Complete Denture Insertion and Trouble Shooting

Question 1

What must you do in the fit appointment?

Answer 1

Ensure dentures as comfortable as possible, check occlusion, ensure dentures stable in function, manage patient expectations, and patient understands how to insert remove and clean

Question 2

What do stages 1-3 of fit appointment which are ‘troubleshooting’ involved?

Answer 2

Repeating many of same ‘checks’ from jaw relation and try-in stages

Question 3

What are the stages in new definitive denture construction?

Answer 3

Impression stage/s, jaw relation stage/s, try in stage/s, fit, and review/s

Question 4

What do you examine underneath/base/impression surface of denture yourself first for?

Answer 4

Sharp projections and extensions that go into undercuts

Question 5

What should you do after you examine underneath/base/impression surface of denture yourself first?

Answer 5

Gently insert denture

Question 6

When can you check for over extension if an acrylic base plate was used?

Answer 6

At earlier stages

Question 7

What should you try if over extension cannot be identified using cast and visual inspection?

Answer 7

A silicone/paste material

Question 8

How is a silicone/paste material applied?

Answer 8

Thinly to edge of denture which is gently inserted until it causes initial discomfort and then removed to identify high spots

Question 9

How is the base checked clinically?

Answer 9

C/- and then -/C are inserted in turn and ensure that there is no pain by gently applying finger pressure on occlusal surfaces

Question 10

How is retention checked?

Answer 10

First insert denture and allow time for a border seal to establish

Question 11

What may anxious patients/those with xerostomia benefit from when checking retention and stability?

Answer 11

Some water and possibly artificial saliva at insertion

Question 12

What is the retention and stability of C/- and -/C?

Answer 12

C/- generally has a better border seal and unlike -/ C, will often stay in place with finger and thumb pulling it down

Question 13

How is stability checked?

Answer 13

Resistance to some gentle horizontal displacement

Question 14

What may the stability be if ridge heigh is compromised?

Answer 14

Reduced

Question 15

What should you check occlusion and that CR=CO for?

Answer 15

For complete dentures/partials where no tooth-tooth contacts and we are re-organizing

Question 16

When do we also check occlusion and that CR=CO?

Answer 16

At try in stage

Question 17

What should first contact be?

Answer 17

Not on one/a few teeth but there should be widespread contacts around arch

Question 18

What if bases move when teeth close from “first touch” to “all way” more than a couple of mm movement?

Answer 18

Then redo jaw relationship

Question 19

How can you stable both bases?

Answer 19

Left finger and thumb hold upper up and lower dentures in place, while right thumb and finger gently guide on chin

Question 20

What can articulating paper be useful to identify?

Answer 20

Which teeth are in contact

Question 21

What should you be aware of with thick paper?

Answer 21

Thick paper paper can mark teeth irrespective of whether they are in contact

Question 22

Why may you be given thicker articulating paper for dentures?

Answer 22

Acrylic mucosa is more mobile than PDL

Question 23

What can be used to hold articulating paper?

Answer 23

Miller’s forceps

Question 24

What is occlusal adjustments in CO commonly done to try and make?

Answer 24

A balancing contacts however, use ‘selective grinding’ gradually

Question 25

What may you do by changing tooth anatomy?

Answer 25

Loose your occlusal vertical dimension, affect aesthetics, and make biting less efficient

Question 26

What should you do if there are any deflective contacts?

Answer 26

Adjust buccal upper and lingual lower cusps on working side, also don’t forget in case contact is on non-working side as well

Question 27

When could deflective contacts make a denture unstable?

Answer 27

When eating

Question 28

What is recommended if minor occlusal adjustments are unsuccessful in correcting an occlusal slide?

Answer 28

To re-articulate and perhaps adjust occlusion out of mouth using an articulator and perhaps in a laboratory setting

Question 29

What may you need to do if there are relatively larger discrepancies in occlusion?

Answer 29

Go back one/more stages in denture construction

Question 30

What may final fit stage be if dentures fitted perfectly at try in stage?

Answer 30

Relatively straightforward unless there are errors from ‘try in’ to ‘fit’ stage

Question 31

What is the split cast mounting technique?

Answer 31

Location grooves used to attach master casts to articulator from jaw relation stage are still present on casts after processing, therefore casts can be returned to articulator in same jaw relation as at trial denture stage and occlusion can then be refined

Question 32

What does too much packing pressure cause?

Answer 32

Teeth are forced into investment plaster

Question 33

What does too much packing pressure cause?

Answer 33

Teeth are forced into investment plaster

Question 34

What does normal pressure but investing plaster weakened because of of porosity present/incorrect powder water mix/inadequate thickness of plaster?

Answer 34

Movement of teeth/breaking of teeth

Question 35

What does pressure released too early cause?

Answer 35

Halves separate and OVD of denture increased

Question 36

What does separation of flasks by resin ‘flash’ that should have been removed when flasks closed cause?

Answer 36

OVD too big

Question 37

What are try in stage/s (with acrylic teeth in wax) useful to assess?

Answer 37

Tooth mould and shade

Question 38

When were shade and mould selected clinically?

Answer 38

At jaw relation stage

Question 39

What should you remember if processing to final fit?

Answer 39

Shade cannot be changed

Question 40

What advice to patient specifically on oral hygiene?

Answer 40

Dentures should be cleaned and then left out overnight in order to ensure soft tissues are kept clean and reduce possibility of infection

Question 41

How often can edentulous patients be seen

Answer 41

At least every year/more frequently if they are higher risk of infection

Question 42

What should you do at these appointments for ongoing care after denture review?

Answer 42

Check denture fit, consider relines, and ensure patient is aware that further maintenance is necessary, and problems may occur in order that they do not have a false sense that dentures are fit for life

Question 43

What is a denture reline?

Answer 43

An easy way to add material to the part of the denture that comes into contact with the gums