Complete Denture Insertion and Trouble Shooting Flashcards
What must you do in the fit appointment?
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
What do stages 1-3 of fit appointment which are ‘troubleshooting’ involved?
Repeating many of same ‘checks’ from jaw relation and try-in stages
What are the stages in new definitive denture construction?
Impression stage/s, jaw relation stage/s, try in stage/s, fit, and review/s
What do you examine underneath/base/impression surface of denture yourself first for?
Sharp projections and extensions that go into undercuts
What should you do after you examine underneath/base/impression surface of denture yourself first?
Gently insert denture
When can you check for over extension if an acrylic base plate was used?
At earlier stages
What should you try if over extension cannot be identified using cast and visual inspection?
A silicone/paste material
How is a silicone/paste material applied?
Thinly to edge of denture which is gently inserted until it causes initial discomfort and then removed to identify high spots
How is the base checked clinically?
C/- and then -/C are inserted in turn and ensure that there is no pain by gently applying finger pressure on occlusal surfaces
How is retention checked?
First insert denture and allow time for a border seal to establish
What may anxious patients/those with xerostomia benefit from when checking retention and stability?
Some water and possibly artificial saliva at insertion
What is the retention and stability of C/- and -/C?
C/- generally has a better border seal and unlike -/ C, will often stay in place with finger and thumb pulling it down
How is stability checked?
Resistance to some gentle horizontal displacement
What may the stability be if ridge heigh is compromised?
Reduced
What should you check occlusion and that CR=CO for?
For complete dentures/partials where no tooth-tooth contacts and we are re-organizing
When do we also check occlusion and that CR=CO?
At try in stage
What should first contact be?
Not on one/a few teeth but there should be widespread contacts around arch
What if bases move when teeth close from “first touch” to “all way” more than a couple of mm movement?
Then redo jaw relationship
How can you stable both bases?
Left finger and thumb hold upper up and lower dentures in place, while right thumb and finger gently guide on chin
What can articulating paper be useful to identify?
Which teeth are in contact
What should you be aware of with thick paper?
Thick paper paper can mark teeth irrespective of whether they are in contact
Why may you be given thicker articulating paper for dentures?
Acrylic mucosa is more mobile than PDL
What can be used to hold articulating paper?
Miller’s forceps
What is occlusal adjustments in CO commonly done to try and make?
A balancing contacts however, use ‘selective grinding’ gradually
What may you do by changing tooth anatomy?
Loose your occlusal vertical dimension, affect aesthetics, and make biting less efficient
What should you do if there are any deflective contacts?
Adjust buccal upper and lingual lower cusps on working side, also don’t forget in case contact is on non-working side as well
When could deflective contacts make a denture unstable?
When eating
What is recommended if minor occlusal adjustments are unsuccessful in correcting an occlusal slide?
To re-articulate and perhaps adjust occlusion out of mouth using an articulator and perhaps in a laboratory setting
What may you need to do if there are relatively larger discrepancies in occlusion?
Go back one/more stages in denture construction
What may final fit stage be if dentures fitted perfectly at try in stage?
Relatively straightforward unless there are errors from ‘try in’ to ‘fit’ stage
What is the split cast mounting technique?
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
What does too much packing pressure cause?
Teeth are forced into investment plaster
What does too much packing pressure cause?
Teeth are forced into investment plaster
What does normal pressure but investing plaster weakened because of of porosity present/incorrect powder water mix/inadequate thickness of plaster?
Movement of teeth/breaking of teeth
What does pressure released too early cause?
Halves separate and OVD of denture increased
What does separation of flasks by resin ‘flash’ that should have been removed when flasks closed cause?
OVD too big
What are try in stage/s (with acrylic teeth in wax) useful to assess?
Tooth mould and shade
When were shade and mould selected clinically?
At jaw relation stage
What should you remember if processing to final fit?
Shade cannot be changed
What advice to patient specifically on oral hygiene?
Dentures should be cleaned and then left out overnight in order to ensure soft tissues are kept clean and reduce possibility of infection
How often can edentulous patients be seen
At least every year/more frequently if they are higher risk of infection
What should you do at these appointments for ongoing care after denture review?
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
What is a denture reline?
An easy way to add material to the part of the denture that comes into contact with the gums
