9. Diagnosis and Management of RPD Problems Flashcards
Problems that can occur during any stage of RPD treatment (3)
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)
Types of RPD problems (8)
Denture fit/looseness Pain Food trapping/problems eating Appearance Altered speech Fracture Loss of natural teeth/additions Combination of problems
Features of patient selection and assessment (4)
Expectations
Previous denture wearing history
Careful selection
Are dentures required
Aim of taking primary impressions
To accurately record clinically relevant landmarks without excessive tissue distortion
Issues with taking primary impressions (4)
Wrong tray
Inaccurate impression
Inaccurate study model
Reasons to survey casts (2)
To decide on a path of insertion
To identify and measure the depth of hard/soft tissue undercuts
Types of design errors (5)
No support Poor retention Incorrect clasp for size of undercut Not considering occlusion (occlusal interference) Poorly designed path of insertion
Errors with special tray assessment and modification (4)
Inappropriate spacer thickness
Wrong adhesive
Wrong material
Extension of tray
Aim of master impressions
To record the entire functional denture bearing area to ensure maximum support, retention and stability during use
Errors during recording the jaw relationship (3)
Wrong record of occlusion
Reasons for symptoms (increased OVD/inadequate freeway space)
Risk of fracture (repeated flexing of the denture)
Wax trial checks (4)
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
Definition of post dam
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
Problems concerned with the metal framework (4)
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
When to undertake insertion checks (2)
Before the patient arrives (correct denture; smooth)
With the patient (insertion and correct seating; undercuts)
Reasons for RPD looseness problems (4)
Adaptation
Over/under-extension
Tooth position
Occlusion
Reasons for RPD pain problems (5)
Over-extension Engaging soft tissue undercuts Too tight a fit Clasps (soft tissue/tooth) Free-end saddles
Reasons for RPD appearance problems (4)
Clasps
Tooth choice
Flanges
Black triangles
Reasons for RPD speech problems (5)
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
Causes of retching (5)
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
Reasons that RPDs may break (5)
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)
Reasons for RPD additions (2)
Teeth have to be extracted
RCT is required
Additions are more often for partial or transitional immediate dentures
Addition techniques (2)
Classical methods
Alternative methods
