3 - 3/18: Complete Denture Insertion Flashcards
What two things does the patient think before the insertion appointment?
Anticipation
Apprehension
When do you do a lab remount?
After processing
What is the process of eliminating errors?
The insertion appointment
How long should the patient leave dentures our prior to the insertion appointment?
24 hours - to let the tissue relax
What should you do to the dentures before the insertion appointment
Inspect dentures, put in denture cup/H2O
What should you look at on the dentures before the insertion appointment?
- no imperfections on surfaces
- borders are round/no sharp angles
- cameo surfaces are smooth
What should you do to the casts before the insertion appointment?
Mandibular remount cast is prepared for clinical remount
Where should the maxillary remount cast be before the insertion appointment?
Already attached to articulator
What should you put on the intaglio surface?
Pressure indicator paste
What is the function of the pressure indicator paste?
Undercut areas
Accuracy of tissue contact
What is zinc oxide paste used as?
A pressure indicating paste (PIP) to detect improper adaptation
What patients is PIP used in?
Patients with xerostomia in order to prevent the PIP from sticking to the mucosa
What is the PIP sequence?
- dry denture surface
- brush a thin even layer of PIP onto the surface of the denture
- seat the denture with pressure in the first molar region
- remove immediately
- inspect and adjust bearing surface as necessary
How should you apply the pressure indicator paste?
Brush on thin coat
Brush strokes visible
What should you remove on the cast after applying paste?
islands of pink
- the area is adjusted with an acrylic burr
- when completed the brush marks are mostly absent and the posterior palatal seal bead is showing
What should you ensure regarding the displaced paste?
Reflects a pressure area before relieving the denture base
Mark again, if not sure
How should you evaluate the borders?
Are dentures stable during speech and swallowing?
Are borders and contours compatible with available space in vestibules?
Borders properly relieved at frenal attachments?
How should you disclose the wax and adjust the borders?
- adjust denture flange as necessary
- reapply, border mold, and adjust until areas of overextension are eliminated
How should you check the phonetics?
- check the thickness of the maxillary palatal portion (a common problem is excessive thickness)
- reevaluate the position of the maxillary anterior teeth
- if everything appears normal it nay be a matter of time for the patient to adapt
- open vertical dimension of occlusion
Why does a patient gag?
- palate excessively thick
- palatal extension too long
- lack of tongue space (teeth set too far to the lingual)
What are sources of occlusion errors?
- Resin shrinkage when processed
- Ill-fitting temporary record bases
- Change of OVD on the articulator
- Inaccurate max-mand. records by dentist
- Incorrect arrangement of teeth
- Overheated when polished
- Water absorption (expands 1-3%)
Since numerous sources of occ. errors exist, what should the dentist assume?
Errors exist and work to find it
What does technique for cheking occlusal errors require?
A willingness to see the error
What happens if you simply tell patient to close the jaw and observe contacts?
The error is unlikely to be detected
What is occlusal harmony?
Patient comfort
“efficient” function (20% of natural teeth)
Preserve supporting tissues
How should you occlude the completed dentures first?
Hand occlude
What should you look for beyond the tooth contacts?
Posterior flange contacts
What should you do prior to making the record?
- seat the posterior paltal seal
- place two cotton rolls between the posterior teeth and have the patient bite down for 5 min
How do you make the clinical remount?
- make interocclusal record
- remount dentures on articulator
- refine occlusion on articulator
When is clinical remount and occlusal refinement done?
Before final delivery of the dentures
What do occlusal errors deform?
The supporting tissues and conceal the errors if postponed
What allows the dentures to move?
Resiliency of tissues
Misleading articulating paper markings result
What interferes with paper markings?
Salive on teeth
What does intraoral occlusal “adjustment” require?
Reoeated patient cooperation
- some can cooperate, others cannot
What should you use as extra security during the intraoral occlusal adjustement?
Denture adhesive powder
What are advantages for clinical remount?
- reduce patient participation
- dentist sees better what to do
- stable working foundation; bases not shifting on resilient tissues
What does absence of saliva create?
More accurate marks with articulating paper
Where should grinding be done?
Away from patient. This prevents patient objections to “mutilating my new teeth”
What is desired occlusion?
Simultaneous contact of all posterior teeth in the retruded mandibular position (CR)
What should be absent in desired occlusion?
- contact on anterior teeth
- deflective interferences in eccentric movements
How should you evaluate the cameo surface acrylic thickness?
- observe intraorally and extraorally
- use pressure indicator paste
- make measurements
- seek patient feedback
What should you do for the patient at each appointment?
Educate
What is the difference between an explanation and an excuse?
The time they are provided
- explain the limitations of dentures as mechanical substances for living tissues
What is an explanation
Before the problem
What is an excuse
After the problem
What are instructions given to patients after denture delivery?
- strange feeling of fullness in lips and cheeks for a few days
- mandibular denture more difficult to use than maxillary CD
- increased flow of saliva first few days
- speaking approves with practice – read newspaper aloud everyday
- expect sore spots during break in period
- return to clinic for adjustements. Don’t adjust dentures at home
- remove dentures at night and store in water
What are instructions to give regarding chewing?
- normal chewing takes about 2 months
- begin with softer foods that are cut into smaller pieces
How is control of the dentures accomplished by?
Manipulation with the tongue, lips, and cheeks
How should you teach the patient to position the tip of their tongue?
Next to the lingual surfaces mandibular anterior teeth (have the patient say “e”)
What should the patient use for extra security?
Denture adhesive powder AS NEEDED, during the first month
What is care of the prosthesis?
Brushing (over a sink with water or a washcloth in it), soaking in a container, remove any adhesive
What is care of the mouth?
Gingival massage, tongue brushing with a soft toothbrush
