Clinical Complete Denture Prosthodontics

Question 1

Complete denture objectives

Answer 1

 Preserve remaining associated oral structures  Provide adequate masticatory function.
 Restore natural appearance.
 Restore normal speech.
 Enhance patient’s quality of life,

Question 2

Limitations of Complete Dentures

Answer 2

The essential between natural and artificial teeth is that the former are firmly rooted in the bone of the jaws. On the other hand, artificial dentures rest on slippery mucosa of the alveolar ridges and are subjected to powerful displacing forces.

Stability of complete dentures can vary within wide range of limits depending on the shape and size of the edentulous arches

lack of food sensation and taste, and the lack of tooth guidance mechanism.

 Maximum forces of 13 to 16 lb (6 to 8 kg) during chewing have been recorded with complete dentures, and are in the region of 44 lb (20 kg) for the natural teeth.

 In fact, maximal bite forces appear to be five to six times less for complete denture wearers than for persons with natural teeth.

dentures is almost invariably accompanied by an undesirable and irreversible bone loss

Question 3

Ideal Denture-bearing Area

Answer 3

1. Alveolar ridge configuration.
2. Palatal configuration.
3. Arch form.
4. Buccal shelf area.
5. Mucosal coverage.
6. Vestibular depth
7. The role of the tongue.
8. Physiology of the saliva
9. Muscle tonicity.

Question 4

Sequelae of Complete Denture Wearing

Answer 4

1. Mucosal reaction.
2. Altered taste perception.
3. Gagging.
4. Residual ridge resorption

Question 5

The successful wearing of complete dentures could be affected by some local or systemic conditions which can be broadly divided into:

Answer 5

A. Conditions affecting the ridge shape. Paget’s disease, acromegaly, and hyperparathyroidism.
B. Conditions affecting oral mucosa. Anemia, Aphthus stomatitis, Lichen planus, and erythema
multiforme.
C. Conditions affecting patient physical capability to control the dentures. Parkinson’s disease, epilepsy, and facial paralysis.

Question 6

Refractory Patients

Answer 6

A patient who has chronic complaints following appropriate therapy.
 These patients continue to have difficulty in achieving their treatment expectations

Question 7

Mental attitude: House’s classification:

Answer 7

A. Philosophical patient: A patient with a rational, sensible, calm and composed disposition.
B. Exacting patient: Who likes to know every procedure in detail.

C. Indifferent patient: Who is least bothered about the treatment being offered,

D. Hysterical patient: Who has an unhealthy fear about the treatment

Question 8

Neuromuscular skills or coordination cases

Answer 8

Para-functional and uncontrolled movements complicate the recording of maxillo- mandibular relations and contraindicate the use of a balanced occlusal scheme with anatomic teeth.

Question 9

Mucosal Thickness

Answer 9

Normal (3-4 mm)

Question 10

Mucosal Irritation
Common Causes

Answer 10

 Overextension of the denture peripheries
 Dirty, ill fitting denture
 Continuous wearing of a denture
 Faulty occlusion
 Small spicules of alveolar bone
 Traumatic injury

Question 11

Management of poor denture foundation
Flat Ridges

Answer 11

1. Relief denture at areas of mental foramina.
2. A peripherally adapted impressions extend to cover
   retromolar pads to counteract lip pressure.
3. Non Anatomic teeth should be used.
4. Surgical procedures to improve the ridge (Sulcus deepening, vestibuloplasty, ridge augmentation, or bone grafts)
5. Implant retained soft tissue supported complete overdentures if possible.

Question 12

Management of poor denture foundation
Knife-edged Ridges

Answer 12

Knife-edged Ridges
1. Alveolectomy. Surgical excision of a portion of the dentoalveolar process, for recontouring of the alveolar ridge at the time of tooth removal.
2. Relief the fitting surfaces.
3. Lining the denture with a resilient material that
should be replaced periodically as it deteriorates.
4. Reducing the occlusal vertical dimension.
5. Maximum coverage of basal seat and reduction of occlusal table.

Question 13

Undercuts are classified into:

Answer 13

i. No bony undercuts
ii. Small undercuts
iii. Opposing bilateral buccal undercuts

Question 14

Palatal throat form (Posterior Palatal Seal)

Answer 14

The width of the area between the distal border of the hard palate and the anterior border of the movable tissue of soft palate.
Class I Class II Class lll

Question 15

Lateral throat form (Retromylohyoid space)

Answer 15

It is the space distal to mylohyoid muscle. It is bounded by the retromolar pad laterally, the superior constrictor

Both the palatoglossus muscle and the lingual slip of the superior constrictor muscle are called the Retromylohyoid curtain.

Class l no movement
Class ll about half as long and narrow as class l flange and about twice the length of class lll
Class lll the entire finger/ mirror is displaced

Question 16

Border Tissue Attachment (Muscle & Frenum)

Answer 16

1. Normal (Low) line of tissue attachment lies well below the crest of the ridge allowing well-extended denture flanges to support dentures against horizontal forces.
2. Near ridge (High) line of tissue attachment lies close to the crest of the ridge reducing the amount of support against forces dislodging the denture base.

Question 17

The presence of large denture notches to accommodate thick frenai will

Answer 17

compromise denture seal leading to air leak in and retention loss.

Question 18

The stress on the anterior midline of the maxillary complete denture increases with a higher labial frenulum leading to

Answer 18

midline fracture.

Question 19

Residual Ridge Relationship

Answer 19

1. Normal.
2. Prognathic.
3. Retrognathic
4. Parallel.
5. Divergent.

Question 20

Inter-ridge distance

Answer 20

Favorable. 16-20 mm

Question 21

Clinical oral dryness score

Answer 21

10 points