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REVISION BDS > complete dentures > Flashcards

complete dentures Flashcards

1
Q

anatomical effects of edentulism

A
  • bone resorption
  • 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 fucntion
  • loss of proprioception
  • decreased swallowing efficiency
  • redcution in speech quality
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3
Q

av bone loss

incisors

A

6.5mm

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4
Q

av bone loss

canines

A

8.5mm

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5
Q

av bone loss

premolars

A

10.5mm

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6
Q

av bone loss molars

A

12.5mm

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7
Q

Atwood and Howell

Ridge Classification

I

A

pre-extraction - dentate

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8
Q

Atwood and Howell

Ridge Classification

II

A

post-extraction - immediately edentulous

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9
Q

Atwood and Howell

Ridge Classification

III

A

high well rounded

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10
Q

Atwood and Howell

Ridge Classification

IV

A

knife edge ridge

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11
Q

Atwood and Howell

Ridge Classification

V

A

low well rounded

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12
Q

Atwood and Howell

Ridge Classification

VI

A

depressed

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13
Q

design principles for C/C denture

A

R etenion

E xtension

S upport

S tability

A esthetics

O cclusion

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14
Q

retention

definition

A

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

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15
Q

retention provided by

A

accurate fit

border seal

retromylohyoid area - in lower jaw

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16
Q

extension of upper complete denture

A

suclus depth all way round

avoid frenal attachments

palate of denture should extend to vibrating line (junction of hard and soft palate, 1-2mm anterior to the palatine fovea)

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17
Q

extension of lower complete denture

A

sulcus depth all the way round

avoid frenal attachments

2/3 onto the retromolar pad and into the retromylohyoid area

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18
Q

support

definition

A

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

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19
Q

support provided by

(upper complete)

A

residual ridge

hard palate

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20
Q

support provided by

(lower complete)

A

residual ridge

buccal shelf

anterior 2/3 retromolar pad

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21
Q

stability

definition

A

resistance to horizontal displacement of the denture

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22
Q

stability provided by

A

adequate extension of the denture

using the retromylohyoid area (lower)

balance occlusion

utilising the muscular forces in the neutral zone

  • lips and cheeks press in from the outside
  • the tongue from the inside
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23
Q

2 factors of C/C aesthetics

A

shade of teeth

  • translucency
  • value
  • hue
  • chroma

profile

  • lip support
  • creating a normal lateral view of the pt
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24
Q

Balanced Occlusion - Hanau’s Quint

A

C ompensating curve

O rientation of the occlusal plane

C uspal angle

C ondylar guidance angle 30o

I ncisal guidance angle 15o

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25
Q

Occlusal Vertical Dimension

A

OVD

the 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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26
Q

increased OVD

A
  • TMD
  • poor masticatory efficiency
  • speech problems
  • facial pain over masseter
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27
Q

inadeqaute OVD

A
  • angular cheilitis
  • occlusal truama
  • clicking teeth
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28
Q

RVD

A

resting vertical dimension

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

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29
Q

FWS

A

freeway space

difference between RVD and OVD

should be 2-4mm

30
Q

assess of pt for Complete dentures

A

History

Exam

  • E/O
    • ‣ Face shape
    • ‣ Profile
    • ‣ Changes
  • I/O
    • ‣ Ridge shape (Atwood and Howell)
    • ‣Undercuts - spicules/irregularities
    • ‣ Consistency
      • ➡ Firm
      • ➡ Friable (flabby)
      • ➡ Jagged (knife edge)
    • ‣ Tissue health
    • ‣ Saliva flow and quality
    • ‣ Sulcus depth
    • ‣ Muscle relationships
    • ‣ Skeletal relationship (AP)
31
Q

primary impressions for complete denture

A

Assess if undercuts - this will determine material used

  • ‣ If undercuts then use - Alginate (Irreversible Hydrocolloid)
  • ‣ If no undercuts then use - Impression Compound (Non-Elastic)

Use the same material for Upper and Lower usually

32
Q

lab prescription for primary imps to master imps

A

Please pour up primary impressions in 50/50 Stone and Plaster

Please construct special trays in light cure PMMA A.

  • Upper - E/O handle
  • Lower - I/O handles w/ stub handles over premolars

Spacer - For the material you will use at MASTERS!

  • Alginate - 3mm
  • Silicone/Compound
    • i) Upper - 2mm
    • ii) Lower - 1mm
33
Q

master impression stage for complete dentures

A

Trim special tray

check extension

Modify trays with greenstick tracing compound (heat till it begins to droop)

  • Upper - Canine stops, Post dam extension full posterior border of tray
  • Lower - Canine stops, Retromolar pad
  • Both - Add material to fill functional sulcus and border mould

Use Polyvinyl siloxane (Extrude) - Medium body

➡ remember that PVS is hydrophobic so will create blebs - dry mucosa!

➡ Polyether (impregum is an alternative but has one visocity but is hydrophilic)

34
Q

lab prescription master imps to jaw reg

A
  1. Please pour up the secondary impressions in 100% dental stone
  2. Construct upper and lower wax occlusal rims on light cured bases
  3. Please do to post dam as marked
35
Q

6 stages in jaw reg

A

MEASURE RESTING FACE HEIGHT AND OVD

adjust upper record block

lipline and occlusal plane

measure vertical dimension and establish face height

tooth position

registration

selection of teeth

36
Q

adjusting upper record block

A
  • Trim any overextensions otherwise will drop
  • Don’t give too much lip support
  • Adjust rim vertically till youre roughly happy where it is
  • Don’t adjust too much so as you have working room for occlusal plane determination
37
Q

lipline and occlusal plane

A
  • use the alar tragus line (superior part of EAM and the alar of the nose (nostril squishy side bit) make parallel with foxes bite plane and also view from front and make sure foxes bite plane parallel to interpupillary line
  • Determine Canine line - inner canthus of the eye with floss
  • Mark high smile line here as you’re done adjusting the occlusal plane
38
Q

measure vertical dimension nad establish face height

A

Willis bite gauge used to measure RVD and OVD

To get OVD try and replicate their RCP as this is what youll use later

  • lick lips and look out window absent mindedly
  • then measure RVD
  • OVD should be 2-4mm less than this depending what you want your FWS to be! - are you increasing or maintaining OVD?

If you want to change FWS then adjust lower block and not the upper! youve done that already

39
Q

tooth position

A

Biometric guidance (Watt and McGregor)

Set upper teeth buccal to the residual ridge

8-10mm anterior to the incisal papilla

Set lower teeth on the ridge

40
Q

registration

A

Make sure cenine line, high smile line and centre line marked

Make two location notches in the premolar region of the two blocks to allow them to be accurately articulated

Use Jetbite to register together

41
Q

lab prescription jaw reg to tooth trial

A
  1. please mount casts to the registration recorded on an average value articulator
  2. Please set the upper teeth to the record block
  3. Please set the lower teeth to the upper teeth.
  4. See shade and mould overlea
42
Q

tooth trial assess

A

retention

extension

support

stablity

aesthetics

occlusion

43
Q

retention checks at tooth trial

A

pull sharply down on anteriors

get pt to raise tongue for lowers

44
Q

extension check at tooth trial

A

check that the functional sulcus is filled

post dam included

no uncomfortable overextensions or loose underextensions

45
Q

support check at tooth trial

A

push down on occlusal surfaces of teeth

should displace slightly but not overly so

look for bony spicules and relieve

46
Q

stability check at tooth trial

A

grab molar teeth move from side to side

use retromylohyoid area to maximise this

neutrol zone respected?

47
Q

aesthetics check at tooth trial

A

is the pt happy with shade and mould?

profile?

midlines coincide

smile line

buccal corridors

48
Q

occlusion check at tooth trial

A

mandibular occlusal plane at level of RMP

practice in retruded arc of closure

even contacts

49
Q

lab prescription after tooth trial

A

to delvery

  1. please wax up for finish and process in heat cured PMMA
  2. Also Mark post dam at this stage.

IF retrial

Re-Trial: remount casts and make specified changed for second tria

50
Q

delivery of complete denture

A
  • Do same checks as Tooth trial -

Make any trimmings to it -

Give denture advice sheet (see section on Denture Hygiene) -

Review in 2 weeks

51
Q

how to solve denture looseness

A
  • Reline and Rebase

➡ Hard Reline

  • Chairside - Butylmethycrylate (non-irritant)
  • Lab - PMMA

➡ Soft Reline

  • Tissue conditioner - infected tissue - helps healing, can do functional impression by keeping in for 24hrs (short term)
  • Soft reline (long term)

✴ P - pain - from bony prominences, residual monomer, retained roots or pathology

✴A - atrophic ridge

✴S - superficial mental nerve

✴B - bony prominences

✴O - omfs

✴X - xerostomia

52
Q

problem with complete denture occlusal surfaces

A

premature contacts = grind down

incorrect occlusal plane = remake

locked or wedged occlsuion = cuspless teeth

53
Q

problem with polished surface of dentures

A

rare

can be from tongue rubbing or cheek biting - relieve

54
Q

general poor retention of dentures solutions

A

reline

rebase

implant retained

precision attachment

add post dam

55
Q

Replica technique

A
  1. Apply fix to fitting surface of one tray and the outside of another tray i.e the bottom
  2. 5x scoops of lab putty per impression, activator applied measure - 1 width of spoon mark per one scoop of putty
  3. Set denture into tray as you would normally and adapy putty
  4. Locating notches into the putty for when you do opposing impression
  5. Vaseline on set lab putty of first denture impression
  6. Put new ball of putty onto the fitting surface of denture already in impression and push really hard
  7. Push your second tray really hard onto this new putty (the one youve fixed on the back side)
  8. Match locating notches up with ones youve already done
  9. Take dentures out of the moulds by levering from the heel of the denture to minimise chance of fracture
  10. wash old dentures return to patient
  11. put impressions back together
  12. you will be given a shellac base and record block to record jaw reg next time
56
Q

restoration of FWS by

A

occlusal pivots

restore occlusal surface with auto polymerising resin

57
Q

what is a knife edge ridge

A

rapid resorption of lingual and buccal bone resulting of a narrow rudfe

two corries back to back

58
Q

3 reasons for knife edge ridge

A

immediate dentures

severe periodontal disaease before XLA

traumatic surgery before XLA

59
Q

management of knife edge ridge

A

surgical removal of bony spicules

soft liner on denture

60
Q

flabby ridge

process

A

combination syndrome

61
Q

flabby ridge

how does it occur

A

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

62
Q

managament of 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 take impression

63
Q

adv of immediate denture

A
  • Maintain soft tissue
  • Haemorrhage control
  • Reduce dry socket
  • Psychological benefit
  • Aesthetics
  • Prevent soft tissue collapse
  • Maintain muscle tone
64
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
65
Q

what to clean dentures with

A

alkaline hypochlorites

effervescent peroxides

66
Q

alkaline hypochlorites

A

e.g.dentural, Milton

Don’t leave cobalt chromium dentures for longer than ten mins as they 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

67
Q

effervescent peroxides

A

e.g. steradent, boots effervesant original

Powder of tablets

Rapid in action and simple to use

Problems can arise if very hot water used with denture, it can cause bleaching

Additional mechanical cleansing action

Bubbles created by the release of Oxygen which may dislodge debris

68
Q

oragnism involved in denture stomatitis

A

candida albicans

69
Q

aetiology of denture stomatitis

A

wearing at night

poor OH

diabetes

immunocompromised

xerostomia

70
Q

tx denture stomatitis

A

Denture Hygiene take out and clean with separate toothbrush - Alakaline peroxide for 20mins then store in water

CHX mouthwash

Miconazole gel, Nystatin

Fluconzaole, itraconazole, Ketoconazole

Tissue conditioner if youre making new denture to temporarily relive current one

REVISION BDS (43 decks)

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