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BDS2 - prosthetics > clinical stages of RPD design > Flashcards

clinical stages of RPD design Flashcards

1
Q

what occurs in visit 1

A

assessment and primary impressions

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2
Q

what occurs in visit 2

A

master impressions

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3
Q

what occurs in visit 3

A

framework trial

- +/- record occlusion

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4
Q

what occurs in visit 4

A

tooth trial

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5
Q

what occurs in visit 5

A

delivery/fit

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6
Q

what occurs in visit 6

A

review

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7
Q

how is visit 1 carried out

A
  • examination of the patient and previous denture
  • look in the mouth = feel ridge for displaced tissue, free end saddles, bounded saddles, undercuts
  • fill out denture assessment form
  • select a tray and try it in
  • select an impression material
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8
Q

what types of impression trays can be used in visit 1

A
  • dentate = deeper
  • edentate = not as deep, for edentulous patients
  • perforated stock trays with removable handles = handle orientation must be that it won’t lift up the lip and alter impression
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9
Q

what impression material is used for no free end saddles

A

alginate

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10
Q

what impression material is used for free end saddles

A

compound

  • it can modify the tray as stock trays don’t fit everyone
  • is a mixture of waxes and resin = stabilise tray for more accurate impression
  • should not be used on teen as could catch on teeth
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11
Q

what is the most elastic impression material

A

alginate

- also elastomer is quite elastic = made up of silicone and polyether

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12
Q

what are non elastic impressions materials

A
  • impression compound

- ZnO/Eugenol

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13
Q

how are primary impressions taken

A
  • select stock tray and modify peripheries with wax or compound
  • apply adhesive and use alginate or alginate/compound for impression = alginate over top of compound as a alginate wash
  • disinfect and place in sealed bag with wet cotton wool/paper towel = place in perform solution to disinfect and decontaminate
  • label bag and write instruction to technician
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14
Q

why is a wet cotton wool/paper towel placed in bag with impression

A
  • because alginate can take on water so impression wouldn’t. be accurate so paper towel prevents this
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15
Q

what is recording he occlusion

A
  • measuring how the teeth meet
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16
Q

what happens if you can hadn’t articulate the casts

A
  • don’t need to record the occlusion and don’t need a primary record block or wax wafer
  • you can get the casts mounters on an articulate with a wax wafer or nothing at all
  • you can examine the occlusion on the articulator
  • look for space to place rest seats
  • plan for preparation of rest seats if moo space available
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17
Q

what is a wax wafer used for

A
  • inter occlusal record
  • warm wax patients bites on
  • can you see any missing teeth = then not in correct occlusion
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18
Q

how can you tell on the articulator if occlusion isn’t right

A
  • pin of articulator not on table
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19
Q

what do you do if you can’t hadn’t articulate the casts

A
  • you need a primary record block from the lab (can’t obviously see how teeth meet together) = used to mount casts accurately
  • record occlusion using primary record block
  • ask technician to mount the primary casts using you registration
  • if need to have a primary record block this means an extra clinical stage to record the occlusion before primary models can be mounted on an articulator = once found occlusion can mount
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20
Q

when can you move onto master impressions

A
  • once you have surveyed the cast
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21
Q

what is used to stick the casts together in occlusion

A

-wax or silicon registration paste

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22
Q

what instructions do you need to give the technician after visit 1 for master impression

A
  • how much spacing is required

- are there any undercuts = want it to flex/be elastic

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23
Q

what instructions does technician need after visit 1 if you can hand articulate

A
  • pour primary cast

- special tray with spacer = 1-2 sheets of wax depend on master impression material with handles/fingers rests etc

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24
Q

what instructions does technician need after visit 1 if you can’t hand articulate

A
  • pour primary cast = with 50/50 dental stone
  • special tray with spacer = 1-2 sheets of wax depend on master impression material with handles/finger rests etc
  • construct primary record blocks for a preliminary jaw registration = base can be wax, shellac or light sure acrylic
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25
Q

what must be done before visit 2

A
  • design the denture
  • surgery path of insertion ]- surgery to decide undercuts
  • do teeth need modified for rest seat, guide planes and undercuts
  • draw design on laboratory work card
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26
Q

what must you remember when designing the denture

A
  • 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 a space the occlusion will not be correct
  • if there is no space the rest will simply open the bite
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27
Q

what is the system of design

A
  • outline saddles
  • support = rests
  • retention = clasps
  • bracing
  • connectors = minor or major
  • review design
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28
Q

when do you need to do a primary registration

A
  • when you can’t hand articulate
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29
Q

what is done in visit 2

A
  • trim peripheries if overextended
  • modify peripheries with greenstick and fit surface for free end edentulous saddles
  • take master impression
30
Q

what is poly vinyl siloxane

A
  • a medium bodied silicone
  • is an impression material
  • don’t want light bodied as too runny and heavy bodied is like putty
  • don’t need a lot as have custom tray with little spacing
  • brand name = Extrude
31
Q

what is polyether

A
  • an impression material
  • careful with undercuts as will have to cut around these if this gets caught
  • very accurate and gives good impression
  • brand name = Impregum
  • very rigid
32
Q

what is alginate

A
  • an impression material
  • well mixed
  • poured up as soon as possible
  • good if undercuts are present
  • careful or air blows = compromise accuracy of impression
  • need to tell lab if using alginate as needs to be poured on the same day
33
Q

what is impression compound use for

A
  • modify the tray
34
Q

how is the master impression taken

A
  • try in special tray and trim peripheries if overextended = trim with burr
  • modify the peripheries with greenstick and fit surface for free end saddles
  • apply adhesive and sue alginate/polyether/PVS for impression
  • disinfect and place ins elated bag and write instructions to technician = in perform solution
35
Q

why is it important that master impressions are correct

A
  • if not then everything after them in the process won’t be right either
36
Q

why does polyether and silicon not need water

A
  • they are dimensionally stable
37
Q

what do you need to do if the denture is going to be in cobalt chrome

A
  • pour model in improved stone
  • contract chrome framework per design = clear design signed by clinician
  • remember to prepare occlusal rests/guide planes before taking impression
38
Q

what do you need to do if the denture is going to be in acrylic

A
  • pour model in stone

- construct record bloc with shellac base

39
Q

what happens in visit 3

A
  • framework trials and/or not recording the occlusion
  • design is agreed
  • 2-3 weeks
40
Q

what is considered in the framework trial

A
  • does it fit the cast
  • does it seat correctly in the mouth
  • is the cast damaged
  • is the framework interfering with occlusion
  • if not right then adjust at chair side = wear appropriate PPE, use Adam’s pliers for claps
41
Q

when do you register the occlusion

A
  • once happy wit the framework

- check space for rests = and measure the depth of sulu, undercuts for claps

42
Q

why do you 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
  • ensuing loading forces are applied correctly to teeth
  • conformist approach = keeping the occlusion same as it is, need to know the position of teeth in relation to each other
  • re-organised approach = altering the occlusion, tooth wear, not enough teeth to meet
43
Q

what is the aim of the visit for recording the occlusion

A
  • establish inter occlusal relationship to articulate rests
  • establish occlusal vertical dimension
  • establish tooth moult and shade
  • establish extend edentulous spaces =buccal/labial contours of wax and record block, lip support, incisal plane, posterior plane
44
Q

what are you aiming for with recording the occlusion for the technician

A
  • to inform the technician where you want the artificial teeth to be positioned their shade and mould together with information on how the teeth occlude
  • wax occlusal rims for definitive registration
  • made on working casts from secondary impressions
45
Q

what do you need to adjust if the framework doesn’t fit in patients mouth

A
  • if need to trim CoCr need to get the lab to do it or can do it at chair side by need special PPE
  • equipment needed = hot plate, Bunsen burner, palate knife
46
Q

what do you need to do if there are no index teeth

A
  • need to measure the OVD and FWS
  • OVD = occlusal vertical dimension (should be 2mm)
  • FWS = freeway space (should be 2-3mm)
  • use old dentures as initial starting point for OVD
47
Q

why do you need to give the patient 2-3mm freeway space

A

to be able to speak

48
Q

how and why are the blocks trimmed

A
  • use the blocks to tell the technician where the teeth will go
  • try it in, it will be bulky
  • it has to stay in place = may fall out if overextended into sulcus so whenever muscles move it falls out
  • any overextension of the peripheries as it will drop/displace
  • too much lip support and it will drop
  • use the wax knife and hot plate to make adjustments
  • adjust upper rim first
  • you may need to adjust the rim labially/buccally
49
Q

what must you do for prescribing the position of the anterior teeth

A
  • made sure index teeth are in occlusion
  • mark centreline = for technician
  • correct incisal plane
  • correct anterograde-posterior position
  • should follows line of lower lip
50
Q

why must you ask patients for how they want the denture

A
  • any specifics for their own teeth they want replicated
51
Q

what articulator will you use most of the time

A

average value articulator

52
Q

what do you need to do once the framework comes back from the lab

A
  • check it fits properly, if its damaged

- it will come on a working cast

53
Q

what are the reference points

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
54
Q

where is the alar-tragus line

A
  • bottom of nose to the ear

- diagonal line

55
Q

where is the inter pupillary line

A
  • above the eyebrow
56
Q

what needs to be considered for teeth shade and mould

A
  • existing teeth
  • previous denture
  • patient performance
  • measure
57
Q

what is you need a record block on framework

A
  • need an additional visit

- construct wax record blocks on chrome framework

58
Q

how is the tooth trial carried out

A
  • articulate casts to registration

- set teeth for wax trial (shade and mould provided)

59
Q

what happens at visit 4

A
  • tooth trial
  • at this point should have teeth on
  • framework tooth trial
60
Q

what are you checking in framework tooth trial

A
  • framework fit
  • occlusion
  • aesthetics
  • extension
61
Q

what do you do if there are any problems at visit 4

A
  • describe change needed to technician

- do a re-trial

62
Q

what can you adjust at chair side in visit 4

A
  • teeth to lower the bit

- use hot wax

63
Q

what happens in patient happy with denture at visit 4

A
  • take to finish in acrylic

- can get small f=dimensional changes when change to acrylic however

64
Q

what do you look at in the denture on the articulator at visit 4

A
  • check design again as requested
  • examine dentures for roughness/blebs
  • check it seats properly
  • any undercuts = check these, doesn’t always come out once it goes in
  • is the pin on the table
  • does occlusion look correct
65
Q

what are you looking at with dentures in patient mouth

A
  • insert dentures - does it seat properly
  • if elderly patient need to make sure they can get it in and out easily
  • check = stability (does it rock), support (are the rests/flanges seating accurately), retention (adjust clasps with Adams pliers), aesthetics (carry put above checks first, last thing you do is show patient
66
Q

what must you check in occlusion at visit 4

A
  • do teeth meet in the resorbed occlusal scheme our the wax up = check with articulation paper for heavy/early defective contacts
  • is something propping open the bite = small change adjust with acrylic burr chair side, large change may require removal of teeth and re-set in wax
67
Q

what is used to adjust denture in the lab

A
  • hand piece and suction for debris
  • operated by knee peddle under the bench
  • use mop to poohs denture along with the pumice
68
Q

what are the instructions you give to the patient

A
  • coping with the new denture = will be uncomfortable at first
  • pain is expected at first
  • denture cleansing = should be removed at night, bacteria that can be aspirated and cause pneumonia
69
Q

what happens at visit 5

A
  • review = can be the most difficult stage
  • history, examination, adjustments
  • if sore, get patient to still wear it for a couple days before attending as will be more obvious as there will be ulcers at sore area
70
Q

how is the occlusion recorded

A
  • made of wax so easy to adjust
  • reduce height of block until it starts to conform to patients bite
  • can use silicon registration paste = patient bites together and it fits into notches made
71
Q

what do you do if 2 record blocks needed

A
  • same process as if 1
  • sort out upper first then lower
  • 1= identify index teeth
  • 2= adjust one block to keep the index teeth in occlusion
  • 3 = adjust second block with first one still in to keep index teeth in occlusion
  • 4 = record occlusion
72
Q

what are index teeth

A
  • teeth you can reproducibly get bite from together, they meet

BDS2 - prosthetics (10 decks)

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