermittent in nature. Such intermittent
rather than continuous stress is more physiologic to bone.
The application of stresses should be limited to only those areas which are capable of
withstanding forces and that undergo minimal resorption.

Role of occlusion in preservation and prevention in complete denture

Different types of occlusal schemes like neutrocentric, monoplane, balanced, lingualized and
linear occlusion have been proposed to achieve preservation of underlying bone. The following
points are widely accepted in a complete denture occlusal scheme.
 Stability of occlusion in centric relation
 Balanced occlusion for eccentric contacts.
 Unlocking of the cusps mesiodistally to accommodate the inevitable settling of denture
bases.
 Control of horizontal force by buccolingual cusp height reduction according to residual
ridge shape and inter-arch space.
 Functional balance by favorable tooth- ridge crest position.
 Cutting and shearing efficiency.
 Anterior clearance of teeth during masticatory function.
 Minimum occlusal stop areas for reduced pressure during function.

Role of Tissue Conditioners and Soft Liners

Tissue conditioners and resilient liners are soft and flexible polymers that protect supporting
tissues from functional occlusal stresses. Resilient liners can be considered for use in ridge
atrophy, surgical contraindications due to compromised health of the patient, parafunctional

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habits, irradiated patients, in patients with xerostomia, and nerve dehiscence from severe
resorption.

Role of overdenture in prevention

Pressure of a denture base on the bone of the residual ridge may cause circulatory insufficiency
with risk of resorption. In 1861, Barker reported consensus that in many situations retention of
the roots would enable the dentists to give the patient with complete dentures treatment superior
to that obtained after extraction of all roots. In 1927, Stewart propounded that vital and
devitalized teeth have equal sensory capabilities.

Overdentures became quite popular in the decade between 1970-1980. Overdentures were the
last line of defense that successfully kept patients from becoming edentulous. It is concluded that
tooth supported complete dentures are a valid approach to preventive prosthodontics and a
valuable part of the practicing dentists armamentarium.

By the end of that decade, Branemark had provided the evidence to promote titanium implants as
successful tooth replacements. The concept of overdentures is even more popular when applied
to titanium “roots”. Titanium is not vulnerable to the perils of periodontal disease and caries and
implants have better prognosis than compromised teeth or roots.

Removable partial denture and its design as related to maintenance of tissue health

Design considerations play a major role in controlling stresses on the abutment in patients with
removable partial dentures particularly in distal extension situations. The impression procedure
and choice of materials is important for the distal extension partial prosthesis. Frequently a dual
impression procedure or a reline at the time of delivery is a prerequisite for the success of the
distal extension prosthesis.
The various philosophies of RPD design can be broadly classified into
- Those who believe that ridge and tooth supports can be best equalized by the use of
stress breakers (stress breaking philosophy).
- Those who insist on bringing about the equalization of ridge and tooth support by
physiological basing, which is accomplished by a pressure impression.
- Those who uphold the idea of extensive stress distribution for stress reduction at any
point (stress distribution philosophy).

Preventive philosophy in fixed Prosthodontics including implants

Kapur stated that, “The periodontium is the testing ground of all restorative procedures”. In the
practice of fixed prosthodontics, all the procedures should be carried out from start to finish with
total preventive concept in mind. Dental pulp should be protected during teeth preparation. The
final restoration should establish favorable environment for the periodontium and should be
easily cleansed by the patient.
Tooth structure is conserved by using the following guidelines.
1. Use of partial coverage rather than complete coverage restorations whenever possible.
2. Preparation of teeth with the minimum practical convergence angle between axial walls.

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3. Preparation of the occlusal surface so that the reduction follows the anatomic planes to
give uniform thickness in the restoration.
4. Selection of conservative margin compatible with the other principles.
5. Avoidance of unnecessary apical extension of the preparation.

Role of Implants
The use of dental implants to provide support for prostheses offers a multitude of advantages
compared with the use of removable prostheses or a fixed partial denture using natural teeth as
an abutment.
A primary reason to consider dental implants to replace missing teeth is the maintenance of
alveolar bone. There is increase in the bony trabeculae and density when the dental implant is
inserted and functioning. An endosteal implant can maintain bone width and height as long as the
implant remains healthy.

The masticatory performance of implant-supported prosthesis is better than any conventional

removable prosthesis. The current trend to expand the use of implant dentistry will continue until
every restorative practice uses this modality for the abutment support of fixed and removable
prostheses.

Levels of Preventive Prosthodontics

Primary level of prevention- Pre pathogenic phase

It includes the steps like health promotion and specific protection. Dental caries prevention,
plaque control, regular checkup for caries activity, diet counseling etc., are included in health
promotional phase at primary prevention level. Specific protection includes topical fluoride
application and application of pit and fissure sealants.
In the case of old patients due to decreased salivation, gingival recession, root exposure, cervical
abrasion, attrition, there is an increase risk of the caries susceptibility. So for these patients
fluoride rinses and fluoridated tooth pastes are recommended.

Correction of mal-aligned teeth if any and regular care for the prosthesis like complete dentures,
removable partial dentures and fixed partial dentures is essential. The patient is also educated
about the chewing habits, tongue postures for better maintenance of the occlusion and
maintenance of the prosthesis. The jaw exercises are recommended for the complete denture
patients because complete edentulousness may alter the normal muscle engrams.

The primary prevention also involves the protection of the dentoalveolar structures by providing
mouth guards for the personals involved in contact sports and radiation shields for the patients
who are undergoing the radiotherapy.
The mouth guards with moderate resiliency absorb the forces, protect the teeth, TMJ, prevent the
contact of teeth and prevent ankylosis.

It is recommended to protect the adjacent tissues during radiotherapy in the maxillofacial region
by shielding with the appropriate shields. The protection can be provided by various methods
like providing the radiation docking (cone positioning) devices. When the radiation therapy has

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to be provided in divided doses, the docking device helps in the proper orientation of the
radiation cones.

Secondary level– Early detection and prompt treatment

Various treatment modalities include preventive resin restorations of initial caries, direct and
indirect pulp protection, scaling and curettage, etc. Preventive prosthodontic procedures which
can be performed at this level are- occlusal interference correction, treatment for bruxism,
treatment for trauma from occlusion (TFO), correction of plunger cusps and treatment of
obstructive sleep apnea.

Occlusal Interferences
These are any tooth contacts that inhibits the remaining occluding surface from achieving stable
and harmonious contact. Occlusal interference produces mandibular deviation during closure to
maximum intercuspation (MIC) position or may hinder the smooth passage to and from MIC
position. If the occlusal interference cross the threshold of adaptive capacity of the
Temporo-mandibular joint, muscles of mastication and neuromuscular system, it leads to muscle
hypertrophy, muscle fatigue, spasm, headaches, cranio-mandibular dysfunction syndrome, wear
facets, fractured cusps, tooth mobility and parafunctional habits like bruxism. So correction of
occlusal interference is recommended in the early stages.

Bruxism
If occlusal interferences are present, the patient tries himself to equilibrate the occlusion and thus
develop the habit of clenching or grinding of teeth. This can occur due to periodontitis, over
contoured restoration, psychological and physical stresses, sleep disorder, central nervous system
disturbances and alcohol. Bruxism leads to attrition, mobility, muscle hypertrophy, occlusal
facets, alveolar bone loss and TMJ disorders. Symptoms include muscle soreness, fatigue of
masticatory muscle early in the morning, hypermobility, hypercementosis, cusp fractures,
pulpitis, break in lamina dura and furcation involvement. Treatment of bruxism involves
controlling the psychological stress, occlusal correction, coronoplasty and occlusal splints
.
Trauma from Occlusion [TFO]
When occlusal forces exceed the adaptive capacity of the periodontal tissues, it results in tissue
injuries. This tissue injury is called as TFO. Acute TFO is due to sudden heavy forces. Chronic
TFO is due to continuous and long duration occlusal forces, e.g. bruxism, drifting and extrusion
of the teeth. Primary TFO is caused due to high occlusal forces whereas main cause of secondary
TFO is a low threshold of the periodontium. Occlusal corrections are needed for the correction of
the TFO and trauma can be prevented.

Plunger Cusps
These are the cusps which wedge the food forcefully into the interdental spaces of the opposing
arch. These plunger cusps, usually the functional cusp (i.e., palatal cusp of maxillary teeth and
buccal cusp of mandibular teeth) and sometimes palatal incline of maxillary buccal cusp and
buccal incline of lingual cusp. Treatment involves rounding and shortening of the plunger cusps,
and the opposing interproximal space is protected by splinting the adjacent teeth.

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Obstructive Sleep Apnea

The role of dentistry in sleep disorders is becoming more significant, especially in co-managing
patients with simple snoring and mild to moderate obstructive sleep apnea. It is characterized by
cessation of airflow through upper airway while diaphragm movement continues. It can be
caused due to enlarged tonsils, enlarged soft palate, large tongue and retrognathism. This can be
taken care by fabrication of prosthetic mandibular advancement appliances like soft palate lifters,
tongue retainers, mandibular repositioners, snore guards etc., and surgery to remove portions of
the soft palate and uvula.

Tertiary level - Disability limitation and rehabilitation

It refers to the “preventive prosthetic treatment strategy” for treatment of the patients with a
highly mutilated dentition. Various dental procedures that can be performed include complex
restorative treatment of decayed teeth, root canal treatment and extractions. Prosthodontic
rehabilitation incorporates procedures like post and core treatment, removable dentures, fixed
partial dentures and implants.

Treatment for patients with highly mutilated dentition

Planned extraction of highly mutilated teeth prevents the rapid resorption of the alveolar ridges.
In cases of early loss of the permanent teeth, if the definitive treatment cannot be done for
various reasons, the interim denture (treatment dentures) can be utilized as preventive measures.
The treatment dentures act as space maintainers, prevent the migration/drifting, prevent the supra
eruption and prevent the contact between the teeth, alveolar ridge, restore the function, esthetics,
restore the muscular tonicity, restore the vertical height, jaw health and avoids the abnormal jaw
habits.

In the treatment of mutilated dentition, preservation of an incomplete dentition with a minimum

of occluding pairs of teeth in combination with a partial denture is preferable than the total tooth
extraction. This is advantageous for utilization of the natural teeth for retention and stability of
the prosthesis. Presence of the periodontal ligament provides the advantage of biofeedback
mechanism in controlling the occlusal forces.

If the dentition is very compromised and indicated for total extraction, then immediate dentures
are planned to promote better healing (immediate dentures act as surgical stents), protect the
blood clot and aid early healing and promote better ridge form. Immediate dentures also prevent
the facial musculature from collapsing, provide a guide for the vertical dimension, esthetics, easy
adaptation to the dentures and provide psychological comfort.

Single Complete Denture/Complete Denture

When the teeth are completely absent in any one of the arch, the fabrication of a single complete
denture is highly recommended to prevent the contact of the teeth and alveolar ridge, to restore
function, vertical dimension, esthetics and prevent the development of parafunctional habits. The
complete dentures are provided for edentulous patients (edentulous in both jaws) to rehabilitate
them by restoring the function form and esthetics and general health of the patients.

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Overdentures

An overdenture is one of the most popular modes of treatment under preventive

Prosthodontics. It is defined as a removable partial denture or complete denture that covers and
rests on one or more remaining natural teeth, the roots of natural teeth and / dental implants. The
idea of leaving roots of natural teeth to support a prosthesis was proposed by Ledger who
described a prosthesis resembling overdenture as early as in 1856. In 1958, Miller described a
technique to use vital teeth with a coping thimble arrangement for overdenture. Various
clinicians have been successfully practicing retention of vital or non vital teeth as abutments
under removable dentures, including submucosal vital root retention.

The preservation of teeth and roots beneath a removable prosthesis help in maintaining alveolar
bone health and height for longer duration. This can be advantageous in terms of conserving the
natural teeth, reducing the rate of residual ridge resorption, proprioceptive feedback by existing
periodontal ligaments and thus controlling the occlusive forces.

According to Brewer [1980], strategic preservation of abutment teeth and covering them with
denture base can greatly improve the final treatment results in terms of support, stability and
retention of denture. A study by Pacer and Bowman in 1975 compared occlusal force
discrimination between conventional denture and overdenture wearers. They found that the
overdenture patient processed more typical sensory function, i.e., closer to natural teeth than a
complete denture patient in discriminating between occlusal forces. These factors greatly
enhance the patient’s denture coordination and ability to control the denture in his physiologic
environment due to enhanced proprioceptive feedback mechanism.

A study by Crum and Rooney in 1978 showed that by retaining teeth for overdenture, the bone
was preserved in height and width and the resorption of the alveolar bone surrounding these teeth
was reduced by 8 times. Other studies have shown that overdenture patients had a chewing
efficiency which was one-third higher than that of conventional complete dentures. Various
authors have concluded that overdenture treatment provides excellent long term success and
survival, including patient satisfaction, improved oral functions and oral health related quality of
life.

A variety of innovative attachment systems have been used to retain overdentures and proven
both clinically effective and provided predicable results. They include stud attachments, bar
attachments, bar with clips, O- ring attachments, magnetic attachments and telescopic dentures.
The various precision attachment retained overdentures distribute the masticatory forces,
minimize trauma to abutments and soft tissues, decrease resorption and improve esthetics.

Obturator
Obturator is a prosthesis used to close a congenital or acquired tissue opening primarily of the
hard palate and contiguous alveolar tissues. Immediate obturators are placed immediately after
the surgery with or without surgical packing. It is retained by screws or wire fixation,
re-establishes the oral contours, prevents the regurgitation of the fluids into nasopharynx,
protects the wound, allows uneventful healing and prevents the cicatrisation or shrinkage.
Interim obturator is given after the removal of the surgical packing. The interim obturator is

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retained up to 3 months with repeated checking and relining with the tissue conditioner, followed
by definitive obturator.

Preventive Implant Therapy

Preservation of residual alveolar bone in edentulous areas is possible with the placement of
implants. After tooth extraction, the atrophy of edentulous lower jaws can be prevented or
delayed by using implants supporting an over denture or a fixed mandibular prosthesis. Studies
have shown that mandibular ridge shows a slower resorption pattern when it is loaded by
implants supported prosthesis rather than a conventional mucosa supported dentures.

Kalk et al. proposed the resorption stages of the residual ridges which are used in preventive
implantlogy.
Preventive stage I- Anatomic situation after tooth extraction. Further resorption can be
prevented by implantation of the bone substituents.e.g. a non resorbable hydroxyl appetite.
Preventive stage II- After the initial resorption has occurred. In this case, further resorption can
be prevented by placing cylindrical endosteal implants to maintain adequate width and height.
Preventive stage III- Knife edged ridge. Bone removal is necessary for implant placement.
Preventive stage IV- Severe resorption of the alveolar ridge has taken place and only basal bone
is present. Implants are placed directly into the basal bone to prevent total loss of function of the
arches.

Conclusion

According to the World Health Organisation [WHO] criteria, edentulous people come under the
category of physically impaired as they have lost a body part, up to 32 body parts to be exact
[Bouma et al., 1987]. The loss of several teeth can initiate serious problems related to the whole
orofacial region, psychics and the well being of the patient. From this point of view, prosthetic
dentistry is a valuable tool with high therapeutical and preventive character.

Prosthodontic restorations will prevent further damage to oro-dento-facial tissues when

appropriately designed. Prosthodontists also play an important role in educating, motivating and
making aware their patients to act as the custodians of their orofacial health. They also provide
many other services that aim to prevent further damage, contain and carry the therapeutic effects
to the site and prevent adverse effects of abnormal orofacial conditions and habits as well as
confine the effects of radiotherapy and other medications. Various other prosthetic supportive
measures will facilitate future and subsequent treatment fairly easier.

The prosthodontist must make every effort in following patient centered treatment. Even though
Prosthodontics is a specialized field in replacement of missing teeth and adjacent soft and
hard oral tissues, the preventive aspect of Prosthodontics should not be ignored. Despite
recent developments in clinical implantology, the conservative approach of tooth/ root
preservation is still valid in providing proprioception and a cheaper alternative to enhance
support, stability, retention and preservation of underlying tissues.

Meeting the expectations of an ever increasing elderly population for a better quality of life with
respect to both function and esthetics is demanding. Potential problems can be avoided and

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resolved by properly instituting preventive prosthodontic procedures according to the degree or

level of prevention needed to correct it.

The preservation of the teeth, pulp, supporting and surrounding tissues in prosthodontic practice
is a sacred trust that cannot be ignored. The application of the preventive concepts will offer a
long serviceable prosthesis without any complications and compromise.

References

1. Ghani F. Preventive Prosthodontics: What, Why and How? J Pak Prosthodont assoc 2015; 03 (01): 17-22
2. Singh R, Singh J, Ghambir RS, Bhinder KS. Preventive aspect of prosthodontics: An Overview. Eur J
Prosthodont 2018 Jan 18; 3:10-15.
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