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BDS2 CDS Prosthodontics Removable > Clinical Stages of RPD (1 and 2) > Flashcards

Clinical Stages of RPD (1 and 2) Flashcards

1
Q

clinical stages for RPD

A

VISIT 1: Assessment & Primary Impressions

VISIT 2: Master Impressions

VISIT 3: Framework Trial (+/- record occlusion)

VISIT 4: Tooth Trial

VISIT 5: Delivery (Fit)

VISIT 6: Review

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2
Q

visit 1

A

Assessment & Primary Impressions

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3
Q

visit 2

A

Master Impressions

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4
Q

visit 3

A

VISIT 3: Framework Trial (+/- record occlusion)
VISIT 4: Tooth Trial
VISIT 5: Delivery (Fit)
VISIT 6: Review

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5
Q

visit 4

A

Tooth Trial

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6
Q

visit 5

A

Delivery (Fit)

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7
Q

visit 6

A

Review

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8
Q

visit 1 consists of

A

Examination of Patient and Denture

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9
Q

Examination of Patient and Denture in visit 1

A

Remember History and Examination from Lecture 1

Look in the mouth!
- Ridge form
(Displaceable tissue – feel the ridge)
- Free end saddles – no teeth posterior to the saddle
- Bounded saddles- teeth abutments on both sides of saddle
- Undercuts - tooth and soft tissue undercuts

assessment of denture form available on clinics

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10
Q

what do you need to wear on all visits

A

PPE

saliva
blood (potentially)

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11
Q

what to look for when trying in selected tray

A

Fit all teeth

Fit comfortably in oral cavity

Position of tray handle, important because don’t want to distort any of the soft tissues when place
- Wrong way up will lift sulcus up and distort

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12
Q

stock trays

A

perforated with removable handles

edentate or dentate

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13
Q

edentate stock trays

A

shallower

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14
Q

dentate stock trays

A

greater depth

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15
Q

impression material for no free end saddle

A

alginate

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16
Q

impression material for free end saddle

A

compound and alginate

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17
Q

what material is generally used for primary impressions

A

alginate

depends on clinical situation

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18
Q

non elastic impression material

A

impression compound

can be used to modify stock tray to fit better

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19
Q

elastic impression material

A

alginate

elastomer

  • silicone
  • polyether
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20
Q

if there is many undercuts what impression material should be avoided

A

non elastic compound

not able to flex which you need to remove impression

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21
Q

example of when you would need to use compound

A

free end saddle
- Full extent of impression not captured
- retromolar pads missing
modify stock tray before requesting special tray

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22
Q

compound main use

A

Stabilise tray with compound
- prevent rocking when only anterior teeth present

No teeth in compound
- could pull them out if poor perio health
- Use heat and wax knife to remove
place alginate wash over the top

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23
Q

should compound impression include teeth

A

no

alginate wash on

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24
Q

4 stages of primary impression

A

select stock tray and modify peripheries/fit surface with wax or compound and burrs

apply adhesive and use alginate/compound for impression
border mould needs to be strong

disinfect and place in sealed bag with wet cotton wool/paper

label bad and write instructions to technician

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25
Q

why do you need to place impression in a sealed bag with wet cotton wool/paper?

A

alginate can take water on

- expand and be inaccurate if no wet wool (crack)

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26
Q

what is used for decontamination and disinfection

A

perform

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27
Q

hand articulation

A

Put casts together and obvious how they meet
- Sufficient to be transferred to technician

You don’t need to record the occlusion, don’t need a primary record block
- Can go onto master impressions

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28
Q

why do we need to record the occlusion

A

measuring how the teeth meet, the comfortable bite

Look for space to place rest seats when casts on articulator
- Plan for preparation of rests seats if no space available

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29
Q

wax wafer

A

inter-occlusal record

Warm wax the patient bites on
- Used when no free end saddles but occlusion isn’t obvious by hand

Want no space between upper and lower – excess wax will open the bite

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30
Q

too much wax used for inter-occlusal record

A

pin doesn’t lie on table of articulator

Something has happened to the OVD (too much wax or articulating paste)

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31
Q

what type of casts cannot be hand articulated

A

free end saddles

need a primary record block from the lab

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32
Q

reasons for primary record blocks

A

You can’t obviously see how the teeth meet

Use to mount the casts accurately

Look for space to place rest seats and baseplate

Plan for preparation of rests seats if no space available

  • Facilitating the design
    (How to obtain information needed for denture design and how to plan for it (rests))
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33
Q

how to bond sides of a free end saddle together

A

wax or silicone registration paste

squashed in between arches

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34
Q

what can be an additional visit

A

if a primary record block is required as there is not enough teeth to hand articulate (free ed saddle)

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35
Q

instructions to the technician if hand articulated

A

Pour primary cast

Special tray with spacer
- 1-2 sheets of wax depends on master impression material with handles/ finger rests etc.

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36
Q

instructions to the technician if non hand articulated

A

Pour primary cast

Special tray with spacer
- 1-2 sheets of wax depends on master impression material with handles/ finger rests etc.

Construct primary record block for a preliminary jaw registration
- Base can be wax, shellac or light cure acrylic

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37
Q

what needs done before visit 2

A

Design the denture – cannot take master impression before completing this

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38
Q

how to design the denture

A

Survey to decide the path of insertion

Survey to decide undercuts etc – know where clasps to be placed

Do you need to modify teeth to produce rest seats, guide planes and undercuts (Dr Cross lecture)

Draw the design on the laboratory work card and get signed off by clinician

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39
Q

4 key points to remember in denture design

A

The denture design must conform to the patients occlusion unless you are planning to change

If there is no inter-occlusal clearance for a rest either make space by cutting a rest seat or do not place a rest.

If you don’t make space the occlusion will not be correct.
- Will bother patient – pressure on rest will lead to it breaking off

If there is no space the rest will simply open the bite.

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40
Q

first things to do on visit 2

A

try in special tray

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41
Q

special tray

A

Bespoke custom tray made to primary impression - Needs to be accurate

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42
Q

3 things to check with the special tray

A

overextended

under extended

Handles shouldn’t disrupt soft tissue - up from lip

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43
Q

overextended special tray modification

A

Trim peripheries if overextended with slow speed

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44
Q

under-extended special tray modification

A

Modify peripheries with greenstick and fit surface for free end edentulous saddles (under extended)

45
Q

4 impression material options

A

Poly vinyl Siloxane (medium bodied silicone)

Polyether

Alginate

Impression Compound (modify the tray)

Use the specific tray adhesive for the material you are going to use,
specify to nurse the one you wish to use

46
Q

medium bodied silicone (PVS) properties

A

Brand name: Extrude

3 bits - mixed together coming out of nozzle

Do not use a lot - enough to cover surfaces wanted to record

Shallow spacing (1-1.5mm)
- Don’t want excess - cannot swallow as doesn’t biodegrade, gets stuck in GIT
47
Q

polyether properties

A

Brand name: Impregum

Addition polyether

Mixes in nozzle

Wipe of excess in tray

Be careful in undercuts
- Periodontal disease could get tray stuck

Very accurate

48
Q

alginate properties

A

Well mixed (smooth)

Poured up as soon as possible

Good if undercuts present

Careful for air blows – will compromise accuracy of impression and therefore casts

49
Q

why do you need to cover alginate with damp cotton wool and cast ASAP

A

Cover with damp cotton wool seal in bag to prevent alginate drying out
Needs to be cast as soon as possible to avoid inaccuracies developing as a result of the dimensional instability of alginate

50
Q

why are the master impressions important stage

A

everything that follows will not be accurate

51
Q

master impression stages

A

try in special tray and trim peripheries if overextended

modify peripheries with greenstick and fit surface for free end saddles

apply adhesive and use alginate/polyether/PVS for impression.
- Border mould needs to be strong

disinfect place in sealed bad and write instructions to technician

52
Q

do you need water in sealed bag for polyether or silicone material

A

no

dimensionally stable

53
Q

cobalt chrome instructions to technician after master impressions

A

Pour model in improved stone

Construct chrome framework per design
- Clear design signed by clinician

Remember to prepare occlusal rests/guide planes before taking impression

54
Q

acrylic instructions to technician after master impression

A

Pour model in stone

Construct record block with shellac base

55
Q

before visit 3 you have already

A

Check spaces for rests

Designed agreed

Measured depths into sulcus, undercuts for clasps

RPI planned for free end saddle

56
Q

6 points to check in the framework trial in visit 3

A

Does it fit the cast?
- No then won’t fit the patient

Does it seat correctly in the mouth?

Is the cast damaged?

  • Undercut too great (tooth came off in process)
  • Difficulty inserting and removing – need to alter path of insertion

Is the framework interfering with occlusion?
- Interfering with bite, rocking, does it move

Adjust chairside

  • Wear appropriate PPE (special mask for chrome adjustments)
  • Use adams pliers for clasps

Adjust in the laboratory

57
Q

4 key checks of framework before registering the occlusion

A

Does it fit the cast?

Does it seat correctly in the mouth?

Is the cast damaged?

Is the framework interfering with occlusion?

58
Q

if you have record block on the framework already then

A

there is no separate recording of the occlusion

59
Q

5 reasons why we need to record the occlusion

A

To help design the denture

To help the technician set-up the teeth

(To ensure the denture is stable and is not dislodged in function)

Patient comfort

Ensuring loading forces applied correctly to teeth

60
Q

conformist approach to occlusion

A

Keeping the occlusion the same as it currently is

Need to know the position of the teeth in relation to each other. Keep in comfort

61
Q

re-organised approach to occlusion

A 
Altering the occlusion 
- Tooth wear
- Not enough teeth to meet
Different OVD
Not yet, only BDS4 and BDS5
62
Q

aim of recording the occlusion at visit

A

Establish

  • Inter-occlusal relationship to articulate casts (decide where teeth are going to be)
  • Occlusal vertical dimension (OVD)
  • Tooth shade and mould

extended edentulous spaces

  • buccal/labial contours of wax record block
  • lip support
  • Incisal plane
  • Posterior plane
63
Q

wax record block recording process

A

2 lumps of wax on teeth technician knows where to teeth are
- Know what you are aiming for
Similar to primary impression but wanted on mounted casts

64
Q

4 points you are aiming for when recording the occlusion to tell the technician

A
  • where you want the artificial teeth to be positioned
  • their shade
  • mould together
  • information on how the teeth occlude
65
Q

if there is no index teeth then what do you need to measure

A

the OVD and FWS

66
Q

OVD

A

occlusal vertical dimension

67
Q

at rest distance between teeth

A

2-3mm

68
Q

free way space is

A

the difference between the at rest measurement and the measurement when teeth are biting
- use willis gauge

69
Q

what do you use for initial setting point for OVD

A

old dentures

70
Q

equipment you will need to register the occlusion

A
  • Bunsen burner and wax knife

- Hot plate

71
Q

why do we need to trim the registration blocks

A

as they are average sizes so will be bulky and they need to stay in place

72
Q

what will an overextension into the buccal sulcus mean

A

it will drop/displace

- displace with cheek movements

73
Q

how to make adjustments to wax registration blocks

A

Use the wax knife and hot plate/spatula to make adjustments
- Contour where you want teeth

adjust upper rim first
may need to adjust labially/buccally

if there is too much wax in tongue space - reduce

74
Q

too much wax in tongue space of record block

A

reduce

Lingual pouch area - lift tongue does it dislodge

75
Q

4 points you need for prescribing the position of anterior teeth

A
  1. Make sure index teeth in occlusion – bite together
  2. Mark centreline
  3. Correct incisal plane
  4. Correct antero-posterior position

Give technician as much information as possible

76
Q

8 reference points for recording the occlusion on registration blocks

A

Teeth present

Dento-facial midline

Inter-pupillary line

Ala-tragus line

Curvature of lower lip

Smile line

Gingival margins of existing anterior teeth

Previous dentures

77
Q

inter-pupillary line

A

imaginary horizontal line drawn between the centres of the pupils of the eyes

78
Q

ala-tragus line

A

line from the lower border of the ala of the nose to the upper border of the tragus of the ear

79
Q

anterior plane of the rim should be parallel to what?

A

inter-pupillary line

80
Q

what should the centre line coincide with

A

the midline

81
Q

what should the posterior plane coincide with

A

the alar-tragal line

82
Q

2 factors in tooth selection

A

shade

mould

83
Q

shade determination for teeth

A
  • existing teeth
  • previous denture
  • patient preference
84
Q

mould determination for teeth

A
  • existing teeth
  • previous denture
  • measure
85
Q

how to decide how to arrange the teeth

A

Talk to patient how they wish the teeth arranged

- May want replicated crooked teeth

86
Q

what to do after recording the occlusion on the wax and making reference points

A

decontaminate and disinfect

87
Q

articulator instructions for the technician

A

what do you want the cast to be mounted on

Plane line / hinge
- Simple hinge is very straight forward, use when only a couple of teeth missing

Average value
- Most commonly used

Semi - adjustable

88
Q

record block on framework instructions for the technician

A

Construct wax record blocks on chrome framework

Additional visit required

89
Q

visit before tooth trial (to prepare)

A

Received framework back with record block on
- Check fit, damaged, check in patient

Articulate casts to registration

Select teeth for wax trial (shade and mould provided)

90
Q

3 main reference points for jaw registration (always check)

A

Exiting teeth

Midline of face

Interpupillary line

91
Q

what does the pin of the articulator not being on the table indicate

A

Check occlusion in mouth

- Rest seat in bite?

92
Q

4 points to check in framework tooth trial

A

Framework Fit

Occlusion - check bite OK. Registration not right go back to wax bite??

Aesthetics

Extension

93
Q

what is the framework tooth trial purpose

A

Dress rehearsal for the finished denture- patient must be happy before taking to finish in acrylic

Everything needs to be correct or re-trial

94
Q

what can you do if there is issues in the framework tooth trial

A

Can adjust teeth by heating up wax and lowering bite
- Can do a retrial with different shade and mould
describe the changes needed to the technician

Need to get patient agreement before moving on

95
Q

after the tooth trial

A

decontaminate and disinfect

96
Q

finish instructions to the technician

A

Please take to finish in acrylic (no more wax)

97
Q

if the denture doesn’t come on the cast what does this indicate?

A

may not fit

Small dimensional changes in acrylic
- Could effect fit

98
Q

6 things to check on the articulator before placing the denture in the patient

A

Pin on table – seats properly

Nothing interfering with bite

As prescribed

Examine dentures for roughness/ blebs
- Very sharp in mouth

Undercuts- are any teeth on the cast broken?

Does the occlusion look correct

99
Q

4 things to check when patient tries denture

A

Stability
- Does it rock?

Support
- Are rests/flanges seating accurately

Retention
- Adjust clasps with Adams pliers

Aesthetics
- Carry out above checks first, last thing you do is show the patient

100
Q

what to do if the denture doesn’t fit in the patient

A

don’t force it in if doesn’t seat properly

Undercuts- what goes in does not always come out, material may not be elastic enough to flex in and out

101
Q

how to check the occlusion

A

Check with articulating paper for heavy/early deflective contacts (premature early contacts)

teeth meet in the prescribed occlusal scheme per the wax up

102
Q

small change to occlusion requried

A

adjust with acrylic bur at chair-side

103
Q

large change to occlusion required

A

may require removal of teeth and re-set in wax (lab on level 6)

Polish acrylic after adjusting with a bur

104
Q

instructions to give to patient on denture delivery

A

Insertion / removal elderly patients may struggle

Coping with new dentures like breaking in shoes, perseverance to adjust, metal and plastic nothing like natural tissues,
- Brain needs to recognise change in mouth
0 Couple of months for neuromuscular contrail for free end saddles

Pain

Denture cleansing

Speech

Eating

Take out at night
- Denture stomatitis. Can progress to pneumonia

Refer to clinic patient information leaflet

105
Q

what do dentures cause greater production of in the oral cavity

A

more saliva

affect speech, eating, denture cleansing

106
Q

what occurs in the review visit

A

history

examination

adjustments

can be difficult
- Any sore bits - wear for a few days before so they can be seen and assessed (don’t avoid wearing)

107
Q

process of recording the occlusion

A

wax record blocks are easy to adjust

increase veritcal dimension
- creates gap between the arches

heat up wax to adjust
- carve it with a wax knife
reduce height of block to conform with patient bite
- not propping it open

notches cut on wax where teeth are to go

silicone registration paste here to register the teeth
- 2 notches cut in wax
- impressions on wax and bite recorded
avoid excess material which will change bite

start with upper record block
- more aesthetically vital
then work on lower

108
Q

basic process for 2 record blocks

A
  1. Identify index teeth
  2. Adjust one block to keep index teeth in occlusion
  3. Adjust second block with first one still in to keep index teeth in occlusion
  4. Record occlusion

Soften wax or use registration paste to get them to stick together

109
Q

index teeth

A

teeth that you can reproducibly get bite together, they meet

BDS2 CDS Prosthodontics Removable (10 decks)

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