2/19: Exam, Diagnosis and Treatment Planning for Edentulous Patients Flashcards
What are the 3 types of denture occlusion arrangements?
- Balanced
- Non balanced
- Lingualized (can be used with 1,2)
What is balanced occlusion?
The bilateral, simultaneous, anterior and posterior occlusal contact of teeth in centric and eccentric positions
What is an indiciation of anatomic, balanced occlusion?
Young, healthy alveolar ridges
Good neuromuscular control
When you set balance occlusion, what is the only thing you cant control?
Incisal guidance
What is condylar guidance determined by?
Patient’s anatomy
What are monoplane occlusion indications?
Excessive inter-rdge distance
Skeletal class II, class III and crossbites
Successful previous F/F were monoplane
Limited oral dexterity
Severely resorbed ridges
What are the types of patient psychological classifications?
Philosophical
Exacting/critical
Hysterical
Indifferent
What makes up the philosophical patient?
- rational, calm, sensible, confident
- “you make them, ill wear them”
- majority of the patients
- prognosis good
What makes up the exacting/critical patient?
- methodical, precise
- somewhat difficult to please
- may try to dictate treatment
- may demand a written gurantee
- should make a special effort to be neat and organized when treating
What makes up a hysterical patient?
- in poor health
- neglected oral conditions
- may blame dentist for poor oral condition
- “bet you can’t make teeth that i can wear”
- dont make promises
What makes up the indifferent patient?
- unconcerned with appearance and chewing
- often persuaded by relatives to seek treatment
- diet often poor
- prognosis poor unless education successful
What are the main 3 things you should do with a edentulous patient?
- Make impressions of the mouth as the patient presents
- Measure existing VDO
- Record tooth shade
When taking the dental history, what should you record?
- chief concerns or why pnt is in the chair
- history of previous treatment
When taking the medical history, what should you record?
- overall health and current medications
- interactions causing xerostomia
What type of radiographic exam is preferred?
Panoramic
What should you evaluate in a radiographic exam on an edentulous patient?
pathosis: root tips, foreign bodies, impacted teeth
Mucosal thickness, foramen location
Describe the classes of occlusion from ideal to unfavorable
Ideal = Class I
Class II
unfavorable = class III
What is the ideal interarch space?
Space accomodates teeth and bases with esthetic result
What is the unfavorable interarch space?
Too little space or too much space (torque lever is applied to denture bases)
What is the ideal ridge form?
Square to gently rounded
What is the unfavorable ridge form?
Tall, thin, undercut
What is the ideal mm of tuberosities?
ideal: 5-6mm
minimum: 4mm
What happens if you have unilateral or bilateral undercuts?
Unilateral - may be ok
Bilalteral - may need surgical correction
What happens if you have sharp area of ridge?
Surgery needed
What is a palatal torus?
Bony enlargement at midline of hard palate
What is the frequency of palatal torus?
20-25% of population
More prevalent in women
Maximum size in 3rd or 4th decade
When should a palatal torus be removed?
Large and fills palatal vault
Is undercut
Encroaches on vibrating line
Pnt is concerned that its cancer
What is mandibular tori?
Dense cortical bone covered by a very thin layer of mucous membrane
What is mandibular tori susceptible to?
Irritation from denture base
What is the best treatment for mandibular tori?
Surgical removal
What is the ideal depth of the palatal vault?
Medium depth with well-formed rugae
What happens to a flat palatal vault?
Poor resistance to horizontal movement of denture
What happens to a high, narrow, deep palatal vault?
Rapid break of peripheral seal and poor retention
What is an ideal border attachment?
Muscle/frenum attachments are 10mm or more from crest of ridge
What is an unfavorable border attachment?
Attachments near crest of ridge and may interfere with peripheral seal
What are major impact areas of the tongue and complete dentures?
Border seal
Tooth placement
Speech
What is normal tongue position?
Fills floor of mouth
Lateral borders lie on post. alveolar ridge
Apex approximates ant. alveolar ridge
25% of edentulous patients have…
Retruded tongue
- border seal is absent
- stabilizing influence of tongue is absent
- retention/function of mandib. CD difficult
What does an enlarged tongue cause?
Constant dislodging force on mandibular denture
- adaptation to denture may require MONTHS of dedicated effort
What plays an important role in denture retention?
Saliva
What are some things we should know about a pts denture history?
Years edentulous?
Previous dentures/current dentures
Successful
Expectation? Attainable?
Multiple sets of dentures made in a short time - not a good sign
What should you do with existing dentures?
Evaluate and make impressions
What is the prosthodontic diagnostic index?
A tool that every clinican can use to communicate to colleagues and patients the challenges each patient present with his or her unique dental condition
What are prosthodontic diagnostic index checklist items?
- Bone height mandibular
- Residual ridge morphology of maxilla
- Muscle attachments in mandible
- Maxillomandibular relationship
- Conditions requiring pre-prosthetic surgery
- Limited inter-arch space
- Tongue anatomy
- Modifiers
Describe the PDI classifications for compelte edentulism
Class I — straightforward.
Class II – denture-supporting anatomy degraded.
Class III - anatomy degraded; surgical revision
needed; additional factors present.
Class IV – most debilitated edentulous condition
