9. Diagnosis and Management of RPD Problems

Question 1

Problems that can occur during any stage of RPD treatment (3)

Answer 1

During each stage of treatment (impression taking, occlusal registration, design, trial, denture delivery)
Shortly after the delivery of dentures (tolerance, symptoms/adjustments)
At a later stage (changes to denture structure, changes in anatomy)

Question 2

Types of RPD problems (8)

Answer 2

Denture fit/looseness
Pain
Food trapping/problems eating
Appearance
Altered speech
Fracture
Loss of natural teeth/additions
Combination of problems

Question 3

Features of patient selection and assessment (4)

Answer 3

Expectations
Previous denture wearing history
Careful selection
Are dentures required

Question 4

Aim of taking primary impressions

Answer 4

To accurately record clinically relevant landmarks without excessive tissue distortion

Question 5

Issues with taking primary impressions (4)

Answer 5

Wrong tray
Inaccurate impression
Inaccurate study model

Question 6

Reasons to survey casts (2)

Answer 6

To decide on a path of insertion

To identify and measure the depth of hard/soft tissue undercuts

Question 7

Types of design errors (5)

Answer 7

No support
Poor retention 
Incorrect clasp for size of undercut
Not considering occlusion (occlusal interference)
Poorly designed path of insertion

Question 8

Errors with special tray assessment and modification (4)

Answer 8

Inappropriate spacer thickness
Wrong adhesive
Wrong material
Extension of tray

Question 9

Aim of master impressions

Answer 9

To record the entire functional denture bearing area to ensure maximum support, retention and stability during use

Question 10

Errors during recording the jaw relationship (3)

Answer 10

Wrong record of occlusion
Reasons for symptoms (increased OVD/inadequate freeway space)
Risk of fracture (repeated flexing of the denture)

Question 11

Wax trial checks (4)

Answer 11

Appearance (shade, mould, position)
Wax adaptation to the cast (no distortion)
Extension (over and under-extension can cause looseness especially if there are few natural teeth to aid retention)
Anatomical features can affect retention

Question 12

Definition of post dam

Answer 12

A ridge on the posterior border of a denture which helps with the posterior seal. This should be at the junction of the hard and soft palate

Question 13

Problems concerned with the metal framework (4)

Answer 13

Does it fit the cast or is the cast damaged?
Does it seat in the mouth (clasps too tight, path of insertion, advantage of prepared rest seats)
Incorrect occlusion
Adjustments

Question 14

When to undertake insertion checks (2)

Answer 14

Before the patient arrives (correct denture; smooth)

With the patient (insertion and correct seating; undercuts)

Question 15

Reasons for RPD looseness problems (4)

Answer 15

Adaptation
Over/under-extension
Tooth position
Occlusion

Question 16

Reasons for RPD pain problems (5)

Answer 16

Over-extension
Engaging soft tissue undercuts
Too tight a fit
Clasps (soft tissue/tooth)
Free-end saddles

Question 17

Reasons for RPD appearance problems (4)

Answer 17

Clasps
Tooth choice
Flanges
Black triangles

Question 18

Reasons for RPD speech problems (5)

Answer 18

Shape of polished surfaces
Tooth position
Tip of the tongue in relation to palatal aspect of upper incisors
Stability of mucosa borne partial denture
Retention of mucosa borne partial denture

Question 19

Causes of retching (5)

Answer 19

Triggered by stimulation of the soft palate, posterior third of the tongue and fauces
Over-extension of upper or lower partial denture
Thickness of base
Teeth encroaching on tongue space
Denture looseness

Question 20

Reasons that RPDs may break (5)

Answer 20

Impact (dropping)
Flexural fatigue (bending/flexing)
Stress areas can cause fractures (notches, diastema)
Denture base (worn, thin and weak)
Occlusion (locked/worn causing denture to flex and fracture)

Question 21

Reasons for RPD additions (2)

Answer 21

Teeth have to be extracted
RCT is required
Additions are more often for partial or transitional immediate dentures

Question 22

Addition techniques (2)

Answer 22

Classical methods

Alternative methods