6. Removable Prosthetics Flashcards
What are the 5 components of history taking before construction of new dentures?
- Complaints
- Denture history
- Dental history
- Medical history
- Social history
What are 5 medical history points that can impact denture wearing?
Neuromuscular problems
Tremors
Strokes
Dementia
Dry mouth
What are the areas that should be assessed when assessing dentures?
Extra Oral - TMJ, asymmetry, facial fullness
Intra Oral - soft tissues, hard tissues, occlusion, aesthetics
What are the 6 clinical stages of partial denture construction?
- First impressions
- Occlusion
- Second impressions
- Try in
- Fit
- Review
What are the 6 steps of designing a partial denture?
- Note: teeth being replaced
- Chose: saddles
- Chose: connector
- Chose: support
- Chose: retention
- Select: materials
What is a denture saddle?
Part of denture that holds artificial teeth
What is a connector?
The component that connects saddles together
What is a denture support?
The area of a denture that resists vertical load via teeth or bone
What is denture retention?
Resistance of vertical movement away from tissues via clasps
What is a bounded saddle?
When there is teeth on either side of a saddle
What is a free end saddle?
When there is no teeth distal to a saddle
What are the two types of saddles?
Bounded
Free end
What are 5 examples of lower connectors?
Lingual plate
Dental bar (requires 9mm crown height to accommodate 5mm bar)
Lingual bar (requires 7mm lingual sulcus as bar is 3.5mm plus clearance)
Split lingual plate
Swing lock denture
What are the 3 upper connectors for PMMA dentures?
Full coverage
Spoon
T denture
What are the 5 connectors for CoCr dentures?
Full coverage
Anterior palatal bar
Horseshoe
Mid palatal bar
Posterior palatal bar
What are the 2 types of support for dentures?
Teeth
Mucoperiosteum
How is retention achieved in dentures?
Saliva and suction
Muscle activity
Clasps
List 3 clasp types?
Occlusal approaching
Gingival approching
Ring
When would you use an occlusal approaching clasp?
If diagonal survey line
When would you use a gingival approaching clasp?
If high or low survey line
What are 4 materials used for clasps?
CoCr
Stainless steel
Gold
Copolymer
CoCr Clasps can engage undercuts up to a depth of:
0.25mm
Stainless steel clasps can engage undercuts to a depth of:
0.5mm
Gold clasps can engage undercuts up to a depth of:
0.75mm
Copolymers can engage undercuts of:
Any depth
What is the equation for recording occlusion?
FWS = RVD - OVD
FWS means?
FWS should be?
Freeway space
2-4mm
RVD meaning:
Rest vertical dimension
OVD meaning:
Occlusal vertical dimension
What is an index tooth?
A tooth that is in occlusion reproducibly
How is occlusion recorded if there is SUFFICIENT index teeth?
In ICP using bite reg paste
How is occlusion recorded if INSUFFICIENT index teeth?
ICP if bite reproducible
RCP if not
How do you get a patient into RCP?
Tongue to back of palate and guide closed
What are the 2 ways you can make new full dentures?
Conventional technique - start from scratch
Replica technique - replicate previous denture
What are the 6 stages of conventional full denture construction?
- First imps
- 2nd Imps
- Occlusion
- Try in
- Fit
- Review
Recording Occlusion for F/F dentures:
1. What are the 7 steps to recording with the upper block?
2. What are the 2 steps to recording with the lower block?
- Check stability, extension and retention
Check lip support
Check incisal level
Check anterior plane with interpapillary line
Check posterior plane with ala tragus line
Check posterior border
Mark centre line - Ensure even contacts with upper block
Ensure correct OVD with sufficent FWS
What are the 5 clinical stages for replica full denture construction?
- First imps via replica technique outwith the mouth
- Second imps and occlusion
- Try in
- Fit
- Review
How do you record occlusion for replica dentures if:
1. No changes required?
2. Change required?
- Bite reg paste
- Add/remove wax
What is the aim and use of first impressions?
To record all anatomical landmarks to construct models to allow:
Tx planning
Special tray construction
Occlusion examination
Design of denture
What should 1st imps record?
Natural teeth and denture bearing area
What are the 3 checks following first impressions?
Are all edentulous areas included
Are sulci included?
Are all teeth included?
List 4 ways to improve 1st impressions:
Modify tray
Use more or less material
Border mould
Pre pack palate/tuberosity
What is the aim and use of second impressions?
Aim: to record the tissues of the denture bearing area, the teeth and the sulci in a special made tray
Used to: construct a cast which represents the fitting surface of the finished denture
When should 2nd imps be done?
After denture is designed and any tooth modifications are completed
What is the requirement of spacing required for special trays if alginate is the impression material?
3mm
What materials are special trays made of?
PMMA
shellac
What checks should you do at TRY IN stage?
I/O:
Wax extension
Rest seats
Occlusion
Tooth position
Tooth aesthetics
E/O:
Lip support
Incisal level
Occlusal planes
Speech
Aesthetics
What checks should you do at the FIT stage?
I/O:
Comfort
Retention
Stability
Extensions
Occlusion
E/O:
Aesthetics
Speech
What should you check at a REVIEW stage?
I/O
Soft tissues
E/O
Function
Aesthetics
Soeech
List the 5 denture care instructions that should be given to all denture wearers:
- Rinse mouth after every meal
- Remove denture every night
- Brush denture with soap and soft brush
- Store in cold water overnight
- Continue to brush and clean natural teeth
Denture hyperplasia signs and management:
Gum blanching
Management: denture ease
Denture stomatitis signs and management:
Redness and sloughing of denture bearing area
Management:
Denture hygiene
Mouthwash
Antifungals
Kennedy Classification I
Bilateral free end saddle
Kennedy Class II
Unilateral free end saddle
Kennedy class III
Single bounded saddle that DOES NOT cross midline
Kennedy class IV
Single bounded saddle crossing the midline
What are the 2 steps of surveying casts?
- Determine POI with surveyed and analysing rod
- Draw survey lines with graphite marker to determine undercuts
What is a POI?
Path of insertion
The path followed by a P/P denture on insertion
What is an undercut?
Portion of tooth between the survey line and gingiva
What is the RPI system?
A specific design for abutment teeth adjacent to free end saddles that aims to avoid torque on abutment teeth
What does RPI stand for?
R = medial rest
P = distal plate
I = I bar
List 3 metals used for clasps
CoCr
NiCr
Stainless Steel
Components of CoCr
Cobalt
Chromium
Nickel
Components of NiCr
Nickel
Cobalt
Chromium
Components of stainless steel
Steel
Chromium
Nickel
List the 2 denture base materials:
PMMA
CoCr
What is PMMA
Polymethyl Methacrylate
What is CoCr and what is it composed of?
Cobalt chromium
Cobalt
Chromium
Molybdenum
Nickel
What are the 2 materials used for artificial teeth?
Acrylic
Porcelain
What are the 4 stages of IR denture construction?
- First imps
- Second imps and occlusion
- Try in
- XLA and fit
What are the 3 post XLA and fit instructions that should be given?
Keep denture in for 24 hours
After 24 hours:
Salty mouthwash
Begin Denture cleaning regime
When should IR dentures be reviewed?
1 day
1 week
1 month
Then,
6 month recall for either reline or new dentures now full healing occurred
What is the aim of a denture reline?
To add new base material to the fit surface of an ill fitting denture to fill the gap between the denture and mucosa
What are the 3 types of reline and the materials for each?
- Temporary
- Soft: acrylics or silicones
- Permanent: hard acrylic
What is the aim of a rebase?
To replace the entire denture base material of an existing denture
What are the 4 stages of rebase of a denture?
- Removal of undercuts from the fit surface of denture
- Light body imp taken of fit surface in the mouth
- Send to lab
- Fit of denture
How is a denture repaired if pieces can be put back together?
In the lab or chairside
How is a denture repaired if part of the denture has been lost?
Take impressions of denture in the mouth and send to lab
List 2 chairside methods of denture repair:
Self cure acrylic
Cyanoacrylate glue
What are the two methods of denture additions?
Tooth additions
Clasp additions
What are the 5 steps to add a tooth to an existing denture?
- Take impression with denture in place
- Send to lab
- New tooth added to denture
- XLA of natural tooth
- Fit of denture
What are the 3 steps of clasp additions to an existing denture?
- Take impression with denture in place
- Send to lab
- Fit denture
What are 3 advantages of over dentures?
Can correct occlusion
Preserves ridge
Maintains proprioception
List 3 disadvantages of overdentures:
Good OH required
Increases caries and perio risk
Potential for more traumatic extractions
What 2 things must be detailed in a lab card for 2nd imp and occlusion stage:
Special tray: material, spacer required, handle
Record block: material
What must you include on lab card for try in stage?
Tooth: shade, mould
What should you include in lab prescription at fit stage?
Denture details: post dam, relief areas, linings
List 6 common mucosal issues associated with dentures:
Ulcers
Denture stomatitis
Angular chelitis
Denture hyperplasia
Flabby ridges
Allergy
Ulcers signs and management in dentures wearing patients:
Pain, yellow/white/red lesion, redness surrounding
Identify, ease, review
Denture Stomatitis signs and management
Redness, swelling
Denture hygiene, chlorohexidine mouthwash, antifungals
Angular chelitis signs and management
Sores at corners of mouth
Miconazole
Denture hyperplasia signs and management
Enlargement of tissues
Ease denture or make new one, tissue conditioner
Flabby ridges signs and management
Bone resorption that is replaced with fibrous tissue due to trauma
New dentures
Denture allergy signs and management
Redness under denture bearing area
Change denture base material
List 5 denture design ideas for difficult cases:
Modify survey lines
Combine fixed and removable pros
Use precision attachments
Two part dentures
Swing lock dentures
What sort of connector would be used for lingual tilted teeth?
Buccal connector
List 5 ideas for dentures for bruxists:
Metal backing on teeth
CoCr or high impact acrylic
Metal occlusal surfaces
Cross linked teeth
Acrylic post dam
How would you manage problems with extension at try in:
Overextended - trim wax
Under extended- mark extension on casts
How would you manage problems with adaptation at try in?
Take new impression
How would you manage problems with CoCr framework at try in?
Take new inpression
How would you manage too little FWS at try in stage?
Add wax to correct FWS
Re-record occlusion
Retry appointment
How would you manage too much FWS at try in stage?
Remove occlusion teeth and replace with wax
Record occlusion
Retry appointment
How do you manage pain at an ease appointment?
Ease denture
How would you manage movement of denture at ease appointment?
Assess extensions and oral dryness
Reline denture
How would you manage jaw pain at an ease appointment?
Check the FWS
How would you manage occlusal complaints at an ease appointment?
Check there is no sliding
Check occlusion with articulating paper
Grind down any high areas
What should be checked at and IR denture ease appintment and when should this be?
Sockets, any signs of trauma, if pt can insert and remove denture
Should be 24 hours after XLA
When should an IR denture be reviewed?
After 1, 3 and 6 months
When is fully healing complete after XLA and fit of an IR Denture?
6 months post XLA
What are the options after 6 months of an IR denture?
Reline
New denture
When should Full Dentures be reviewed?
Annually
When should partial dentures be reviewed?
As per oral health needs