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PRDP, Final > 11. Altered Cast Impression > Flashcards

11. Altered Cast Impression Flashcards

1
Q 
Distal Extension PRDP
• Not completely \_\_\_\_ supported
– One or more bases cover the ridge \_\_\_\_ to
the last abutment
• Depends on \_\_\_\_ for:
– Support 
– Stability 
– Retention
• Patient must be advised about movement
A

tooth
distal
residual ridge

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2
Q

Factors Influencing Support of Distal Extension Base
• Contour and quality of the ____
• ____ of residual ridge coverage by the
denture base
• Type and accuracy of the ____ registration
• Accuracy of the fit of the denture base
• Design of the PRDP framework
• Total occlusal ____ applied

A

residual ridge
extent
impression
load

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3
Q

Anatomic Form Impression
• One-stage impression method using an ____ impression material
– Produces a cast that does ____ represent a functional relationship between supporting structures of the partially edentulous mouth
• Represents hard and soft tissue at ____

A

elastic
not
rest

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4
Q

Anatomic Form Impression

• When masticatory load is applied
– Rest(s) will act as a ____
• Limits ____ near abutment tooth from transmitting load to underlying anatomic structures
– Distal end of base(s) moves more ____ and will transmit more ____ to underlying tissue
– More ____ will be transmitted to the abutment teeth through the framework

A 
stop
base
freely
load
torque
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5
Q

• PRDP fabricated from a ____-stage, ____-form impression, places more of the masticatory load on the ____ teeth and that part of the bone that underlies the distal end of the extension base.
– can result in ____ loss and loosening of the abutment tooth.

A

one
anatomic
abutment
bone

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6
Q

No single material can record both the ____ form of the teeth and tissue in the dental arch and the ____ form of the residual ridge at the same time…

A

anatomic

functional

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7
Q

Definition
Altered Cast Removable Partial Denture Impression
• A negative likeness of a portion or portions of the edentulous denture bearing area made ____ of and after the initial impression of the natural teeth
• This technique employs an ____ tray(s) attached to the ____ of the removable partial
denture or its likeness

A

independent
impression
framework

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8
Q

Definition
Altered Cast Removable Partial Denture Impression

• Impression and tray attached to ____ framework

A

removable partial denture

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9
Q 
Definition
Altered Cast
• A \_\_\_\_ cast that is revised in part before processing a denture base
• Also called
– \_\_\_\_ cast 
– Modified cast
A

master

corrected

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10
Q

Objectives
• Provide maximum support for PRDP bases to minimize tissue-ward movement
– Some movement unpreventable
– Maintain occlusal contact between natural and artificial dentition with ____ movement of base
• Creates less ____ on abutment teeth

A

minimum

leverage

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11
Q 
Objectives
• Reduce number of \_\_\_\_ visits
• Preserve \_\_\_\_ ridges
• Improve \_\_\_\_ distribution
• Decrease \_\_\_\_ impaction
• Decrease \_\_\_\_ of abutment teeth

ALL LEAD TO INCREASED PATIENT SATISFACTION

A 
postoperative
residual
stress
food
torquing
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12
Q 
Objectives
• Poor support can result in: 
– \_\_\_\_ of abutment teeth
– \_\_\_\_ of mucosa
– Accelerated \_\_\_\_ of the remaining residual ridge

MAY RESULT IN PREMATURE FAILURE OF THE PROSTHESIS

A

mobility
ulceration
resorption

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13
Q

It has been demonstrated that the single most important factor in minimizing abutment tooth movement is the ____ of the base

A

fit

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14
Q

The prosthesis can be stabilized in response to ____ stresses by means of favorable ____ distribution between supporting ____ and abutment ____

A

vertical
load
bone
teeth

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15
Q

Objectives
• Clinical studies have demonstrated that the altered cast impression technique demonstrated
– (1) the ____ amount of movement of the base
– (2)the most ____ ridge-to-denture- base relationship

A

least

favorable

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16
Q

Requirements for Providing Adequate Support
• (1) it records and relates the supporting ____ under some loading
• (2) it distributes the load over as ____ an area as possible

A

soft tissue

large

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17
Q

Selective Tissue Placement Impression Method
• Soft tissue that covers basal seat areas may be:

 Minimally displaced (placed)
displaced
>>
Differs in:
(1)\_\_\_\_ of alteration from resting form 
(2)physiological reaction to the amount of \_\_\_\_

Recorded in resting or anatomical form

A

degree

displacement

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18
Q

Selective Tissue Placement Impression Method

Overly displaced tissues
>
Attempt to gain \_\_\_\_ form
>
tissues become \_\_\_\_ and physiological functions impaired
>
\_\_\_\_ resorption

Minimally displaced tissues
>
respond ____ to additional pressures placed on them (if pressures are intermittent)

A

anatomic
inflamed
bone
favorably

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19
Q

Selective Tissue Placement Impression Method
• Properly prepared, individualized impression tray
– Can record ____ stress-bearing areas in a ____ form
– Non stress-bearing areas in ____ form

A

primary
functional
anatomic

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20
Q

Selective Tissue Placement Impression Method

• ____ is the most important part of the impression

A

tray

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21
Q

Altered Cast

• Mandibular arch
– Most commonly used for ____ distal extension partially edentulous arches
– Kennedy Class I and II
• Greater variation in tissue ____ and tissue distortion or displaceability
– Need ____ tissue placement
– May be due to ____ of mandibular ridge resorption

A

mandibular
distortion
selective
pattern

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22
Q

Mandibular Ridge Anatomy

Should not be ____ in impression (record in anatomic form)

____ support
area (additional
pressure placed

A

displaced

primary

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23
Q

Altered Cast
• Maxillary arch
– Not used as much due to amount of firm ____ tissue for soft tissue support
– If excessive tissue mobility, recommend ____

A

palatal

surgery

24
Q

Maxillary ridge anatomy

Take a look!

A

yay

25
Q

Goal
Selective Tissue Placement

Maximize soft tissue ____
+
Use ____ to their supportive advantage

> >

____ fitted to teeth while registering soft tissue support

A

support
teeth
framework

26
Q

Technique

\_\_\_\_ fitted
>
\_\_\_\_ tray attached
>
selective \_\_\_\_ placement impression
>
altered \_\_\_\_ formation
A

framework
custom
tissue
cast

27
Q 
Technique
• Fit framework
• Use disclosing media
• Identify \_\_\_\_ to enable complete seating
• Identify appropriate contact(s) of components
– During \_\_\_\_
– When seated 
• Do NOT \_\_\_\_!!
A

interferences
seating
force

28
Q

Technique
• Remove ____ and see where binds
– Will prevent complete ____

A

framework

seating

29
Q

Technique
• Framework is carefully adjusted
– Over-adjustment can result in a poorly ____ framework

A

adapted

30
Q

Technique
• Following adjustment, check
for complete ____ of framework
• If not completely seated, may be problem with accuracy of ____

A

seat

framework

31
Q

Technique
• Occlusion checked and adjusted
– until natural tooth contacts that exist without framework ____ are achieved with framework in place
• Polish with ____ points

A

seated

rubber

32
Q

Technique
• If there are opposing frameworks
– Each is adjusted ____ to the natural dentition
– Then, tried in ____ and adjusted until natural tooth contact**

**Need to maintain the same ____ with the frameworks in and out of the mouth!

A

separately
together
contact relationship

33
Q 
Custom Tray Fabrication
• Mark tray \_\_\_\_ on cast
 • \_\_\_\_ seated on cast
• Place a \_\_\_\_ layer baseplate wax
– \_\_\_\_ tissue stop
– \_\_\_\_ tissue stop
A 
extension
framework
single
anterior
posterior
34
Q

Custom Tray Fabrication
• Warm framework and press into position on cast
• Place ____ on cast
• A sheet of tray material is adapted to cast and over framework
• Material is trimmed back to borders
• Tray is ____ cured

A

MRA

light

35
Q

Custom Tray Fabrication
• Cured acrylic resin trays with
framework are removed from cast
– Trays are trimmed to ____ of wax spacer

A

outline

36
Q 
Custom Tray Fabrication
• Borders adjusted to extend \_\_\_\_mm short of tissue reflections
• Holes placed in trays
– Crest of \_\_\_\_ and
\_\_\_\_ pads
– Escape excess impression material
– Retention of impression material
A

2
ridge
retromolar

37
Q

Selective Tissue Placement Impression
• Try framework and trays in mouth
• Adjust ____mm from reflections
• Cover ____ pads

A

2-3

retromolar

38
Q

Selective Tissue Placement Impression
• ____ compound or
triad is added to tray

A

impression

39
Q 
Selective Tissue Placement Impression
• Impression compound
– \_\_\_\_
– Tempered
– \_\_\_\_
– Placed in patient’s mouth
A

softened

seated

40
Q

Selective Tissue Placement Impression
• Borders are heated in individual areas
– ____ cheeks
– ____ movements

A

manipulate

tongue

41
Q

Selective Tissue Placement Impression

• Alternatively, triad is added to tray to ____

A

border mold

42
Q

Selective Tissue Placement Impression

• Following intraoral manipulation, ____ is cured

A

triad

43
Q 
Selective Tissue Placement Impression
• Slight relief provided on border molding
– Borders \_\_\_\_mm
– Undersurface approximately \_\_\_\_mm
• With exception of \_\_\_\_
A

1-1.5
1
buccal shelf

44
Q

Selective Tissue Placement Impression
• Impression compound
removed from ____ in tray

A

holes

45
Q

Selective Tissue Placement Impression
• Final impression is completed with ____ impression wash
• Framework must be perfectly ____ and maintained in ____ during setting

A

elastic
seated
position

46
Q

Altered Cast Fabrication
• Edentulous regions of cast are ____
• Cut surfaces are ____ for additional retention of stone for altered cast

A

eliminated

grooved

47
Q

Altered Cast Fabrication

• Framework and impression are returned to cast and luted with ____

A

sticky wax

48
Q

Altered Cast Fabrication

• Impression is ____ and boxed and poured

A

beaded

49
Q

Altered Cast Fabrication
• Altered master cast with framework in position

 * Buccal shelf regions have been recorded in \_\_\_\_ form * Other regions of basal seats have been recorded in \_\_\_\_ form
A

functional

anatomic

50
Q

Mechanism of Action

Minimize amount of ____ during custom tray fabrication
>
restricts flow of material in ____ stress-bearing areas
>
enables placement or displacement of the ____ over the primary support areas
>
causes ____ pressure to be exerted on the tissue in this area
>
provides support to denture base when PRDP is functionally ____

A 
relief
primary
soft tissues
greater
loaded
51
Q

Clinical Considerations

•____ are placed on altered cast for interocclusal records and tooth arrangement

A

wax rims

52
Q

Clinical considerations

Underextension results in less ____ which may result in instability

Adequately extended ____ base extension

A

support

distal

53
Q

Clinical Considerations

• ____-edge residual ridge with ____-to- severe resorption

A

knife

moderate

54
Q

Summary
Altered Cast Impression Technique

Attempts to make accomodations between differences in:
> resiliency of ____ of edentulous ridges
> ____ tissue of remaining teeth

May result in:
> improved ____ of PRDP
> ____ of remaining supporting structures
> increased patient ____

A

soft tissue
hard

fit
preservation
satisfaction

55
Q

Guidelines at Penn (January 2019)
• Making altered cast impressions is left to the clinical judgement of the supervising faculty
• Final impression must accurately capture all ____ structures (soft and hard tissue) which support the PRDP
– Includes functional impression of all vestibular denture borders, retromolar pads, the retromylohyoid space, hamular notches and retrozygomatic spaces

A

anatomical

56
Q

Guidelines at Penn (January 2019)
• If adequate ____ tissue detail and accurate ____ extensions have been captured in the master impression for the PRDP framework, the altered cast impression will no longer be required.
• Policy will be reassessed after 1 year

A

hard and soft

peripheral

PRDP, Final (21 decks)

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