Complete Dentures Flashcards
List the stages of constructing a complete denture.
patient assessment
primary imrpression - special tray construction in lab
master impressions - wax rim construction in lab
registration
Wax try in/trial
Delivery
maintenance &aftercare
What maxillary anatomy should you assess in visit 1? (4)
- Hamular notch: distal border of denture lies here and creates posterior seal.
- Alveolar ridge: should have good height and width to create support also assess the consistency i.e. is it flabby?
- Any areas of trauma from last denture
- Vibrating line/post dam region: assess by asking patient to say ahhh to show the junction
What mandibular anatomy should you assess in visit 1? (4)
- Retro mylohyoid space: extend into this area it significantly aids retention and stability as it prevents lateral movement and has an undercut present
- Retromolar pad: cover 2/3rds to provide support
- Alveolar ridge: should have good height and width to create support
- Any areas of trauma from last denture
Describe all 6 ridge classifications.
class 1 = dentate class 2 = post extraction class 3 = broad process class 4 = knife edge class 5 = flat class 6 = submerged
During visit 1 what do we assess whilst the old denture is in the mouth?
(also use a denture assessment form)
Stability - rocking side to side @ premolars
extension - upper to post dam/vibrating line and lower to retromolar pads and retromylohyoid space
remove all tissues and see if denture drops
retention - pull down on incisors
occlusion - measure the RVD - OVD = freeway space (should be 2-4mm)
what materials do we use for primary impressions?
• Compound (only used for primary impressions)
- Heat up the stick of compound and apply to the periphery of the impression tray
• Alginate wash over compound
what trays do we use fir complete dentures?
Use specific ones for edentulous patients (shallower)
how do we assess if the tray fits?
- cover the alveolar ridges (2mm space between the tray wall and ridge)
- extend into the sulcus (1mm short of the functional sulcus)
- Upper = cover the hamular notches
describe how to take an impression.
Upper = behind Lower = Infront
- Rotate tray into patient’s mouth
- Use firm pressure to seat the tray from the back to the front
- Soft tissue moulding
- Lower – pull cheeks around the impression tray and ask patient to stick their tongue out. Have two fingers on top of the tray and thumb under the mandible
- Upper - pull lips and cheeks around the impression tray and massage - ensure handle is in the midline of the face
- Place some alginate on back of hand to assess the setting process
- Ask patient to breathe through nose
- Remove tray by breaking the posterior seal and assess
What do we assess after taking a primary impression?
- The denture bearing area being covered
- A good peripheral seal – hard to remove
- Adequate surface detail
- No air blows
- Captured the depth and width of the sulcus and frenum
for lower primary impressions what do we request from the lab?
Please pour the lower PI in 50:50 dental stone and plaster and construct a close fitting (1mm spaced) non-perforated light cured acrylic resin tray.
Stub handle in incisal and premolar region if there is an atrophic ridge
for upper primary impressions what do we request from the lab?
Please pour the upper PI in 50:50 dental stone and plaster and construct a 2 mm spaced light cured acrylic resin tray.
Stub handle midline region and 2x premolar region
describe features of a special tray.
Be 2mm from the mucobuccal fold
Have frenal relief
= ensures border moulding can be achieved
what trays are used to take master impressions?
special trays
what should be added to spaced special trays before taking an impression? describe
3mm greenstick stops
what are the purpose of stops?
prevent compression of the tissues
create space for the impression material
stabilise the tray
what do we assess after taking a master impression?
- The denture bearing area being covered
- A good peripheral seal – hard to remove
- Adequate surface detail
- No air blows
- Captured the depth and width of the functional sulcus
- Captured the vibrating line
- Extend to hamular notches
for master impressions what do we request from the lab?
Ask technician to please pour the master impressions in 100% stone and construct upper and lower wax occlusal rims on light cure bases.
After recording the registration during stage 4 what do we request from the lab?
please mount the upper and lower cast on an average value articulator.
Set the upper teeth to the registration block/wax rim provided and set the lower cast to the upper cast
provide any wanted features for the denture now i.e diastema
at what stage do we request shade and mould of teeth and what teeth do we use for complete dentures?
stage 4 registration
hybrid teeth with 12 degree cusp angle
during stage 5 the wax trial/try in what should we assess before putting the denture in the mouth?
the denture matches the patients details
the design matches the denture
that there is no damage to denture
asses if they can be mounted on the casts and inspect
what should be assessed at the wax trial stage?
stability:
rock from side to side on occlusal surface of premolars
extension:
upper - vibrating line, hamular notches
lower - 2/3rds retromolar pad and into retromylohyoid space
see if denture drops by holding back tissues = under
see if denture drops during function = over extended
Retention - pull down on incisors
support - push down on denture and it should displace slightly but not a lot
occlusion:
- check occlusal plane with fox and spatula to ala-tragal line and the inter pupillary line
- assess canine position with wooden spatula vertically down ala of nose
- measure ovd
- measure rvd
- ensure FW space is 2-4mm
- ensure even and balanced occlusion
appearance:
- position of teeth
- tooth colour
- patient opinion
speech - 60, 70, days of the week
at stage 5; what do we ask the lab for if the try in is successful?
Please wax up the denture for finish in heat cured PMMA
at stage 5; what do we ask the lab for if the try in is unsuccessful?
Remount cast with [ add changes here ] for a second trial
What should we do before the patient arrives for insertion?
- Decontaminate
- Ensure denture matches the patient
- Ensure the denture is of an acceptable quality i.e. no porosities
- Remove sharp edges or rough patches
- Inspect undercuts (might have to adjust)
what checks should we do during delivery stage 6?
same as the wax try In checks;
stability:
rock from side to side on occlusal surface of premolars
extension:
upper - vibrating line
lower - 2/3rds retromolar pad and into retromylohyoid space
see if denture drops by holding back tissues = under
see if denture drops during function = over extended
Retention - pull down on incisors
support - push down on denture and it should displace slightly but not a lot
occlusion:
- check occlusal plane with fox and spatula to ala-tragal line and the inter pupillary line
- assess canine position with wooden spatula vertically down ala of nose
- measure ovd
- measure rvd
- ensure FW space is 2-4mm
- ensure even and balanced occlusion
appearance:
- position of teeth
- tooth colour
- patient opinion
speech - 60, 70, days of the week
what patient instructions do we give?
• Pain:
- if denture gets too sore, take them out and use old dentures.
- Remind patient to put new denture in 1 day before their appointment so it highlights the areas of concern for us.
• Speech:
- you may notice a lisp but speech and have difficulty controlling them but this Should return to normal over time
• Eating:
- Avoid eating hard foods initially.
- cut food into smaller pieces
- chew on both sides to prevent tipping
• Removal at night:
- Allows tissues to breathe and minimises thrush
• Dry Mouth:
- Inform them that having a dry mouth can affect the denture retention so the denture must always be kept moist.
what cleaning instructions should we give to patient with a new denture?
always brush denture morning and night
always clean dentures after eating
always remove dentures at night - place in cup of water
brush denture over a sink of water using a toothbrush and denture cream/ non-perfumed soap
what soaking instructions should we give to patients with a new denture?
soak once a day
milton - 10 minutes
rinse thoroughly after soaking
can soak in water overnight
