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4TH YR- CAD- pros tutorials > Clinical Stage 1 > Flashcards

Clinical Stage 1 Flashcards

1
Q

What are the stages of making a complete denture (include lab and clinical stages)

A
  1. Primary impressions
  2. Cast models and create special tray (LAB)
  3. Secondary impressions
  4. Cast models and create record rims (LAB)
  5. Jaw registration
  6. Mount on articulator and set up teeth (LAB)
  7. Try in
  8. Process to finish (LAB)
  9. Fit
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2
Q

What makes a good impression

A

An impression should record the entire functional denture bearing area to ensure maximum support, retention + stability for the denture during use

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3
Q

What anatomy should an upper primary impression have

A
  1. Hamular notch
  2. Vibrating line
  3. Fovea palatinae
  4. Torus paltaltinus
  5. Mucogingival line
  6. Buccal sulcus
  7. Palatal gingival vestige
  8. Labial sulcus
  9. Buccal frenum
  10. Labia frenum
  11. Incisive papilla
  12. Palatal rugae
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4
Q

What anatomy should an lower primary impression have

A
  1. Retromolar pad
  2. Lingual sulcus
  3. Lingual frenum
  4. Buccal frenum
  5. Labia frenum
  6. Labial sulcus
  7. Buccal shelf
  8. Buccal Sulcus
  9. Pear shaped pad
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5
Q

What is the vibrating line

A

Junction between immovable and movable tissue of the soft palate

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6
Q

How can we identify where the vibrating line is

A

Get the patient to say ahhhhh

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7
Q

What is the fovea palatinae

A

The bilateral indentation near midline of the palate

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8
Q

How is the fovea palatinae formed

A

Coalescence of several mucous gland ducts

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9
Q

Where is the fovea palatinae found

A

Posterior to the hard/ soft palate junction (vibrating line)

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10
Q

What is the torus palatines

A

Harmless bony growth/ exostosis located on hard palate

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11
Q

What is the palatal gingival vestige

A

Raided fibrous ridge on the palatal surface of upper residual ridge

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12
Q

What can the palatal gingival vestige be used to do

A

Distinguish palatal mucosa from vestibular/ buccal mucosa

Can be used as a guide in positioning maxillary teeth

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13
Q

How should a denture sit

A
  1. Sit on firm tissue
  2. Accommodate for bony undercuts
  3. Upper should extend to the vibrating line for a post dam
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14
Q

What criteria must a primary impression fulfil

A
  1. Must record tissues without distortion
  2. Must be completed with minimal discomfort to patient
  3. Covers max denture bearing area
  4. Free of significance
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15
Q

What makes a ‘bad’ denture

A
  1. Significant voids
  2. Under extension
  3. Over extension
  4. Impression material not adhering to tray
  5. Not covering full dentine bearing area
  6. Knife edged areas
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16
Q

What is impression compound made up of

A
  1. Resin
  2. Plasticiser
  3. Filler
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17
Q

How is Impression compound used

A
  1. Softened in a water bath

2. Placed in patient mouth then back into water Bath to soften

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18
Q

What are the advantages of impression compounds

A
  1. Non toxic
  2. Easy to use
  3. Can be re softened
  4. Muco displasive
  5. Corrects gross tray problems
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19
Q

What are the disadvantages of using impression compound

A
  1. Poor surface detail

2. Poor dimensional stability

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20
Q

What are the advantages of alginate

A
  1. Easy to use
  2. Well tolerated
  3. Elastic
  4. Viscosity can be altered
  5. Good surface detail
  6. Mucostatic
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21
Q

What are the disadvantages of alginate

A
  1. Poor stability after setting
  2. Cannot be added to
  3. Increases risk of drying out, shrinkage and syneresis
  4. increased risk of swelling and imbibition
  5. Poor tear resistance
  6. Requires adhesive to stick to tray
  7. Unsupported alginate
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22
Q

What is alginate made up of

A

Irreversible colloid

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23
Q

What is impression compound made up of

A
  1. Resins (Paraffin wax, beeswax, shellac)
  2. Filler (Talc and chalk)
  3. Plasticiser (Stearic acid)
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24
Q

What is silicone putty made up of

A

Polydimethyl siloxane + platinum catalyst

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25
Q

What are the advantages of silicone putty

A
  1. Easy to mic
  2. Relatively easy to use
  3. Moderate surface detail
  4. Well tolerated
  5. Elastic
  6. Supports its own weight
  7. Muco compressive
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26
Q

What are the disadvantages of silicone putty

A
  1. Expensive
  2. Needs tray adhesive
  3. Long setting time
  4. Hydrophobic
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27
Q

What do we put in out lab prescription after taking the primary impression

A
  1. Draw tray outline approximately 2 mm short of periphery on impression
  2. Decide on need for spacing or close fitting design
  3. Upper handle slightly labially proclined
  4. Lower vertical handle and finger rests in premolar region
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28
Q

What do we add onto special trays to take secondary impressions

A

Stops

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29
Q

What are the purposes of stops

A
  1. Allows for space for material to flow out
  2. Prevents build up of hydrostatic pressure
  3. To ensure we get an even layer of material
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30
Q

If we forget to prescribe for stops in our special tray what can we do

A

Use green stick to make stops

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31
Q

What are the step we take for an upper occlusion rim

A
  1. Liner upper rim with shellac
  2. correct lip support
  3. Adjust incisal level by getting the patient to smile
  4. Ensure occlusal rim is parallel with inter pupillary line
  5. Ensure occlusal im is parallel with Ala tragal plane
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32
Q

What is the ideal nano labial angle

A

90-100 degrees

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33
Q

How can we alter the lip support

A

By adding or removing wax

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34
Q

How can we ensure the occlusal plane is parallel interpupillary line

A
  1. Using fox’s guide plane

2. Standing in front of patient and asking them to look at your nose

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35
Q

Which occlusal rim should we do first upper or lower

A

Upper

36
Q

What are the step we take for an lower occlusion rim

A
  1. Line with thin light cure acrylic
  2. Measure RVD using willis gauge
  3. With both the upper and lower rim adjust the height to the correct OVD
  4. Mark on midline with score levels in premolar region
  5. Cut v notches on lower and upper models
  6. Place silicone adhesive on lower model
  7. Guide patient into RCP and get then to occlude
  8. Seal models with blu mousse
37
Q

What should the patients RVD be

A

At rest teeth should be slightly apart

38
Q

What should the free way space be

A

2-4mm

39
Q

How is the free way space calculated

A

RVD - OVD = FWS

40
Q

After adjusting the occlusal rims what do you do

A

Select shade, size and shape of teeth

41
Q

What are the aims of the wax try in

A
  1. To identify and correct any errors prior to finish

2. Allow patient to assess appearance of dentures so any appropriate modifications can be performed

42
Q

How is a wax try in placed to assess for errors

A
  1. On articulator

2. In mouth

43
Q

What do we check for on an articulator

A
  1. Balanced occlusion

2. Balanced articulation

44
Q

What do we check for when assessing balanced occlusion

A

All teeth meet evenly

45
Q

When carrying out your wax try in the mouth what must we do between trials

A

Immerse the wax try in in cold water regularly

46
Q

Which denture do we assess first the upper or lower

A

Upper

47
Q

What do we look at when assessing a wax try in upper or lower individually

A
  1. Retention
  2. Stability
  3. Extension of base
  4. Relationship to neutral zone
48
Q

How do we assess assess wax try ins relationship to the neutral zone

A

Check curve of Wilson and ridge position

49
Q

What do we look at when assessing a wax try of an upper and lower denture together

A
  1. Appearance
  2. Occlusion
  3. Free way space
50
Q

What can happen if the base of the wax try in is over extended

A

Denture will displace

51
Q

What can happen if the base of the wax try in is under extended

A

Poor retention for upper dentures

52
Q

How can we correct an over extended wax try in base

A

Correct by decreasing 0ver extended flange

53
Q

How can we correct an under extended wax try in base

A

Correct by taking a wash impression however this isn’t idea and it would be better to back t secondary impression stage

54
Q

Where should the flanges extend to on a wax try in

A

Extend beyond the full depth of the sulcus

55
Q

What does accurate and correct flange extension ensure

A

Creates seal which will increase retention

Makes movement of air and saliva slower decreasing displacement

56
Q

What can happen if the flange width is too wide

A

Can decrease stability and traumatise soft tissues

Air and saliva will move over the denture faster increasing risk of displacement

57
Q

What is a too wide flange caused by

A

Excess green stick

58
Q

How do we assess the lip support of a patient at the wax try in stage

A

Look at patient from all angles

Ask patient for there opinion

59
Q

What should the Naso labial angle be

A

90-110

60
Q

How much of the incisors should be seen at rest

A

2-3mm

61
Q

What happens to the level of the incisor seen at rest as age increases

A

Lip becomes less elastic so patient may show less teeth

62
Q

What must we ensure the smile line and midline are parallel to

A

Alar tarsal line

63
Q

How do we correct an unfavourable incisal level

A

Need to go back to wax rim phase

64
Q

What are specific thing you look at when assessing a lower try in

A

Discomfort from the renal attachments, tori and mental nerves

65
Q

What is the neural zone

A

The area where balanced forces from surrounding muscle (eg Tongue and cheeks) prevents the denture from unseating in function

66
Q

Where should the tongue sit at rest when the denture is placed in

A

Tongue should lie just behind lower anterior teeth

67
Q

How do we measure RVD

A

Get patient to place lower denture only
ask patient to relax
Use willis gauge

68
Q

What do we check in regards to occlusion web both wax try ins are placed in the mouth

A
  1. Check initial contacts in RCP

2. Check lateral and protrusive movements (but make sure patietn uses light movement)

69
Q

Talk through the method of occlusal assessment for wax try ins

A
  1. Visual
  2. Patients perception
  3. Articulating paper (be careful as teeth readily displaced int ax
70
Q

What must we do if there is a problem with occlusion at the wax try in stage

A

Go back to wax rim stage

71
Q

assess OVD How do we a

A
  1. Insert the lower denture and measure RVD
  2. Insert upper denture and measure OVD
  3. Assess free way space at this point
72
Q

What should you do if your free way space is inaccurate

A

1, Remove teeth and re record occlusion
OR
2, Go back to wax try in stage

73
Q

Other than occlusion and aesthetics what else should we check when both wax try in are in the mouth

A

speech

74
Q

How do we assess the patients speech with was try in

A

Ask patient to count from 60-70
If patients teeth drop then there’s a problem with retention
If patients teeth click then there’s a problem with the free way space

75
Q

What does it suggest if the patietn struggles with saying the letter s

A

OVD is excessive or absent

76
Q

What is an average free way space value

A

2-4mm

77
Q

what can excessive free way space cause

A
  1. Increased load on denture bearing tissues
  2. Soreness of mucosa
  3. Increased load on TMJ
  4. Teeth clock together while speaking
  5. Teeth constantly in contact
78
Q

what can a lack of free way space cause

A
  1. Over-closure to get teeth to meet
  2. Difficulty eating
  3. No teeth show
79
Q

When a patient is assessing their appearance at the wax try in stage what should you remind them of

A

That this is the last chance for them to change their mind before the denture is finished

80
Q

What must you make clear on the lab prescription If you wax try ins are successful

A

write clearly you wish for these wax try ins to be processed

81
Q

What must we ensure we achieve by the end of the denture giving appointment

A

New denture should be as comfortable as possible:

  1. No pain experienced by patients during insertion removal or occlusal contact
  2. Teeth meet evenly
  3. Dentures are retentive with good extension
82
Q

In regards to patient understanding what should we check they know before leaving with their new dentures

A
  1. How to control the dentures
  2. Benefits and limitations of dentures
  3. Denture hygiene
83
Q

What do we check for on the denture surface before giving it to patietn

A
  1. Sharp edges
  2. Acrylic pearls
  3. Undercuts
84
Q

What do we check for upon insertion of new dentures

A
  1. Fit and occlusion
  2. Occlusion
  3. Assess OVD
  4. Free way sauce
  5. Appearance
85
Q

What can be some common causes of pain from a denture

A
  1. Undercut flange which will traumatise mucosa

2. Acrylic spicules, nodules or sharp surfaces

86
Q

How can we assess occlusion with dentures in situ

A
  1. Tactile visual assessment
  2. Feedback from patient
  3. Articulating papaer (last resort)
87
Q

when should we recall a patietn who we have given a new denture to

A

1 week

4TH YR- CAD- pros tutorials (9 decks)

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