Clinical Case: Mrs Xena Xavier

Mrs Xavier has presented complaining of difficulty wearing her upper denture. At the end of this case, you will get a chance to design a new lower denture on-screen.

Study the case information and photographs by running your mouse over the picture bar on the right. Then answer the questions below.

Diagnoses
Aetiology
Treatment Plan
Oral Medicine
Prosthetics
RPD Design
Diagnoses

Q1
In broad terms, what diagnoses have you made for Mrs Xavier? Your answer should include:
• Sjogrens Syndrome
• Chronic Marginal Gingivitis
• UR3 Lost Crown
• Inadequate dentures

Remember - diagnoses are generally simple statements - do not confuse them with aetiology.




Q3
The Upper Right 3 has been decoronated (i.e. dentine and Metal-Ceramic crown lost). Why do you think this has happened? Weak tooth, excessive forces.
• The tooth had been root filled, and a PFM crown was present, so most of the coronal dentine had been destroyed by dentistry.
• No post was present for additional retention.
• Due to lack of other upper teeth, all forces went through this tooth.



Q4
What is the aetiology of Sjogrens syndrome? • Sjogrens syndrome is an auto-immune disease, caused by production of auto-antibodies.
• No single factor is known to cause Sjogren's syndrome, though the cause may be a combination of genetic, immunologic, hormonal, and probably infectious factors.



Q5
What are the causes of the patient's problems with the upper denture? • Upper denture is worn and poorly extended.
• Occlusal plane not correct as denture sinks into the tissues on closure.
• Poor occlusion.



Q8
What is the age and sex distribution of Sjogrens syndrome, and how common is it? • Women are affected 9 times more than men.
• Onset can occur at any age, but usually between 45 and 55.
• 1% of the population has it (maybe more, due to under-diagnosis).



Q9
How is Sjogren's syndrome treated? • There is no known cure for Sjogren's syndrome.
• Ocular dryness responds to the use of artificial tears applied every one to three hours.
• Dry mouth can be relieved by drinking water, chewing gum, or using saliva stimulants such as pilocarpine.
• Non-steroidal Anti-Inflammatory Drugs (NSAIs) can reduce gland inflammation.
• For life threatening complications, medications such as corticosteroids and cyclophosphamide are occasionally needed.



Q10
What is the difference between Primary and Secondary Sjogren's syndrome? Primary Sjogren's syndrome is when lacrimal and salivary glands are infiltrated and dysfunctional. This occurs without presence of other autoimmune connective tissue disease (e.g., lupus, rheumatoid arthritis, etc.)

Secondary Sjogren's syndrome is when Sjogren's symptoms are present and accompanied by a disease affecting the body's connective tissue. The distibution is 50:50



Q11
What special tests are needed to confirm Sjogren's syndrom? • Blood tests for auto-antibodies,
• Flow tests to determine the degree of dry eye and mouth
• Salivary Gland Radiographs
• Lip biopsy (for minor salivary gland histology)



Q13
What are the disadvantages of retaining the UR2 and/or UR3 roots for an overdenture? • A unilateral abutment can cause the denture to rock. Much better if UL3 was also present.
• The undercut is severe around the canine eminence, so a good border seal will be hard to achieve.
• High risk of abutment caries, due to dry mouth from Sjogrens.



Q14
What are the advantages of retaining the UR2 and/or UR3 roots for an overdenture? • It would prevent excessive forces being placed on the ridge.
• Alveolar bone would be maintained, ensuring stability in the years to come..



Q16
What do you think of the positions of the occlusal rests? • LL58 rests are satisfactory, but to support a free-end saddle, LR4 rest should be mesial.



Q17
Why should the LR4 rest be mesial? • To prevent tilting of the tooth distally.



Q18
What is wrong with the clasps on LL5? 1. They are unnecessary. A denture normally only needs two retentive clasps.
2. A retentive clasp should not be placed on the other side of the support axis from a free-end saddle. As the saddle sinks, the clasp will rise, "uprooting" the tooth.
3. The retentive clasp is too short, and thus too rigid.
4. It is unaesthetic.



Q19
What would be a better clasping system for the free-end saddle? • The RPI system. (Rest : Plate : I-bar)



Q20
What is a more modern name for a free-end saddle? • A Distal Extension Saddle



Q21
What are the functions of the occlusal rest on LL5? • It gives support to the bounded saddle
• It provides indirect retention (if the free-end saddle rises)



Now you have answered these questions, design a better denture yourself on the drawing board below. Use your mouse to select a colour, then add components to the design. When you have drawn your design, click here to see how it compares with a good design.
Educational aims of this juce

 This Clinical Case involves a 62 year old woman with Sjogrens syndrome and denture problems.
   You will examine the patient and the radiographs, and consider the treatment options.
 You will be asked questions about aspects of her dental conditions and care, and given model answers.
 Excellent practice for professional examinations involving real "unseen" patients!

This page contains verifiable CE / CPD




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