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complete dentures Flashcards

1
Q

anatomical effects of edentulism

A

bone resorption - max rate first 3m
profile changes
loss of muscular support
reduction in face height

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2
Q

physiological effects of edentulism

A 
reduced incising efficiency
reduced masticatory efficiency
loss of proprioception
reduced swallowing efficiency
reduced speech quality
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3
Q

average bone loss - incisors

A

6.5mm

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4
Q

average bone loss - canines

A

8.5mm

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5
Q

average bone loss - premolars

A

10.5mm

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6
Q

average bone loss - molars

A

12.5mm

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7
Q

design principles

A 
retention
extension
support
stability
aesthetics
occlusion
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8
Q

how many classes in Cawood and Howell ridge classification?

A

6

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9
Q

Cawood and Howell ridge classification - 1

A

dentate (pre-ext)

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10
Q

Cawood and Howell ridge classification - 2

A

immediate post-ext

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11
Q

Cawood and Howell ridge classification - 3

A

high well-rounded broad alveolar process

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12
Q

Cawood and Howell ridge classification - 4

A

knife edge ridge (painful loading)

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13
Q

Cawood and Howell ridge classification - 5

A

flat ridge (no alveolar process) low well rounded

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14
Q

Cawood and Howell ridge classification - 6

A

submerged ridge (loss of basal bone) depressed

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15
Q

U denture extension

A 
sulcus depth all way round
avoid frenal attachments
extend to vibrating line
 - jct HP/SP
 - 1-2mm anterior to palatine fovea
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16
Q

L denture extension

A

sulcus depth all way round
avoid frenal attachments
2/3 onto RM pad

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17
Q

retention

A

resistance to vertical displacement of the denture away from the edentulous ridge

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18
Q

what is retention provided by?

A

accurate fit
border seal
retromylohyoid area (L)

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19
Q

support

A

resistance to vertical displacement of the denture towards the denture bearing tissues

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20
Q

U support areas

A

residual ridge

HP

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21
Q

L support areas

A

residual ridge
buccal shelf
anterior 2/3 RM pad

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22
Q

stability

A

resistance to horizontal displacement of denture

L often significantly worse

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23
Q

achieving stability

A 
adequate extension
using retromylohyoid area
balanced occlusion
utilising muscular forces in neutral zone
 - lips and cheeks from outside
 - tongue from inside
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24
Q

aesthetics - tooth shade

A

translucency
value
hue
chroma

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25
Q

aesthetics - profile

A

lip support

creating a normal lat view of the pt

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26
Q

Balanced occlusion: Hanau’s Quint

A 
Compensating Curve
Orientation of the occlusal plane
Cuspal angle 0-30 degrees
Condylar guidance angle 30 degrees
Incisal guidance angle 15 degrees
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27
Q

OVD definition

A

height of the face from the lower border of the nose to immediately underneath the chin when the teeth are together

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28
Q

overly increased OVD

A

TMD
poor masticatory efficiency
speech problems
facial pain over masseter

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29
Q

inadequate OVD

A

angular cheilitis
occlusal trauma
clicking teeth

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30
Q

RVD

A

the height of the face from the lower border of the nose to immediately underneath the chin when the teeth are apart at rest

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31
Q

FWS

A

difference between OVD and RVD

should be 2-4mm

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32
Q

EO exam

A 
face shape
profile
changes
smile line
nasolabial angle
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33
Q

IO exam

A 
ridge shape (attwood and howell)
undercuts - spicules/irregularities
consistency - firm, friable (flabby), jagged (knife edge)
tissue health
saliva flow and quality
sulcus depth
muscle relationships
skeletal relationships AP
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34
Q

primary impressions - what determines the material?

A

assess if undercuts
- UCs - alginate (irreversible hydrocolloid)
- no UCs - impression compound (non-elastic)
silicone putty (£)
usually use same material for U and L

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35
Q

primary impressions - lab prescription

A

please pour up impressions in 50/50 stone and plaster
construct special trays in light cure PMMA (no perforations)
- U: EO handle
- L: EO (IO handles with stub handles over premolars)

spacer - for the material you will use for master

  • alginate 3mm
  • silicone/compound/polyether: U 2mm, L 1mm
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36
Q

master impressions

A

check extension and trim special tray
modify with greenstick
use PVS (extrude) - medium body
- hydrophobic so will create blebs - dry mucosa
Polyether (impregum) is an alternative, has one viscosity but is hydrophillic
or alginate

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37
Q

master impressions - modifying with greenstick

A

U: canine stops, post-dam extension, full posterior border of tray
L: canine stops, RM pad
both: add material to fill functional sulcus and border mould

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38
Q

master impressions - lab prescription

A

please pour up master impressions in 100% dental stone
construct U and L wax occlusal rims on light cured bases
please do to post dam as marked

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39
Q

jaw registration first stage

A

adjust upper record block to maximise retention

  • trim any overextensions otherwise will drop
  • lip support
  • adjust rim vertically until roughly happy - don’t adjust too much so you have room for occlusal plane determination
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40
Q

jaw registration second stage

A

adjust upper record block for tooth position
LIMBO
lip support (90-110 degrees)
incisal level (0.5-1.5mm show), high smile line
midline, canine
buccal corridor
occlusal plane - ala tragus, interpupillary (don’t alter incisors - you have already done that)

  • use prev dentures if available
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41
Q

jaw registration 4th stage

A

vertical dimension and establish face height

  • RVD and OVD
  • to get OVD try and replicate their RCP as this is what you’ll use later - lick lips and look out window absentmindedly. check heels aren’t in contact - cut where L7s would be
  • measure RVD
  • 2-4mm FWS - adjust lower block if want to change
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42
Q

jaw registration 3rd stage

A

lower tooth position
- set L teeth on ridge
neutral zone
lower polished surfaces - aim to direct forces of tongue in favour of denture stability - triangular - base wider than top - tongue will help push it down

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43
Q

jaw registration 5th stage

A

registration
make 2 location notches in the premolar region to allow them to be accurately articulated
Jetbite

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44
Q

jaw reg 6th stage

A

selection of teeth

shade - translucency, hue, value and chroma - shade guide, pt preference, prev denture, skin colour
*not B1 - far too white for most denture pts
cusped, cuspless or hybrid
shape - mould, prev dentures, photos (careful)

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45
Q

jaw reg lab prescription

A

please mount casts to the registration recorded on an average value articulator
set U teeth to the record block
set L teeth to the U teeth
see shade and mould overleaf

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46
Q

things to check in tooth trial

A 
check on model first
assess each denture independently and then together
retention
extension
support
stability
aesthetics
occlusion and occ planes
OVD, RVD, FWS
speech
pt view
post dam
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47
Q

tooth trial - retention

A

pull sharply down on anteriors

get pt to raise tongue for L

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48
Q

tooth trial - extension

A

check fct sulcus filled
postdam included
no uncomfortable overextensions/loose underextensions

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49
Q

tooth trial - support

A

push down on occlusal surfaces of teeth
should displace slightly but not overly so
look for bony spicules and relieve

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50
Q

tooth trial - stability

A

grab molars and move side to side
use retromylohyoid area to maximise this
neutral zone respected?

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51
Q

tooth trial - aesthetics

A 
pt happy?
profile
midlines
smile line
buccal corridors
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52
Q

tooth trial - occlusion

A

mandibular occlusal plane at level of RMP
practice in retruded arc of closure
even contacts

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53
Q

tooth trial lab prescription

A

please wax up for finish and process in heat cured PMMA
also mark post-dam - please prep post dam to…
IF retrial
- remount casts and make specified changes for second trial

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54
Q

delivery

A

do same checks as tooth trial
any trimming
give denture advice sheet
review in 2wks

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55
Q

looseness - adjusting the fitting surface

A

rebase
reline
- hard: chairside or lab
- soft: tissue conditioner or soft

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56
Q

hard reline

A

chairside - butylmethacrylate (non-irritant)

lab - PMMA

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57
Q

tissue conditioner

A 
infected tissue
helps healing
can do fct impression by keeping it in for 24hrs
short term
2-4 weeks
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58
Q

soft reline

A 
long term
pain - from bony prominences, residual monomer, RR or pathology
atrophic ridge
superficial mental nerve
bony prominences
omfs
xerostomia
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59
Q

looseness - occlusal surface

A

premature contact - grind down
incorrect occlusal plane - remake
locked or wedged occlusion - use cuspless teeth

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60
Q

looseness - polished surface

A

rare but may be from tongue rubbing/cheek biting - relieve

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61
Q

general poor retention

A 
reline
rebase
implant retained
precision attachment
add post dam
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62
Q

rebase

A

entire fitting surface altered with hard acrylic

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63
Q

replica denture procedure

A

apply fix to fitting surface of one tray and the outside of another tray (bottom)
lab putty, 5 scoops to one width of activator
set denture into tray as you normally would and adapt putty
3 locating notches into putty
Vaseline on set lab putty
put new ball of putty onto the fitting surface of denture already in imp and push hard
push second tray hard (upside down) onto it (fixed on back side)
match location notches
lever denture out from heel to minimise fracture risk
wash denture, return to pt
put imps back together

you will be given a shellac base and record block for jaw reg next visit

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64
Q

restoration of FWS

A

occlusal pivots

restore occlusal surface with autopolymerising resin

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65
Q

what is a knife edge ridge?

A

rapid resorption of lingual and buccal bone resulting in a narrow ridge

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66
Q

reasons for a knife edge ridge

A

immediate dentures
severe PDD before XLA
traumatic surgery before XLA

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67
Q

management of a knife edge ridge

A

surgical removal of bony spicules

soft liner on denture

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68
Q

flabby ridge process

A

combination syndrome

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69
Q

cause of combination syndrome

A

forces directed at upper anterior ridge covered by a denture occluding with dentate lower causes rapid resorption of maxillary ridge
the overlying tissue becomes v fibrous and flabby

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70
Q

management of combination syndrome flabby ridge

A

mucostatic impression material
window technique - 2 stage impression with wash - cut out square in the tray and inject light body
relief holes precut before you take impression

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71
Q

advantages of immediate denture

A 
maintain ST
haemorrhage control
reduce risk of dry socket
psychological benefit
aesthetics
prevent ST collapse
maintain muscle tone
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72
Q

disadvantages of immediate denture

A 
knife edge ridge
poor fit with resorption
no trial stage so can't refine
difficult with surgical XLA as bone removal
requires reline/rebase
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73
Q

alkaline hypochlorites

A 
e.g. dentural, milton
don't leave CoCr for >10mins - can corrode
superior cleaning properties
effective dissolution of plaque
stain removal properties
bacterial and fungicidal properties
possible bleaching of acrylic resin
residual taste after use
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74
Q

effervescent peroxides

A

steradent
powder/tablets
rapid action, easy to use
problems can arise if hot water used with denture, can cause bleaching
additional mechanical cleansing action
bubbles created by the release of O2 which may dislodge debris

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75
Q

basic denture hygiene advice

A

brush and soak every day

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76
Q

what should you do before soaking dentures?

A

use a soft brush and non-abrasive cleaner (not toothpaste)

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77
Q

denture stomatitis - organism

A

c albicans

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78
Q

denture stomatitis - aetiology

A 
wearing at night
poor OH
diabetes
immunocompromised
xerostomia
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79
Q

initial denture stomatitis tx - local measures

A

brush palate daily
clean dentures thoroughly by soaking in CHX MW or NaOCl for 15mins x2 daily (only use NaOCl for acrylic)
leave dentures out as often as possible during tx period

if dentures are identified as contributing to the problem - adjust/remake to avoid recurrence

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80
Q

what can you use for denture stomatitis if you are making a new denture?

A

tissue conditioner to temp reline current one

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81
Q

CHX MW for denture stomatitis

A

effective against fungal infections

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82
Q

denture stomatitis - what can antifungal agents be used for?

A

adjunct

esp to reduce palatal inflammation before taking imps for new dentures

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83
Q

first line antifungals for denture stomatitis

A

fluconazole capsules 50mg

miconazole oromucosal gel 20mg/g

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84
Q

fluconazole capsules dose

A

50mg
7 capsules x1 daily
max 14 days for tx of this

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85
Q

contraindications to fluconazole

A

on warfarin/statins

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86
Q

miconazole oromucosal gel dose

A

20mg/g
80g tube
apply pea-sized amount to fitting surface of U denture after food x4 daily, then reinsert
continue to use for 7days after lesions have healed

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87
Q

contraindications to miconazole oromucosal gel

A

warfarin/statins

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88
Q

denture stomatitis - if fluconazole/miconazole contraindicated

A

nystatin oral suspension 100 000units/ml

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89
Q

nystatin oral suspension dose

A

100 000units/ml
30ml
1ml after food x4 daily for 7 days
remove dentures, rinse suspension around mouth then retain suspension near lesion for 5mins before swallowing
continue use for 48hrs after lesions have healed

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90
Q

maxilla - limiting structures

A 
labial frenum
labial sulcus
buccal frenum
buccal sulcus
hamular notch
vibrating line
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91
Q

maxilla - relief areas

A

incisive papilla
palatine raphe
crest of alveolar ridge
palatine fovea

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92
Q

maxilla - supporting structures

A

rugae
posterior palate
tuberosity

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93
Q

limiting structures

A

guide optimum extension - engage max SA without enroaching upon muscle actions

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94
Q

symptoms of overextension

A

dislodgement of denture

soreness

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95
Q

symptoms of underextension

A

reduced retention, stability, support

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96
Q

relief areas

A

areas where resorption under constant load, fragile structures or covered by thin easily traumatised mucosa
masticatory load shouldn’t conc on these areas

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97
Q

supporting structures (stress-bearing areas)

A

most of load should be concentrated on these areas

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98
Q

labial frenum

A

fibrous band covered by mucous membrane
labial aspect of residual ridge - lip
passive - no muscle fibres
V labial notch on denture - narrow but deep enough to avoid interference, seat around frenum - peripheral seal

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99
Q

labial sulcus boundaries

A

teeth, gingiva and residual alveolar ridge
lips
runs between buccal frenums

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100
Q

buccal frenum

A

fibrous band covered by MM

need greater clearance (shallower and wider) than labial frenum

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101
Q

buccal frenum attachments

A

levator anguli oris
orbicularis oris
buccinator

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102
Q

buccal sulcus location

A

buccal frenum to hamular notch

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103
Q

size of buccal sulcus vestibule depends on:

A

contraction of buccinator
position of mandible
amount of bone loss in maxilla

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104
Q

hamular notch

A

depression between distal of tuberosity and hamular process of MP plate
soft area of loose CT

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105
Q

where should the distal border of the U denture extend and why?

A

hamular notch

helps with posterior palatal seal

106
Q

vibrating line

A

junction between hard and soft alate - division between moveable and immovable tissue of soft palate
on posterior part of palate, between hamular notches

107
Q

identifying the vibrating line

A

ask pt to say ahhh

mark with pressure indicating paste

108
Q

vibrating line and palatine fovea

A

vibrating line usually 2mm in front of palatine fovea

109
Q

importance of vibrating line

A

denture needs to extend here to get seal

110
Q

incisive papilla

A

midline, behind central incisors
exit point of nasopalatine nerves and vessels
relieve - if not nerve/vessels compressed - necrosis of distributing areas and paraesthesia of anterior palate

111
Q

palatine fovea

A

2 depressions approx 2mm behind vibrating line

112
Q

palatine raphe

A

incisive papilla to distal end of hard palate
median suture area covered by thin submucosa
relieve - most sensitive part of palate to pressure

113
Q

maxilla primary supporting area

A

posterior palate

114
Q

maxilla secondary supporting areas

A

rugae

tuberosity

115
Q

lower labial frenum

A

fibrous band with CT
labial of residual ridge to lip
helps in attachment of orbicularis oris
sensitive - labial notch

116
Q

mandible - limiting structures

A 
lingual frenum
labial frenum
labial sulcus
buccal frenum
buccal sulcus
alveololingual sulcus
retromolar pad
117
Q

mandible - supporting areas

A

buccal shelf

residual alveolar ridge

118
Q

mandible - relief areas

A

genial tubercle
mylohyoid ridge
torus mandibularis

119
Q

which muscle is active in the lower labial sulcus region?

A

mentalis

120
Q

lower buccal frenum

A

attaches fibres of buccinator

relieve - prevent denture displacement

121
Q

lower buccal sulcus

A

buccal frenum to outside back corner of retromolar region

122
Q

why can the lower buccal sulcus be safely area maximised?

A

fibres of buccinator run parallel to border so displacement due to buccinator is slight
imp at widest here

123
Q

lingual frenum

A

attaches tongue to alv process

relief

124
Q

retromolar pad

A

pear shaped soft pad of tissue at posterior end of ridge
forms posterior seal and support
denture should extend up to anterior 2/3

125
Q

alveololingual sulcus

A

lingual frenum to retromylohyoid curtain
overextension - soreness and instability - assess extension by moving tongue R and L
divide into 3:
1 - anterior part: lingual frenum to mylohyoid ridge
- shallowest (least height part) of the lingual flange
2 - middle region: premylohyoid fossa to distal end of mylohyoid region
3 - posterior portion: mylohyoid ridge end to retromylohyoid curtain
- undercut area - retention

126
Q

genial tubercle

A

muscle attachment - genioglossus and geniohyoid
lies away from crest of ridge
prominent in resorbed ridges - relief needed

127
Q

torus mandibularis

A

abnormally bony prominence
bilaterally on lingual side near premolar area
thin mucosa - relieve

128
Q

mylohyoid ridge

A

mylohyoid attachment
along lingual surface of mandible
anteriorly close to inferior border of mandible
posteriorly close to residual ridge
thin mucosa - relieve
extension of lingual flange beyond the palpable position of the mylohyoid ridge, but not in the undercut

129
Q

buccal shelf

A

primary stress bearing/supporting area
buccal frenum to RM pad
between EOR and crest of alveolar ridge
width increased as alveolar resorption continues

130
Q

residual alveolar ridge mandible

A

secondary supporting area

buccal and lingual slopes are secondary areas

131
Q

retromylohyoid space

A

distal end of lingual sulcus posterior to mylohyoid muscle
aids retention and stability
- can’t get sideways movement
- often a small UC

132
Q

where is the loss of bone more significant?

A

in the mandible

133
Q

maxilla alveolar ridge resorption

A

anteriorly - resorbs palatal direction

posteriorly - narrows palate

134
Q

mandible alveolar ridge resorption

A

anteriorly - more vertical
posteriorly - down and out, widens mandible
- often make dentures with a CB

135
Q

EO changes

A

changes in upper lip (lack of support)
changes in lower lip
change in lower face height
change in profile - appear class 3 due to rotation as close
nasolabial angle increases
bone resorption reduces support for muscles/ST

136
Q

psychological factors of edentulism

A 
relief of no more teeth
lost limb syndrome
embarassment
denial (partner doesn't know)
depression
137
Q

definition

A

a removable dental prosthesis that replaces the entire dentition and associated structures of the maxilla or mandible and can be replaced by the pts own free will

138
Q

objectives

A

provide adequate masticatory fct
restore natural appearance
restore normal speech
comfort and preservation of supporting structures

139
Q

parts

A

base
flange
border
teeth

140
Q

surfaces

A

fitting
polished
occlusal

141
Q

factors affecting success

A

retention
stability
support

physiologic comfort
psychological comfort
longevity

142
Q

testing retention

A

pull vertically on anterior teeth away from tissues

care not to tip by uneven forces

143
Q

aspects which lead to good retention

A

fit - no space between
border seal - flanges, postdam
no interference with muscle/frenal attachments

144
Q

factors affecting retention

A

physical
anatomical
physiological
mechanical

145
Q

physical factors affecting retention

A

adhesion
cohesion
atmospheric pressure
gravity

146
Q

adhesion

A

the forces of attraction existing between dissimilar bodies in close contact (between saliva and denture base)

147
Q

cohesion

A

forces of attraction existing between similar bodies in close contact (surface tension of saliva)

148
Q

atmospheric pressure

A

the physical factor of hydrostatic pressure due to the weight of the atmosphere on the earth’s surface

149
Q

gravity

A

works against Cu, and for Cl

150
Q

anatomical factors affecting retention

A

shape of the edentulous area
undercuts
anatomy of the border tissues

151
Q

anatomy of maxilla class 1

A

square

152
Q

anatomy of maxilla class 2

A

V

153
Q

anatomy of maxilla class 3

A

flat

154
Q

physiological factors affecting retention

A

NM control

viscosity and volume of saliva

155
Q

mechanical factors affecting retention

A

balanced occlusion - bilateral simultaneous, anterior and posterior occlusal contact in centric and eccentric position
contour of polished surface - teeth and polished surface should be contoured and harmonious with oral structure
position of occ plane - occ plane of L must be in correct level ie corner of mouth provides anterior landmark
position of teeth in respect to ridge - L posterior teeth are positioned directly above the lower residual ridge, and within the neutral zone

156
Q

testing stability

A

place fingers on occ surface and try to rock the denture side to side

157
Q

tx options

A 
Cu and Cl
Cu or Cl
 - most common Cu and lower teeth
nothing
implant supported removable prosthesis
implant supported fixed prosthesis
158
Q

stages in conventional dentures

A 
assessment of pt and dentures, primary imps
master imps
jaw reg
tooth trial
delivery
review
159
Q

stages in replica dentures

A 
assessment of pt and dentures, replica imps
master imps and occlusion (same visit)
try in
delivery
review
160
Q

pt assessment of dentures

A 
age of dentures
denture hygiene
appearance
movement
comfort 
speech
chewing
biting
satisfactory/unsatisfactory
161
Q

denture assessment

A 
current denture design
base extension in all areas
tissue adaptation
retention and stability - position of teeth, occ plane
relationship of dentures
appearance
other factors
diagnosis/problem list
162
Q

tissue adaptation

A

shouldn’t see spaces between mucosa and fitting surface of denture

163
Q

where should U teeth be set?

A

slightly buccal and labial to the ridge

tongue space and prevent stress and fracture of base

164
Q

where should L teeth be set?

A

over ridge as ridge resorbs straight down

165
Q

too much FWS

A

overclosure, more prone to angular cheilitis

166
Q

too little freeway space

A

speech, TMJ, pain over denture-bearing area

167
Q

ideal articulation

A

group fct - contact and balance both sides

168
Q

neutral zone

A

musculature either side is equal

169
Q

materials for primary imp

A

alginate
(impression compound)
silicone

170
Q

alginate pros and cons

A

cheap, easy to use, elastic, quite accurate

can be messy, poorish dimensional stability - need to pour quickly

171
Q

impression compound - what should it not be used for?

A

dentate pts - except e.g. for a FES

because non-elastic

172
Q

imp compound pros and cons

A

poor surface detail - only for primary imps
not cheap anymore
can be messy

173
Q

silicones

A 
dimensionally stable
hydrophobic
consistencies - light, med, putty
can be messy to use
v accurate
174
Q

polyether (impregum)

A

dimensionally stable
hydrophillic - tend to get less saliva bubbles
no variety of consistencies (med body)
can be messy to use
v accurate
v solid - so in stone single teeth may come off in cast
need vaseline on lips

175
Q

ZOE

A

mainly historic
thick
not elastic
mucocompressive - good for posterior flabby ridge

176
Q

reversible hydrocolloid (agar)

A

mostly historic

lab for duplicating casts

177
Q

impression definition

A

a reverse/negative form of the tissues which is converted into a positive model/cast using plaster or stone

178
Q

correct sized primary tray

A

fully engages over alveolar ridge and depth of tray comes fully into sulcus

179
Q

adhesive

A

2-3mm beyond edge of tray on the external surface

180
Q

inspection of primary impression

A

covered denture bearing area?
achieved a good peripheral seal? - hard to remove and sucking sound
recorded adequate surface detail?
suitable to produce a satisfactory primary cast?

181
Q

trying in the U special tray - what to do if it is under/over extended

A

over - reduce extension

under - correct during border moulding

182
Q

border moulding

A

addition of material to the outside of the periphery of the trays to fill the functional sulcus
greenstick or silicone
don’t bring onto fitting surface
not always needed for alginate but usually need for silicone/polyether
- they don’t hold shape as well so don’t hold sulcus depth well
once the material is still soft and you place in mouth you manipulate the tissues - gives width of sulcus

183
Q

occlusal stops - creating space in the upper tray

A

function is to make sure we have the correct thickness of imp material
can use GS/silicone putty
‘stops’ to the space prescribed in the canine (palatal) and post-dam regions
allow accurate correction of the posterior borders of the tray and will pre-form space for the imp material
- make tray more stable
- stop you pushing tray in too far (tissue compression)
stops should involve the whole of the posterior border of the tray
light body silicone - 1mm thick
alginate - 3mm thick

184
Q

creating space in the lower tray

A

‘stops’ to the space prescribed on the RM pad and on the ridge in the canine areas
allows space for the imp material

185
Q

assessing your master imp

A

same as primary
good functional sulcus?
good surface detail?

186
Q

modifying a denture with the replica technique

A

temp modify the old dentures with GS

187
Q

prescription for replica dentures impressions

A

replica blocks in wax/shellac

- shellac base, wax polished and tooth surfaces

188
Q

slightly flabby/fibrous ridge

A

ask for extra spacing on tray
ask for perforations in area of ridge - so material can flow down and not displace ridge
runny alginate

189
Q

mucostatic window technique for flabby ridge - how to ensure lid doesn’t apply pressure

A

lid peripheries will overlap special tray bordering the flabby tissue to prevent compression (2mm)
lid has own handle to support it - ensures no pressure applied to flabby tissue

190
Q

what material is used for the spacer?

A

wax

191
Q

how to aid creating a posterior palatal seal with impressions

A

ask pt to blow through their nose while their nostrils are pinched closed
- increases intranasal pressure to allow soft palate to mould the GS

192
Q

disadvantage of silicone putty compared to GS for border moulding

A

silicone can’t be refined

193
Q

gagging tips

A

open mouth wide
breathe through nose
wiggle toes

194
Q

how should you place material in tray to prevent any air getting in and causing blows?

A

keep tray close to material dispenser

195
Q

boxing in

A

addition of ribbon wax - preserve width and depth of sulcus when it comes to casting master imp
at least 4-5mm from the deepest vestibular sulcus depth
‘land area’

196
Q

advantages of impregum over silicone

A

fixotropic - runs when border moulding but holds shape when not
hydrophillic
slightly thicker

197
Q

what should the horizontal distance between the index finger on the incisive papilla and the probe against incisal edge of labial surface of maxillary incisors be?

A

1cm

198
Q

what should you do on the primary imp if you think it is overextended?

A

draw where you would like the special tray border to finish

199
Q

registration stage objectives

A 
define the shape of the maxillary rim
determine occlusal plane
define position of lower teeth
determine jaw relationship
select shade and mould
200
Q

how to mark canine line

A

use floss down from canthus of eye, ala of nose and down

201
Q

arch and buccal corridor

A

broad arch = small buccal corridor
narrow arch = broad buccal corridor
how much tooth gets seen

202
Q

overbite

A

want shallow

if too deep, when protrude dentures will rock against each other - displaced

203
Q

posterior teeth occlusion

A

normal occlusion - bone resorption - can get normal occlusion if you push U teeth outwards beyond the ridge (would affect buccal corridor)
cross bite
don’t lingualise occlusion - specialised

204
Q

should you use a facebow?

A

no

205
Q

RCP

A

a reproducible maxillomandibular relationship in edentulous pt
guided occlusal relationship at the most retruded (superior posterior) position of the condyles in the joint cavities
tongue back as far as possible and bite together

206
Q

why is RCP reproducible?

A

because when condyle is retruded it can only do the hinge movement, can’t rotate - reproducibility

207
Q

why not wax for jaw reg?

A

once you have recorded it it is set and you can’t open it

often it is good to put blocks back in mouth and see if the bite recording paste corresponds to their teeth

208
Q

what are cuspless teeth good for?

A

pts who don’t have a reproducible bite, C3s

209
Q

what are hybrid teeth good for and what is their degree?

A

12

complete dentures, a bit of articulation

210
Q

what teeth aren’t used for complete dentures?

A

cusped (33)

too high

211
Q

alma gauge

A

measure original denture and compare to rim
biometric principles - trying to set teeth in pre-ext position
incisors set 9-10mm anterior to incisive papilla
used to determine the vertical and horizontal position of anterior teeth relative to a point on the denture base e.g. incisive papilla

212
Q

upper record block dimensions

A 
height
 - anteriorly 22mm, posteriorly 18mm
width
 - anteriorly 5-7mm, posteriorly 8-10mm
rims set buccal to residual ridge
213
Q

lower record block dimensions

A

height - 18mm
posterior height is 2/3 height of RM pad
width - 10mm
position over the ridge

214
Q

incisive papilla and positioning anterior teeth

A

distal of papilla to labial aspect of 1s approx 10mm
a line extended horizontally from the distal of the incisive papilla at RAs to the median sagittal plane will indicate the position of the centre of the canine

215
Q

setting posterior teeth

A

centre of lower alveolar ridge line transferred to occlusal surface of rim
contour of ridge drawn onto wall of cast
indicator for height of occ plane
- shouldn’t be above the RM pad
- tongue should be above the level of the occ plane to control food bolus on the surface of the teeth

216
Q

last molar

A

do you need to include last molar or would it be bettwe to give increased space for tongue - aids stability

217
Q

why is retention not as good in a tooth trial?

A

no post dam

218
Q

assessing stability in tooth trial

A

check for rocking

confirm tongue lies above L occlusal plane and denture extends to RM pad

219
Q

assessing extension in tooth trial

A

hold tissues away from denture - does it drop? - possible underextension
manipulate tissues - if drops overextension
too much lip support - will drop
make adjustments with wax knife (not fitting surface)
- hold trial so wax doesn’t drip onto acrylic teeth

220
Q

assessing retention in tooth trial

A

frenal relief
hold tissues out way and see if denture drops
- not as good as finished denture (no post-dam)

221
Q

lower occlusal plane

A

for most pts the level of the incisal edge is at the level of the L lip at corner of the mouth
if occ plane too high the tongue will be cramped and the denture will be unstable
tongue should rest on occ surfaces of teeth to help hold the denture in position

222
Q

if OVD is increased in a tooth trial what should you do?

A 
teeth need to be removed from one or both dentures and replaced with a wax rim
if U correct
 - remove L teeth
 - replace with wax
 - re-record the occlusion
 - prescribe another wax trial
223
Q

assessing occlusion in tooth trial

A

articulating paper
balanced - even contacts
balanced articulation - contacts on WS and NWS
protrusive contacts
centric relation (RCP) = centric occlusion in edentulous

224
Q

pt view in tooth trial

A

comfortable?
do they feel loose?
- remember retention at trial stage reduced
appearance
- warn pt wax looks redder
speech clear?
- will move more than processed dentures but they should be retentive and stable enough to check speech

225
Q

assessing speech during tooth trial

A

count 60-70 or days of week

226
Q

assessing speech during tooth trial - if clicking

A

teeth make contact during speech, not sufficient inter-occlusal space between teeth
- need to reduce OVD to give more FWS

227
Q

assessing speech during tooth trial - if whistling during sss

A

air escaping

OVD may need to be increased or anterior tooth position changed

228
Q

fricatives

A

f, v

229
Q

post dam

A

lip on back of denture to give good posterior seal
draw on cast where you want it w pencil
- ask technician to cut the post dam
feel for jct of hard and soft

230
Q

why might you ask for a double post dam?

A

if pt unsure and thinks yours is too far back
one where you want it
one a bit further forward

231
Q

Hanau’s Quint - 5 variables that affect occlusal contacts

A 
inclination of occlusal plane
mandibular condylar guidance (SCGA)
incisal guidance angle
cuspal angle
compensating curve
232
Q

compensating curves

A

allow for downward travel of the condyle

used to compensate for the difference between the CGA and the IGA (christensen’s phenomenon)

233
Q

why is there often a shortened occlusal table?

A

because setting teeth on an inclined plane can cause instability particularly for L denture

234
Q

how much of your biting strength do you lose with dentures compared to normal teeth?

A

75%

modify pt expectations

235
Q

3 types of porosity and where can it happen?

A

gaseous, contraction, granular
often thickest areas e.g. L lingual
if on fitting surface need replaced

236
Q

insertion stage things to check

A 
check on models
extension
retention
stability
occlusion
appearance
speech
237
Q

adjustments - which surface shouldn’t you trim?

A

fitting surface

238
Q

roughness

A

can cause pain

239
Q

extension into undercuts

A

can be painful - usually on insertion and removal

balance with retention

240
Q

assessing denture for sore patches

A

can use pressure indicating paste

smooth and polish if necessary e.g. pumice and whiting

241
Q

why might the occlusion need adjusted at delivery?

A

occ interferences occur at delivery
inaccuracy of recording RCP
limitations of articulator (av value)

242
Q

ways of adjusting the occlusion at delivery

A

selective grinding

re-record occlusion

243
Q

selective grinding

A

articulating paper
remember bases are unstable and denture moves
adjust carefully
palatal of anteriors - don’t take much off

244
Q

BULL rule

A 
buccal upper (palatal surface of buccal cusp)
lingual lower (buccal surface of lingual cusp)
adjust contacting surfaces rather than tips of cusps - appearance
245
Q

re-recording the occlusion at delivery stage

A 
clinic
 - check where the problem is
 - remove L teeth (if U is fine)
 - replace with wax
 - re-record the registration
 - prescribe another wax trial
 - give both dentures to the lab
lab
 - remount on articulator
 - reset lower teeth
clinic
 - retrial
246
Q

advice for pt at delivery

A

pain
- if too sore wear old dentures
- if possible wear new set day before review to highlight areas of rubbing
speech
eating
- not hard diet initially - takes time to get used to
remove at night
- lets tissues breathe - less likely to get thrush
dry mouth?
- will affect retention, always put denture in moist
denture cleaning

247
Q

denture cleaning advice

A

remind them to clean fitting surface
toothbrush and toothpaste twice a day
- not abrasive
chemical cleaners - soak for 20mins

248
Q

methods of retaining an upper denture

A

muscular
adhesion cohesion
post dam
extension to buccal sulcus and peripheral seal

249
Q

restoring FWS in v worn dentures

A

occlusal pivots
OR
restore occlusal surface with autopolymerising acrylic resin (provisional)

250
Q

what is a knife edge ridge?

A

rapid resorption of lingual and buccal alveolar bone with a hard bony presentation with thin gum overlying it

251
Q

causes of a knife edge ridge

A

traumatic XLA
severe PDD before XLA
immediate dentures

252
Q

management of a knife edge ridge

A

soft lining

surgical removal of sharp bony spots if painful

253
Q

soft lining vs tissue conditioner

A

soft lining - may be used on healthy mucosa as a cushion/shock absorber in a reline or for atrophic/knife edge ridges
tissue conditioner - used in unhealthy/ulcerated mucosa to aid healing. It also dissipates forces but is a more short term option

254
Q

functional impression

A

used with a tissue conditioner
the material is applied and the pt wears the denture and impression in function for approx 24hrs
they return and the impression is sent to the lab for a reline

255
Q

ways of improving denture retention without remaking them

A 
rebase
reline
trim any overextensions
implant retained
precision attachments - tooth only supported dentures
256
Q

checking retention clinically

A

‘pull’ on premolars

push on anteriors to check post dam

257
Q

consequences of an incorrect OVD

A

angular cheilitis
TMD
clicking when speaking

258
Q

c albicans virulence factors

A 
germ tube formation
adherence
acidic metabolites
EC enzymes
switching mechanism
259
Q

post dam

A

hamular notch to hamular notch
along vibrating line which is jct of hard and soft palate and is compressible tissue
1-2mm anterior to palatine fovea

260
Q

why is the buccal shelf used for support?

A

it is relatively resistant to resorption

261
Q

4 things that make up shade

A

value
chroma
hue
translucency

262
Q

Watt and McGregor Biometric Guidelines

A

Set Upper teeth anterior to the residual ridge
Incisors should be 8-10mm anterior to the incisive
papilla
Set Lower teeth on the residual ridge
2mm of the incisal edge should show when at rest
Set teeth so BULL rule of ICP applies (Buccal Upper
Lingual Lower)

dentures (2 decks)

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