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Prosthodontics > Basic treatment planning & impressions for complete dentures > Flashcards

Basic treatment planning & impressions for complete dentures Flashcards

1
Q

What histories are required to make complete dentures?

A

Patient complaints
Denture history
Dental history
Medical history
Social history

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2
Q

What are the things a patient might complain of?

A

Appearance
Eating
Pain/Discomfort
Looseness
Retching
Speech
Dislike wearing a denture?

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3
Q

What are key questions in denture history?

A

Age of dentures?
Matched set?
Most recent set worn?
When 1st denture?
How many sets dentures?
Material/soft lining?
Success or failure?

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4
Q

What questions to ask about dental history?

A

When teeth lost?
Why teeth lost?
Any retained roots, pain or swelling?
Anxiety, mobility & dental attendance
Has anything else been tried for current problem?

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5
Q

What information is important in the medicial history?

A

Neuromuscular problems Tremor eg: Parkinson’s disease
Stroke
Dementia
Dry mouth - Xerostomia
Medication eg: Antidepressants; polypharmacy
Sjogren’s syndrome
Radiotherapy

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6
Q

What types of medication can affect denture making?

A

Anti-resorptive drugs – MRONJ Polypharmacy (taking multiple drugs)

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7
Q

What questions should be asked in the social history?

A

Mobility
Barriers to treatment
Alcohol/smoking
Capacity to consent
Support needed

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8
Q

What should be assessed extra orally?

A

Signs of TMJ dysfuction eg: Click or tenderness
Facial pathology
Facial contours
Overall appearance of dentures

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9
Q

What should be assessed intra-orally?

A

Mucosal health
If overdenture abutments (retained roots):
Periodontal health
Periapical status
Caries

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10
Q

What are common tissue diseases that occur with denture users?

2

A

angular cheilitis
denture stomatitis

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11
Q

What is denture hyperplasia?

A

a condition that occurs when the tissue in the mouth is chronically irritated by an ill-fitting denture

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12
Q

In the intra-oral exam, what needs to be assessed for the denture?

A

Support in edentulous areas
Mouth opening – trismus
Peri-oral opening

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12
Q
A
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13
Q

What is support?

A

Resistance of vertical movement of a denture towards the ridge

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14
Q

What are the primary and secondary support areas in the upper jaw?

A

primary - hard palate
secondary - ridge crest

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15
Q

What are the primary and secondary support areas in the lower jaw?

A

primary - buccal shelf and pear shaped pad
secondary - ridge crest and genial tubercles

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16
Q

When the denture is in the patient’s mouth, what should be assessed?

A

Occlusal planes: anterior & posterior
Vertical Height – RVD – OVD = Freeway Space
Occlusion recorded correctly in retruded contact position
Tooth position
Lip support
Overextension or Underextension
Retention; Stability; Adaptation

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17
Q

What is the intercuspal position (ICP)?

A

The complete intercuspation of the opposing teeth independent of condylar position, sometimes referred to as the best fit of the teeth regardless of the condylar position

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18
Q

What is the retruded contact position (RCP)?

A

Guided occlusal relationship occurring at the most retruded position of the condyles in the joint cavities.

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19
Q

What is the most reproducible position?

A

RCP

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20
Q

What position is used in complete dentures?

A

RCP
we do not use ICP as there are no opposing natural teeth

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21
Q

What is retention?

A

The resistance to displacement of a denture away from the ridge

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22
Q

What is stability?

A

Ability of a denture to resist displacement by functional stresses

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23
Q

What is adaptation?

A

the degree of fit between a prosthesis and supporting structures

24
Q

What should be assessed in the denture out of the mouth?

A

Base extension – underextension
Tooth position
Excessive wear of denture
Hygiene
Repairs, additions etc

25
Q

What is the pre treatment phase?

A

Usually done if a need to get the tissues healthy prior to constructing replacement prostheses

  • Tissue conditioners

Referral for investigation or further opinion if concerns about mucosa

26
Q

What are the steps to treatment plan formation?

A

Pre –treatment phase if necessary
Referral for opinion if necessary e.g. persistent ulcer
Reassessment & modify plan if necessary
Construction of dentures
Review after treatment

27
Q

What are casts made from primary impressions used for?

A
  • Treatment planning
  • Construction of special trays
28
Q

How can stock trays be modified?

A

Can be modified with various materials e.g. soft red wax / greenstick / putty / composition;

can reduce tray extension of plastic tray with an acrylic bur

29
Q

Are complete complete trays perforated or not?

A

usually perforated

30
Q

What are the materials used to extend the stock trays?

A
  • Putty
  • Soft red wax
  • Red composition
  • Greenstick
31
Q

What are the qualities of putty?

A

expensive
long setting time

32
Q

What are the qualities of soft red wax?

A

Cheap
Can manipulate easily in hands
Poor dimensional stability

33
Q

What are the qualities of red composition?

A

Cheap
Requires boiling water
Less available in practice
Very short working time

34
Q

What are the qualities of greenstick?

A

Cheap
Rarely used in stock trays
Requires intense heat
Tricky to manipulate
Runny so better suited for smaller additions on special trays – used frequently as material of choice for extending a special tray

35
Q

How can the extension of stock trays be reduced?

A

acrylic bur with straight handpiece with eye protection

36
Q

Where are the reductions done?

A

Mandibular
reduction to accommodate lingual fraenum
reducation to accommodate mandibular tori

Maxillary
reducation for muscle attachments
reduction for labial fraenum
palatal reduction

37
Q

What are the limitations of stock trays?

A
  • Trays are not made to measure
  • Peripheral extensions - often over or under extended
  • Limited sizes available
  • Require master impressions to record denture bearing area with accuracy on
38
Q

What is the material for denture impressions?

A

alginate

39
Q

What are common errors with stock trays?

A

tray handle upside down
excessive load of material on tray

40
Q

When might you use red composition without alginate?

A

Retching patients
Rapid working time
Seconds rather than minutes

41
Q

What is the clinical procedure of primary impressions?

A
  • Explain procedure to patient
  • Select trays - use tray with most appropriate extension
  • Assess this visually in the mouth by manipulating cheeks, lips and tongue
  • Change tray size if too big or small
  • Reflect – Are you happy with the tray – Use it no modification; Are you unhappy – add material or remove part of tray or both, select appropriate material
  • Apply thin layer of adhesive over tray AND putty / wax/ composition and allow to dry
  • Mix alginate (dental nurse) Load tray (you) with alginate
  • Seat loaded tray in mouth
  • Border mould muscles eg: cheeks and lips whilst constantly supporting tray
  • Once alginate set remove it with sharp sudden movement
42
Q

What should the ideal distance between tray flange and denture bearing area be?

A

4mm

43
Q

How should you border mould the lower anterior lingual sulcus?

A

Sticking the tongue out to get correct sulcus depth

44
Q

What should be assessed in the primary impression?

A
  • Are all the edentulous areas included?
  • Are the sulci areas to be included in the denture recorded fully?
  • Are deficiencies present due to air inclusion??
  • Is the impression fit for purpose or not?
45
Q

What should you consider to improve your impression in the repeat time?

A
  • Tray modification – too big/ too small/adjustment
  • Amount of material – too much/too little
  • Tray placement – anterior/posterior/right/left
  • Was border moulding sufficient?
  • Do I need to pre-pack palate / tuberosities?
  • Can the patient cope with a repeat impression today?
46
Q

What does a master impression do and what does it use?

A
  • Record denture bearing area, functional depth and width of sulci
  • Use custom made special (individual) trays prescribed after primary impressions
47
Q

What are the features of the upper denture bearing area (edentulous)?

11

A

labial sulcus
labial frenum
palatine rugae
incivsive papilla
buccal frenum
palatine raphe
tuberosity
buccal sulcus
hamular notch
palatien foveae
vibrating line

48
Q

What are the features of the lower denture bearing area (edentulous)?

A

labial sulcus
labial frenum
lingual frenum
buccal frenum
buccal sulcus
lingual sulcus
buccal shelf
retromolar pad

49
Q

What are the two materials used to make special trays and what are their qualities?

A
  • VLC resin PMMA (acrylic)
    pre-rolled sheets
    easy to mould
    very rigid – sometimes problems removing from model
  • Self-cure PMMA (acrylic)
    problems rolling an even layer
50
Q

What impression materials require no spacer?

A

Silicone elastomers – no spacer
[Replica or resorbed ridge Conventional]

Zinc oxide/eugenol impression paste-no spacer [Replica & Conventional – rarely used]

51
Q

What impression materials require a 3mm spacer?

A

Alginate - 3mm
Silicone elastomers/polysulphides - 3mm

52
Q

What are the advantages of special trays?

A
  • Accurate peripheral extension
  • Uniform thickness of material
  • Reduced amount of material
  • Less discomfort as tray fits individual mouth
  • Records denture bearing area more accurately
53
Q

What is the clinical procedure for master impressions?

A
  • Check extension - ought to be ~2mm short of sulcus depth to allow border moulding
  • Mould Stops: (Greenstick)
    position
    maintain spacing for material
    allow consistent placing of tray
  • Check extension and modify if necessary – add or remove material – add use greenstick; remove similar to stock tray with acrylic bur & straight handpiece
  • Apply thin layer of adhesive - dry
  • Less alginate required than primary impressions
    • Excess material may obstruct airway or prevent seating of tray - retching
  • Pre-pack where necessary – high arched palate/tuberosities
  • Support tray throughout procedure
  • Border moulding
  • Assess the impression like primary impressions but more accuracy required
  • Rinse with water and keep moist with damp paper towel
54
Q

What should you aim for in master impressions?

A
  • Well rounded borders
  • Minimal air blows & none in important areas
  • Impression centrally placed in tray
  • Ensure all clinically relevant areas included
55
Q

What are problems that may occur with master impressions?

A
  • Obvious differences between sulcus width on either side
  • Underextended tray leads to underextended impression
  • Incomplete tray seating
  • Sharp border to lingual pouch
  • Overextended tray leads to overextended impression
56
Q

How should alginate be handled?

A
  • must be kept moist and cast asap
  • especially important for master impression
57
Q

How should elastomers be handled?

A
  • more dimensionally stable
  • don’t require moist environment
  • BUT cast to avoid damage
58
Q

How should impressions be disinfected and stored?

A
  • Rinse in running water to remove saliva, blood or debris
  • Disinfect - for 10 minutes in disinfectant solution
  • Note the time impression is to be removed from solution
  • Rinse thoroughly (having put on clean gloves)
  • Cover alginate impressions with damp paper towel
  • Label and place in a plastic laboratory bag
  • On laboratory prescription indicate that impressions have been disinfected which MUST be signed by supervising clinician
  • Take to laboratory asap for casting

Prosthodontics (6 decks)

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