Association with maxillary impalnt retainet overdentures.
Indeed, whne the time
needed for postplacement adjustment and repairs was considered, each remoyable implant-supported prosthesis averaged four times as many postplacement adjusment and twice as many repairs as did the fixed implant supported prostheses. In this content, ball-retained-overdentures needed more repairs and adjusments than bar-retained overdentures. Decision making in Treatment Planning In prosthetic treatment planning for older adults the choice of and prognosis for treatment are determined partly by the patients situation and partly by the clinicians background and evaluation of the situation (Table 4-7). For example, patients with higher educational level are more likely to choosea more sophisticated solution that takes comfort and esthetics into account. Previous personal or family experiences with fixed or removable prostheses are important for the patients actual choice. The patients commitment to conserve and maintain remaining teeth, as well as his pr her ability to maintain appropriate oral hygiene, are important for the prognosis of the dentition. Finally, the patients economic situation is often a seriously limiting factor in the choice of treatment. When proposing a realistic treatment plan, the clinician considers the patients demand and the oral and dental situation. Quite often, however, other factors intervene (see Table 4-7). Contohnya seorang dokter gigieducational level and skill often, and should, limit the choice; those with the limited experience in prosthodontics are likely to propose ea simpler solution so the prosthesis can be corrected and remodeled if its fit is not optimal. Also it is normal to choose teknik dan treatment solution with which one has had good personal experience. As a dentist is is important to be commited to ones clinical work and to strive for excellence. However, when treating older adults, it is particularly important to put the patient first, not only with regard to dental and prosthetic treatment, but as a human being. The implies among other rhings that clinican takes the patients socio-economic situation into consideration and proposes a treatment the patient will and can afford to pay; the clinician never should propose an expensive and sophisticalted teratment which in biologically unfounded. Some patient-related guidelines such as oral hygiene, degree of coo[eration, periodontal status, tooth loss, and expected adaptive capacityto a prothesis may be used in choosing between different prosthetic treatment modabilities (Table 4-S). In a patient with good oral hygiene and a high level cooperation, there is a multitude of treatment alternatives, to those listen in the above table. However, if the patient neglects oral hygiene in spite of repeated instructions, a nondefinitive treatment solution should be designed. A removable partial denture ca be transformed and extended if some teeth have to be romeve , and a fixed partial denture might be constructed in the future, if oral hygiene improves. Similiarly, an overdenture can be transformed into a conventional complete denture if cooperation remains poor, and attachment can be placed or
combination of fixed and removable partial denture constructed id f the degree
of cooporation improves. In patients with poor oral hygiene who likely to show poor adaptation to removable dentures, it may be better not to replace the missing teeth so as not to advance the destruction of the remaining teeth. Eventually, an acid-etched partial denture may be used to replace one or two missisng anterior teeth.