Clinical Application Case Report Of Loose Abutment Below ?° In The Design Of Removable Partial Dentures

Background:At this stage,the oral health of the elderly in our country is still in a situation that can not be optimistic.On the one hand,dentition defects are common and frequently-occurring disease in the elderly population.On the other hand,there are more loose teeth in elderly population under the action of occlusal trauma,periodontitis and apical periodontitis.In order to delay the elderly entering edentulous stage and improving the therapeutic effect of dentition defect repair,partial loosen teeth below ? degree still need to be retained.For elderly patients with dentition defect and loose teeth,it can not only restore the integrity of the teeth,but also can distribute to reduce the stress on the loose teeth by making restoration of dentition as early as possible.Due to the physical and psychological limitations of the elderly,removable partial denture is still a common solution for the elderly in the treatment of recuperation.In cases of dentition defect with residual teeth loosened,denture design will inevitably use loose teeth as the abutment.With the potential of the periodontal ligament declining,the bite force it can bear and the supportive force it can provide will decrease.Therefore,the denture design should remove the pathogenic factors of the loose tooth first and then do reasonable denture design.Reasonable denture design can reduce the force of loose abutment and increase its supportive force,so we can controll the force within the physical tolerance of the abutment.This will avoid aggravating the abutment motion while restoring the integrity of the dentition.Objection: To evaluate the clinical effect of denture restoration and the health status of loosen teeth when the loose teeth below?degree are used as abuement of removable partial dentures to restore the dentition defects in the elderly.Medical records and Methods: Eight patients with dentition defect were selected and collected from the Affiliated Stomatological Hospital of Dalian Medical University from October 2016 to October 2017.Among them,6 cases were maxillary,5 cases were mandibular,6 cases were?degree of abutment loosening,5 cases were?degree loosening.The patients also were divided into several groups,including 2 cases of male and 6 cases of female,the youngest is 57 years old,the largest is 82 years old,with an average age of 69 years old.Patients need to be systematically inspected before repairion,such as the health of remaining teeth in the mouth and the status of soft and hard tissue,and the etiology of tooth mobility needs to be analyzed.Then we need to understand the patient's subjective expectations of the effect of repair and treatment,communicate with patients treatment plan,and ultimately develop a reasonable and feasible oral rehabilitation program.Several basic treatment such as supragingival scaling,root canal therapy,crown repair,teeth adjusting,need to be done before the repair of loose teeth for different causes of tooth loosening.According to the abutment mobility,the denture can be designed to extension clasp,continuous clasp,combined clasp,RPI / RPA clasp group,The abutment can set near rest,joint rest or no rest.Reserved design need to be considered for the abutment on poor condition.After the denture is completed,we teach the patient how to wear the denture and give oral hygienic guidance to the patient.We can evaluate the effect of prosthetic denture restoration and the health status of loose teeth when the removable partial dentures were repaired with loose teeth below ? degree by checking the abutment mobility and the use cases of functional dentition after wearing among 2~12 months.Results: When the denture was first worn in 8 patients,the stent could be put in place smoothly,the base and the mucous membrane were close and the denture retention was good.4 of them feel mucosal area tenderness after wearing 1 to 2 weeks and the four all feel better after adjustment.After wearing denture about 2~12 months,8 patients feel no mucous membrane tenderness.They all have a good efficiency while chewing.There was no aggravation of abutment motion in the clinical examination,and there was no significant change in the depth of periodontal pocket and periodontal exploration.One patient had red gingival periapical glands at the time of referral,which was related to the patient's poor oral hygiene.The remaining seven patients had good periodontal conditions,no swelling in their gums,and no bleeding during probing.Conclusion: While we design the ?degree loose teeth as the abutment of removable partial denture,the first is to eliminate loosening pathogenic factors by appropriate treatment.Then we can make reasonable denture design according to the degree of residual loose teeth and soft and hard tissue.The design of denture needs to control the occlusal force within the range of loose abutment,which can improve the masticatory efficiency of the patient and prevent the abutment from loosening and maintain the long-term health of the abutment.