Complete Dentures Matsubara summary Flashcards
What should be noted in the medical history of all patients we plan to give complete dentures to?
Drugs: Most patients getting complete dentures also deal with polypharmacy
Saliva flow: Often compromised due to polypharmacy as well as conditions
Systemic factors such as neurological disorders
What is the outcome of lots of denture patients’ medical histories?
Often drugs cause poor saliva flow leading to poor denture retention
Neurological disorders can affect denture retention as well as neuromuscular control
Which medical history factors influence overall denture outcomes?
Drugs -> altered saliva flow -> Altered retention
Systemic factors -> Neurological disorders (eg Parkinson’s) -> Altered denture retention and neuromuscular control
Oral manifestation of systemic illnesses -> Sjogren’s syndrome -> Denture retention and comfort
Psychological factors -> Neuroticism -> Denture satisfaction
Thin or low saliva flow -> Reduced retention and lubrication
Poor anatomy for denture -> reduced retention
How can anatomy of the residual ridge affect the retention of a denture?
A high frenal attachment can reduce retention so preprosthetic surgery would be indicated for that
Short starting VD makes it harder to produce dentures of adequate size for the patient
If buccal and lingual sulcus are deep there will be better retention
Palatal and mandibular tori
Size and activity of the tongue
Where is a shallow alveolar ridge more common?
Maxilla more common than mandible
What medical problems should be noted with dentures?
Candidiasis before placing denture.
Neoplasms can be missed due to association with irritation
Treat disease before insertion of denture
How does salivary thickness affect denture retention?
Thick saliva pushes the denture away and thin saliva provides poor suction of the denture
Does not provide lubrication for the denture
What are the options of treatments for patients seeking dentures?
Complete dentures
Implant-supported overdentures
Implant-supported fixed prostheses
What history should be taken of the patient seeking to get dentures?
Medical history (Drugs, diseases, etc)
Denture history (With, with adaptive denture history, with maladaptive denture history)
How does denture history affect outcome of patient satisfaction?
Patients without prior denture experience will struggle initially with the new prostheses
Patients with maladaptive prior experience will likely have issues with the new one if nothing was wrong previously
Patients with positive denture experience will be the best patients for a new denture
How are dentures produced?
1) A primary impression is taken using alginate (use correct stock tray size)
2) Create the study model from the preliminary impression.
3) Create a special tray from the remaining study model
4) Check fit of special tray and then border moulding using putty.
5) Use low viscosity PVS impression material to take a final impression of the patient’s mouth.
6) Beading and boxing to create wax structure around the cast used to create the master model.
7) Base and wax rim is created using standard measurements. Needs to follow the shape of the alveolar ridge.
8) Anterior teeth are tried in first
9) Posterior teeth try-in (Get patient to have a friend check)
10) Denture processing/insert
How should the stock tray size be chosen?
In the maxilla cover the tray should cover the maxillary tuberosity, leave 5 mm of space between the edge of the tray and the alveolar ridge to allow the alginate to flow into the sulcus.
With the mandible the width doesn’t matter so much as the length. It should cover all or at least part of the retromolar pad
What will a patient with an atrophic jaw’s alveolar ridges look like?
Patient with atrophic jaw will have large mandibular ridge and small maxilla because of the direction of bone resorption
What should be achieved from a preliminary impression?
The retention of a complete denture is dependent on a complete border seal and that is created by close adaptation of the impression material on the anatomy of the patient.
Prelim impression should catch the tissues around the dental flange and should be visible on the study model
How should pressure be applied when obtaining an impression?
impression should be pressed down posteriorly first then anteriorly so impression can flow into the sulcus.
Don’t press too hard to avoid the tray coming in direct contact with the palate/alveolar ridge
Retract the cheeks while taking the impression to prevent interference
How is a special tray made?
Draw a line starting at the hamular notch that goes to the opposite hamular notch and then move anteriorly underneath the maxillary tuberosity then at the area where the canines are move between the attached gingiva and the buccal mucosa to create an imaginary line for the special tray
In the mandible the posterior limit is the retromolar pad. Buccal limit is the external oblique ridge
The acrylic for the special tray is placed on the anatomy until the limit drawn out.
The lines can also be drawn without the landmarks and just 2 - 3mm from the full depth of the sulcus but this risks denture being too long and hurting the patient.
How is the fit of the special tray checked?
Special tray is placed inside the patient’s mouth and vertical pressure is applied to check for movement when applied on the alveolar ridge.
Check for sharp edges and sharp contact with the flange.
Then retract the lips and cheeks to check for any contact with the frenum or the sulcal structures.
Border moulding can account for the edge being too far from the flange, however, it shouldn’t be too low to avoid the tray not being able to support the impression material.
Always check the fit of the maxillary impression posteriorly. It should always be about 2mm behind the vibrating line.
