D3 Denture Final Flashcards
What are 3 things that must be done to the master casts to prepare them for mounting on the articulator?
- Plece 4 widely-spaced indices in denture base
- Soack casts for 3-5 minutes to eliminate trapped air
- Lubricate indices with light film of petroleum jelly
What is verified before mounting the master casts on the articulator(?
Use Centric Jaw Relation (CJR) record to ensure the maxillary and mandibular casts do not contact which would prevent the record bases from seating into the CJR
If the casts contact and prevent the record bases from seating in the CJR ?
Reduce maxillary and mandibular casts to eliminate interferences
What anatomy on the maxilla and anatomy on the mandible should one try not to remove when adjusting master casts to eliminate interferences that prevent the record bases from seating in the CJR?
Maxilla - maxillary tuberosity
Mandible - retromolar pad
How and why should the incisal guide pin on the articulator be set when mounting the master casts with the CJR?
Incisal pin 1-2mm above center mark.
This compensates for slight increase in VDO by the centric jaw relations (CJR) record
What is recorded after the CJR is removed from between the articulated casts / record bases?
The +/- from the 0 mark the incisal guide pin is moved to give contact b/w the Max/Mand rims or the correct vertical overlap is established
Does the tentative VDO set by the index pin have to be maintained or can it be changed?
Can be changed at wax try-in
What anatomic landmarks should be marked on master cast to aide setting denture teeth?
- Maxillary Midline
- Incisive papilla
- Line perpendicular to the palatal suture through the incisive papillae to the land areas adjacent to the canine area
- Center of the mandibular residual edentulous ridge
- Point at whch the mandibular ridge inclines abruptly
What are 2 common things that must be done to the record base and the denture teeth to make room for the denture teeth(?
- Thin the record base
2. Shorten the denture tooth
What part of the denture tooth is normally shortened?
Ridge lap area
What are the reference points of the maxillary occlusal plane?
- Maxillary central incisor
2. Two wax cones posteriorly
What wax is used to attach denture teeth to the record base and is sticky wax necessary in this process?
- Set up wax
2. No sticky wax required
Why must the teeth be set imagining a root extending into the edentulous ridge?
Account for ridge resorption
Is the occlusal rim the only thing to be considered when arranging denture teeth?
No. Anatomic landmarks must also be considered.
What is of utmost importance when arranging mandibular denture teeth?
Arranged in the correct faciolingual position to the mandibular ridge
What is mechanically desirable with respect to the mandibular posterior teeth?
Some horizontal overlap (normal bite or crossbite)
What should be the denture tooth occlusal arrangement for the wax try-in even if other occlusal schemes will be used for the denture?
Monoplane
What are 2 reasons to have a monoplane occlusal scheme at the wax try-in even if another occlusal scheme is to be used?
- Easiest to develop
2. More practical to verify VDO, centric relation mounting, esthetic, and phonetics
What wax is used to wax-up and festoon the record base once the denture teeth are set?
Soft baseplate wax
How should the baseplate wax be added to the record base and why?
Melted on so the wax is solid, not layered. Prevents peeling when festooning, and eliminates air between layers to give wax-up a uniform color
What should be the appearance of the wax-up before try-in?
Neat
What are the objectives of the wax try-in appointment for complete dentures?
- Verify the esthetics, phonetics and mechanical arrangement of denture teeth
- Verify the vertical dimension of occlusion
- Verify the CR mounting of the mandibular cast
- Obtain esthetic approval of the tooth arrangement Select the denture base shade
What can be used as an aide to retain the max and mand record bases during the wax try-in, but must be completely removed before replacing the record bases on the master casts ?
Denture adhesive
What 2 things, besides the record bases, that can be used to evaluate the Vertical Dimension of Occlusion (VDO)?
- Pre-extraction records, if available
2. Comparison with the VDO of current dentures
If the VDO is good, what should the patient be able to do with their lips at mandibular rest position?
Comfortably close their lips together without straining the mentalis muscle
What should a denture with good VDO do at mandibular rest position?
Give acceptable facial esthetics by supporting the upper and lower lips
How much interocclusal clearance should there b at mandibular rest position and between what teeth is this measured?
2-4mm interocclusal clearance between opposing premolars
What movement of the mandible should be noted when patient closes from mandibular rest position to VDO?
Upward movement
What facial esthetics should the denture patient have at VDO?
Acceptable, not looking over-closed or over-open
What are the sibilant sounds?
S, Sh, Z, Zh, Ch, J
What is the position of the mandible during the sibilant sounds?
Mandible reaches its highest point in speech
Do teeth generally touch during sibilant sounds?
No
The closest speaking space where the mandibular incisors almost contact the maxillary incisors should be what measurement?
1mm or less
The definite relationship between the mandibular incisal edges and the maxillary anterior teeth is dependent on what?
Patient’s skeletal relationship
What teeth can be adjusted if the VDO is found deficient?
Maxillary anterior teeth
Which way should the incisal guide pin on the articulator be adjusted if the patient’s VDO is found deficient at the wax try-in?
Lower (the upper member of the articulator will now be further from the incisal pin guide table), then reestablish contact of mandibular posterior teeth against the Maxillary at the phonetically determined VDO
If the patient’s VDO is found to be excessive, what must be done to the mandibular posterior teeth?
Remove all mandibular posterior teeth and place them in order on rope wax or manufacturer’s card
If the VDO is found excessive, what must be done to the incisal guide pin to decrease to the VDO determined phonetically?
Raise the incisal guide pin (the upper member of the articulator will now be closer to the incisal pin guide table)
Once the mandibular posterior teeth are removed and the guide pin has been raised to increase the VDO on the articulator, what must be constructed on the mandibular record base to reevaluate the new VDO?
Construct mandibular posterior baseplate wax occlusion rim to contact the maxillary posterior teeth in the new VDO
When you do the esthetic try in, when should the maxillary midline be adjusted if it is found not to be coincident with the patient’s midsaggital plane: before the patient has approved the color, size (width and length) and shape (outline form) of the maxiallary anteriors, or after the patient has approved the teeth?
After patient approval
The Lower lip should brush against the incisal edges of the maxillary incisors as the patient pronounces which sounds?
F and V
F and V are what type of sounds?
Labiodental
When the patient makes the labiodentals F and V sounds, the maxillary incisal edges should contact the lower lip at what line?
Wet-dry line of the lower lip
The amount of maxillary anterior teeth a patient shows when they smile is dependent on what?
Upper lip length
How much of the maxillary anterior teeth should be seen on a pt with a long upper lip?
Only a little of the anatomic crown
How much of the maxillary anterior teeth should be seen on a patient with a Medium Upper lip?
1/2 to 2/3 of an anatomic crown
How much of the maxillary anterior teeth should be seen on a pt with a Short Upper lip?
The entire anatomic crown and possibly some of the labial gingival (the base)?
When the patient smiles, where should the incisal edges of the maxillary anterior teeth be located and what should they follow?
- Follow the contour of the lower lip
2. Located at wet-dry line
What should be seen when a patient smiles and is described as some space between the premolars/molars and the patient’s cheeks?
Buccal corridor
How much of the facial surfaces of the premolars and molars be visible from the frontal view when the patient smiles?
Slightly visible
Where should the maxillary canines be located when the lips are relaxed?
Corners of the lips
How far anterior to the center of the incisive papillae should the labial surface of the maxillary central incisors be placed?
5-10mm
A root projected onto the crown of the denture should project where and allow for what?
Should project into the residual ridge and allow for the amount and direction of bone resorption
Mandibular anterior teeth should be in what relation to the maxillary anterior teeth when the patient pronounces the sibilant sounds?
Almost contact the maxillary anterior teeth
The relationship of the mandibular teeth to the maxillary teeth when the patient is pronouncing the sibilant sounds is virtually the same as what relationship?
Same with the 3 skeletal classifications
How should the lower lip look when supported esthetically by the mandibular denture teeth?
Lower lip slightly behind the upper
What should be present between the lip and chin with a properly made mandibular denture?
Mentolabial sulcus - concavity between the lower lip and the chin
Where should the mandibular teeth be when the lower lip is relaxed?
Slightly below the top of the lower lip
The occlusal plane of the maxillary anterior teeth should be perpendicular to what?
Patient’s midsagittal plane
The occlusal plane of the mandibular teeth should be located where in relation to what?
Just slightly inferior to the dorsum of the patient’s tongue in its normal position
The maxillary occlusal plane should be located where in relation to what?
2-3 mm inferior to the opening of the parotid gland (Stenson’s duct)
From a lateral view, the occlusal slant should slant in which direction toward the posterior?
Superiorly toward the posterior
The occlusal plane will normally be parallel to what plane and will terminate where?
Parallel to the ala-tragus plane (Camper’s plane = line from inferior border of ala of nose to superior border of tragus of the ear)
Terminates in upper 1⁄2 of retromolar pad
What should be seen with respect to the record bases with a properly made centric jaw relation record (CJR)?
All teeth occlude simultaneously with the record.
No movement of either record base.
When both record bases have been removed from the patient, how are they checked with the CJR record?
- Dentures are stable / no rock in the record.
2. Buccal cusps of maxillary teeth fit flush with the trimmed CJR record.
How is the CJR record checked on the articulator?
First when articulator centric locks closed.
Second with articulator centric locks open.
What are the criteria for an accurate CJR record on the articulator with the centric locks closed?
All teeth hinge closed into the record simultaneously without movement of the record bases on their casts
What slide from Dr Uram’s lecture should we focus on?
The one about making a record and establishing an occlusal plane without preexisting records. There are numbers and stuff on it.
What are the criteria for an accurate CJR record on the articulator with the centric locks open?
With the teeth closed into the CJR record, the condylar balls should be in contact with the condylar walls of the articulator
What is the relation of the incisal plane of the mounted denture teeth to the incisal guide pin?
Perpendicular
How should the occlusal plane of the mounted denture teeth be positioned with respect to the maxillary and mandibular ridges?
Equal distance between the ridges
The projection of the mandibular posterior occlusal plane should terminate where on what landmark?
Upper half of retromolar pads
A patient will notice if the midline of the denture is off by what amount?
3-4mm
Should the occlusal plane of the mounted denture teeth approximately parallel the maxillary and mandibular ridge crests?
Yes
What should be done in the patient chart once the patient has given esthetic approval of the denture teeth?
Sign a statement that they approve the denture tooth selection and they understand there will be extra fees for changing the denture teeth or their arrangement after denture processing
How is the denture base shade picked?
Pick the shade that closest matches the patient’s mucosa.
What should you ensure is scribed onto the master cast on the wax try-in appointment?
Posterior palatal seal
What instructions are given to the patient to do prior to their denture delivery appointment?
Leave current dentures out of the mouth for the same amount of time they were left out before the master cast impression (48 hours if left out 48 hours prior to the master cast impression appointment)
What must be done to the record bases to prepare them for processing?
- Cut out the palate of the maxillary cast
- Seal record bases to the master casts filling in the vestibule
- Fill in the palate
How many thicknesses of baseplate wax are added to the palate?
2 Thicknesses
What should be done periodically with the maxillary and mandibular denture as they are being waxed up for final processing?
Reverify the occlusal plane and occlusion. Adjust if necessary.
What should be the thickness of a properly festooned gingival mating?
About 1mm
How are the master casts removed from their mountings?
Soak in slurry water, then tap the cast-mounting interface with a lab knife and hammer. Retain the mountings.
What is done with the processed maxillary denture before recovering from its cast if the cast still fits into its cast mounting (made by placing the maxillary cast into wet plaster on the remount stand of the articulator)?
Facebow preservation.
What is the purpose of the facebow preservations?
Allows mounting of the maxillary remount cast in the articulator without requiring a new face bow and maxillary remount at they ry-in appointment
How is a remount cast produced?
Undercuts in denture are blocked out with wet paper towels. Type III Yellow dental stone is poured in using the single pour technique.
What will be required at the complete denture try-in appointment and why?
Clinic remount to determine occlusal adjustments.
Besides washing and disinfecting, what should be done to the denture before it is placed in the patient’s mouth for the first time?
Painted with a thing layer of pressure indicated paste (PIP)
When placing the denture for the first time, should you stop if the patient feels discomfort?
Yes. Check and eliminate interferences.
Where should you apply pressure when you place the denture?
Index fingers in the first molar-second premolar region (the anterioposterior center of the denture-bearing area)
Why is the mucosa checked for leftover PIP after the denture is removed?
There can be false pressure areas in the PIP pattern
What are 2 ways to provent PIP from sticking?
- Moisten with saliva or water
2. Spray more silicone spray on the PIP
Why is it customary to have PIP wiped off in the distobuccal region of the denture bilaterally?
- It’s a common area for pressure spots
- The denture is narrower than the master cast in this area due to the polymerization shrinkage of he methylmethacrylate acrylic resin
Why will there not be PIP contact in the posterior 2/3 of the palate?
Denture does not fit there because of dimensional accuracy of the impression, cast, and denture base materials
What is the PIP patter that shows the denture is fitting well?
Brush marks disrupted and having a stippled appearance along the entire edentulous ridge and the rugae area, and possibly at the posterior palatal seal. Minimal wiping off in the facial flange area.
How should the maxillary denture be placed?
Seat anterior then roll onto the posterior
How should the mandibular denture be placed?
Seat posterior then roll onto the anterior
Denture borders which were developed from a carefully border molded impression of a vestibule are assumed (correct or incorrect) at delivery?
Correct
The distolingual border of the denture should terminate where?
Where mylohyoid muscle turns toward the lingual to join the superior constrictor.
What is used to evaluate the border extension?
Disclosing wax
What must be done once both dentures are verified as far as retentive fit via the PIP?
Make a CJR record to mount the mandibular remount cast to the lab mounted maxillary cast (maxillary was mounted via the face bow preservation)
Once the mandibular cast is mounted on the articulator using the CJR record you just made with the PIP adjusted dentures in the mouth, what is done next?
Make another CJR record as you just did
What is the purpose of this new CJR record?
Verify that the new clinic remount is accurate, i.e. with the dentures on the casts, the denture teeth in the CJF record, and the articulator centric locks open, that the condylar balls are in contact with the condylar housing
What is adjusted first when adjusting the denture occlusion?
Maxillary denture ensuring all the stamp cusps contact the occlusal plane metal template
How is the maxillary denture adjusted to ensure the maxillary stamp cusps all contact the occlusal metal template for monoplane occlusion
Sanding the maxillary teeth with wet / dry sandpaper on a glass slab
What must you not do when adjusting the occlusal plane of maxillary denture teeth for monoplane occlusion?
Adjust so a vertical overlap (overbite) of anterior teeth develops.
If you grind down the maxillary teeth too much on the processed denture, what must be done?
Replace the non-contacting teeth on the denture.
Add to the occlusal surface of the non-contacting teeth.
What should be the only eccentric contacts for laterotrusive movements of the denture?
Contacts on the lingual of the first premolar only.
What are the proper contacts for protrusive movements of the denture?
First premolar only.
Should the patient be instructed to bite the denture into place?
No
Should the patient be instructed to bite on the anterior prosthetic teeth?
No. Food should be cut up or broken apart, then chewing with both sides of back teeth.
What is the chewing stroke for a denture patient with monoplane occlusion?
Vertical
What should be used to clean the denture?
Liquid soap, water, soft toothbrush. No abrasive, not even toothpaste.
How long should the patient be instructed to leave the dentures out of the mouth?
8 hours a day
How should dentures be stored when not in the mouth?
In water
Can dentures be worn to sleep in?
Yes. As long as they are out of the mouth for 8 hours / 24 hour period
What is necessary for successful denture wear?
Patience and perseverance through the sore spots, speech difficulties, increased saliva as the patient and their body adapts to functioning with the denture
What is denture adhesive permissible?
Occasionally for special occasions. Should not use adhesives to make an ill-fitting denture stay. That should be evaluated and fixed by a dentist
What are the routine post-delivery appointments?
- 24-48 hours
- 1 Week
- 1 Month
What are 3 advantaged to a 24-36 hour denture post-delivery appointment?
- Make adjustments when problems are small
- Expedite patient’s denture adaptation
- Maximize the patient’s confidence
What are 3 advantages to a 24-36 hour denture post-delivery appointment?
- Make adjustments when problems are small
- Expedite patient’s denture adaptation
- Maximize patient’s confidence
What is the real period for dentures?
- 6 Months after initial delivery
2. 1 year if no oral problems
All denture patients should be seen how often?
At least once a year
What must be done at the post-delivery appointment before adjusting the denture?
- Record patient’s comments / complaints
- Preform and oral exam and examine the denture
- Make a diagnosis to correlate oral and denture exam findings to the patient’s complaint
What should be examined on a denture at all recalls?
- Retention
- Stability
- Occlusion
- VDO
- Esthetics
- Phonetics
- Base fit
- Border extension
- Prosthetic tooth wear
How is the denture retention (resistance to movement away from the tissue bearing areas) tested on the maxillary denture?
Pull down on maxillary incisors
How is the denture retention (resistance to movement away from the tissue-bearing areas) tested on the mandibular denture?
Push up with an instrument b/w #24-#25 with patient’s tongue in the normal position
How is denture stability (resistance to movement when forces are applied toward the ridge)
Press tissue ward in 1st molar on one side of the arch, the other side of the denture should not lift away from the ridge. Press tissue ward on the incisors, the posterior should not lift away from thee entire bearing tissue.
When is the only time there can be rotation of the denture when you try to rotate the denture with your fingers to test for stability?
Only if the denture foundation tissue is displaceable
When verifying CR with the denture in, what contact are you looking for as you guide them into CR and occlude?
All posterior teeth should contact without denture base movement
What does a visual space between the maxillary and mandibular posterior teeth indicate at a recall appointment?
A clinical remount is required to adjust the occlusion
Why is denture occlusal adjustment done on an articulator versus in t he mouth?
Because any slight movement of the dentures give false occlusal contact marks
What 3 PIP records are done at a denture recall?
- Static PIP record
- Occslual PIP (CR and MIP)
- Functional PIP (patient chewing food)
What can be used to evaluate the occlusal plane as you visually inspect the denture for prosthetic tooth wear?
Occlusal plane template
What are 13 common complaints of denture patients?
- Discomfort (sore spots)
- Denture too long
- Loose dentures
- Cannot chew with denture
- Excessive saliva
- Chewing gum sticks to teeth
- Denture too bulky
- Food accumulates around denture
- Food gets under denture
- Various problems with speech
- Burning sensation on palate or tongue
- Gagging
- Biting cheek or lip
Mucosal irritations, abrasions and ulcerations result in a swelling which produces what in the PIP?
Heavy pressure area
What are 7 causes of denture mucosal irritations, abrasions, and ulcerations?
- Base not fitting properly at delivery
- Base not fitting because “denture settling” initially or bone resorption over time
- Incorrect occlusion
- Patient improperly functioning with denture
- Clenching / bruxing
- Something stuck under denture causing injury (e.g. a seed)
What is important to do before adjusting the patient’s denture base in an effort to relieve a sore spot?
Determine the cause (in other words, do not adjust the denture base if the occlusion is what is causing the problem)
What is the ideal way to diagnose and then treat a patient’s denture sore spot?
Have the patient leave the denture out until no more discomfort or swelling, then evaluate the denture fit and occlusion
Why will an immediate denture or a denture made from impressions within a few weeks or months of extraction (e.g. on an unhealed, unreserved ridge need to be relined)?
To compensate for the resorption of the alveolar bone.
What is the initial treatment when the edentulous ridge has resorbed enough that the dentures lose retention and stability?
Temporary reline with tissue treatment material or temporary base materials, either soft or hard
What are 2 treatments for an immediate denture or a denture that was fabricated from an impression made as the ridge was still healing?
- Reline with a hard base material (lab or chair side reline)
- Replace with a new denture
On a definitive denture that is made from impressions made 2 or more years after extractions, when would it be expected to replace or restore worn plastic denture teeth?
Every 2-3 years
On a definitive denture that is made from impressions made 2 or more years after extractions, when would it be expected to reline the denture?
Every 2-3 years
On a definitive denture that is made from impressions made 2 or more years after extractions, when would it be expected to replace the entire denture?
Every 5-7 years
The ADA recommends replacement of dentures how often?
Every 7 years
Most dental insurance allows for payment of their usual and customary fees for dentures how often?
Every 5 years
Why should a patient not keep a denture for 20 years?
Because tissue changes and wear of prosthetic teeth
What should you evaluate if the patient has remaining teeth when considering an RPD or complete denture?
- Any teeth salvageable (periodontally, restoratively)?
- Does patient want to maintain natural teeth?
- Is RPD treatment cost effective?
- Can the patient afford the RPD?
- Is the mandibular over denture the treatment of choice?
To be an abutment for a fixed or removable partial denture, a tooth should have a crown:root ratio of what?
1;1
What is the treatment indicated if the patient requires a mandibular complete denture, but still has some teeth in the maxilla?
C/C
What is the rationale of doing a C/C and not an RPD/C?
It decreases the occlusal forces on the mandibular edentulous ridge
When would it be allowed to do an RPD/C?
If the mandible will be restored with implant-supported prosthesis (e.g. hybrid implant prosthesis or implant-supported PFm FPD)
What is a means to get a crown with a C’R of less than 1:1 back to 1:1?
- Shorten clinical crown via enameloplasty
- Shorten clinical crown with a crown
- Shorten clinical crown w/ Endo, post and core, crown
Can the tooth have mobility if it will be an abutment for a fixed or removable partial denture?
No
What is a reality when considering a patient’s ability to maintain the teeth they have remaining and the effectiveness of treating with an RPD?
Most patients lost teeth due to poor oral hygiene and only a few patients oral hygiene can be improved long term
What is the sequence for doing a natural tooth root mandibular over denture?
- EXT all mandibular teeth except #22 and #27
- Endo treat #22 and #27
- Amputate clinical crown #22 and #27 and restore access openings with amalgam or composite?
What is the minimum amount of time after last tooth extraction or preprosthetic surgery before the master cast impression is made?
3 months
Denture construction usually takes how many appointments?
6-8
Total edentulous time without denture figuring the above times together?
6 months
What is the amount of space required between the maxillary tuberosity and the retromolar pad for dentures?
Minimum 6mm
Why would pre-extraction diagnostic casts be indicated?
If interarch space is inadequate and VDO is not established by natural tooth contact
To construct a reduction template and surgical stent
What is the sequence for extracting teeth and delivering an immediate complete (IC)/C?
- EXT all teeth except #6 through #11
- Allow healing and construct IC/C
- EXT remaining teeth (#6 through #11)
- Deliver IC/C
- Reline IC
The IC will need to be relined or remade within what time frame?
One year
Is a mandibular immediate complete denture a treatment that is not routinely used in our clinic?
No
Clinical data that are obtained from the patient before their natural teeth are extracted?
Pre-extraction records
What are 3 uses of pre-extraction records?
- Determine the VDO
- Selecting shade, mold (length, width, and outline form) of denture teeth
- Arranging denture teeth
When making a C/natural, is a custom tray made of the first impression or an occlusion rim?
Occlusal rim
What is the purpose of this first occlusion rim instead of a custom tray for a master cast impression?
Must get a facebow record to mount the maxillary cast and do a CJR record against the occlusal rim to mount the mandibular natural teeth impression, in order to determine how to adjust the mandibular natural teeth to give an overall stable occlusion
When doing inlays or crowns for the mandibular teeth, what template is used to finalize the occlusion of the waxed up crowns or inlays?
20° occlusal plane template
When doing enameloplasty for the mandibular teeth to occlude with a maxillary complete denture, what is used to guide the reductions?
Tooth reduction template
Once the tooth reduction has been completed, an impression of those teeth is taken and poured up in what dental stone type?
Type IV stone
For a C/natural, what is fabricated once the complete maxillary occlusal rim is made and the mandibular natural dentition has been adjusted and the cast poured up?
Construct a maxillary visible light cure (VLC) custom tray with handle for border molding and master cast impression
When setting teeth for the C/natural, are the teeth to be ground at all before the wax try in?
No
How are the maxillary posterior teeth of the C/natural to be adjusted?
Place in hyper occlusion then grind down the occlusal surface to the VDO
What are 3 objectives of adjusting maxillary posterior teeth out of hyperocclusion into occlusion in a C/natural?
- Reestablish VDO
- Develop good CR occlusal contact
- Develop balanced occlusion
What are 3 general state of a patient’s current denture or RPD when evaluating?
- Satisfactory
- Unsatisfactory but can be made satisfactory
- Unsatifactory and must be replaced
If a pt has an unsatisfactory dentue, but the dentist determines is can be made satisfactory, what methods can the dentist used to make the unsatisfactory denture satisfactory?
- Adjustment
- Repairs
- Relines / rebases
What are requirements of an acceptable RPD design when evaluating a current RPD?
At least 3 points of contact of framework with teeth (3 or more rests, or at least 2 rests and a lingual plate)
What is the purpose of the 3 points of contact of the RPD framework with the teeth?
Positively orient framework to the teeth and the base to the ridge
What type of retention is required in a tooth- tissue supported RPD?
Indirect retention
Must the design of the RPD meet prosthodontic principles?
Yes if not it must be remade
Can an RPD be flexible ?
No, it must be rigid
What is one of the major advantages of an RPD that is made by an RPD being rigid?
Forces applied at one point will be transmitted to other teeth and tissues contacted by the framework?
What is the prosthodontic principle that is met by having a rigid RPD?
Distributing forces to as many teeth and as much denture bearing area as practical
What is an indicator that a tooth has been added to an existing RPD framework?
They are added with autopolymerizing acrylic resin that discolors over time as well it is more bulky where it wraps around the framework
What must an RPD replace?
Must replace all missing natural teeth encompassed in their design
If the component parts of an RPD are not correctly related to the soft/hard tissues and teeth, what is indicated?
A new prosthesis is indicated
f a framework does not fit the teeth and tissues, is a new RPD necessary?
No, may improve fit by relieving areas that bind and improve the rest margins. If this is not possible, a new RPD must be fabricated
If an RPD has missing, broken, or worn component parts, must a new RPD be made?
May be able to fix or replace certain parts and prolong the service of the prosthesis
When evaluating the fit of the base and framework simultaneously, what should the PIP show on the denture base and what should the disclosing wax show on the framework?
Tooth tissue supported RPD’s should show framework, seats, and some contact of the base with the ridge under on occlusal force (static record). Tooth supported RPD should only show framework contact and con contact of the base with the ridge
Is an anteroposterior rock (A-P rock) acceptable in a tooth tissue supported RPD?
No
Is an A-P rock test necessary for tooth-supported RPD?
No
What does an A-P rock indicate?
That tissueward forces are not distributed to the teeth and denture bearing area simultaneously
What are 2 methods to correct and A-P rock on a tooth- tissue supported RPD?
- Reline or rebase
2. Construct a new RPD
Should the occlusion of the natural teeth be the same with and without the RPD in the mouth?
Yes
What is one of the most frequent RPD problems?
Premature contact or occlusal interference on RPD components
Tooth-tissue supported RPD denture borders must extend how far?
To the moderately activated vestibule and the vibrating line hauler notch area
If a clasp fits the tooth, but has unacceptable retention, can it just be bent to give it more retention?
No, it must be placed more cervically to engage a deeper undercut
Can a reciprocal plate that does not touch the teeth be corrected?
No. A new RPD must be made.
Should prosthetic anterior teeth on an RPD be in occlusion at all?
Little to none. They are for esthetics only.
What is the mandibular rest position interocclusal distance to look for when evaluating existing dentures?
2-4mm in the premolar area
What is the term for the space to evaluate between the mandibular incisal edges and the incisal edges or lingual surfaces of the maxillary anterior teeth when the patient says the sibilant sounds, and should be 1mm or less?
Closest speaking space
For a C/RPD, which arch establishes the occlusal plane?
Established off mandibular dentition using 20 degree occlusal plane
What is the difference in a static PIP pattern and an occlusal PIP pattern?
Static is made with just finger pressure while occlusal is made with the patient biting
Should the static and the occlusal PIP pattern of a denture base be similar?
Yes
What are 3 things that biting on anterior teeth do?
- Cause denture to lose seal
- Fracture anterior denture teeth or base
- Increase anterior bone resorption
If it is noted the patient is functioning improperly with their dentures, how long after giving them proper functioning instruction should you see them to reevaluate their function?
1-2 weeks
What type of process is denture acrylic processing: injection or compression molding?
Compression
Due to the compression molding of the waxed-up denture, what is a common problem?
Denture teeth can move, common with posteriors
Should only the patient view the denture at the esthetic wax try-in?
No. A person with a valued opinion should be there also.
What type of resin is used for the compression molding of dentures?
Heat activated
What is the advantage of using heat activated resin for the denture processing?
- Denser
- Holds color longer
- Less porous
What is placed over the cast to prevent the acrylic resin from sticking to it?
Tin foil substitute (dilute alginate)
The denture flask pieces are closed together with how much pressure?
2500 lbs/in2
The denture is processed at what temperature for how long?
165 degrees F for 9 hours
What will be seen during the lab remount of the processed dentures and what will it indicate?
Incisal pin does not touch guide table indicating there has been some tooth movement
If the facebow preservation is skipped in the lab before recovering the dentures, is it a problem?
No. Will just do a new face bow and clinic remount with patient.
What is the goal of the facebow preservation?
Prevent taking another facebow transfer at time of denture placement
Should processed denture be pried from the master casts?
No. Let the lab recover it.
Should the pumice used to polish the denture be wet or dry?
Wet. Dry would burn the acrylic.
What is the first step of polishing the denture?
Make the entire denture base the same roughness with a bur.
Is the tissue surface of the denture to be polished?
No
What is the correct occlusion for C/C?
Bilateral simultaneous contact in centric occlusion
What is required on C/C delivery appointment?
Maxillary remount cast mounted on articulator
What is required on C/C delivery appointment?
- Maxillary remount cast mounted on articulator with facebow preservation
- Mandibular remount cast
- C/C denture polished
Which surface of the denture is fitted first at delivery?
Tissue surface
What surface of the denture is fitted after the tissue surface has been adjusted?
Oral surface that touches lips and cheeks
What is the last part of the denture that is adjusted and what does it require?
Denture occlusion via casts mounted on CJR record verified articulator
Does PIP show how hard surfaces are touching?
No. Just indicates touching.
Should a CJR record be completely in material or should the teeth contact through it?
Should only be in material to avoid tissue displacement
Can occlusal adjustments be done before verifying the mounting?
No
What is the most common bit area due to the loss of elasticity of mucosa and overlap of posterior denture teeth?
Cheek
What is the one feature that distinguishes a C/natural (single complete) from a C/C?
A single complete occludes on nature teeth so maxillary denture occlusion is dictated by mandibular natural teeth
What is the cause of clicking?
Excessive VDO
What is the occlusion of a single complete denture?
Balanced with vertical overlap of anterior teeth with group function
When doing the maxillary occlusal rim for the single complete denture how do the mandibular teeth act against it?
They fit into it to account for the vertical overlap
When adjusting cusped teeth of the C/natural, what is adjusted first: the occlusal fossa or the eccentric contacts?
Occlusal fossa to get MIP with some contact on lingual maxillary denture teeth
What are the eccentric contacts to adjust for the C/natural?
Maxillary buccal inclines
What is the number one problem dealt with in C/natural?
Occlusal plane
What is the occlusal scheme for C/natural (single complete)?
Cross-arch, anterior posterior balanced occlusion with cusped teeth
What is a denture that is made prior to the removal of remaining teeth and placed at the time of removal of the remaining teeth?
Immediate denture
What is the objective of an immediate denture?
Provide a complete denture service for those patients who are to become edentulous (at least in one arch) and who wish to have immediate replacements for their natural dentition
What are the advantages of an immediate denture?
- Maintains TMJ in its normal relationship
- Provides masticatory apparatus
- Muscle tone is not lost
- Prevents muscle fatigue
- Tongue does not spread laterally
- More satisfactory phonetics
What are the disadvantages of an immediate denture?
- Surgical risk in patient with systemic disease
- No opportunity by patient to observe esthetics or anterior teeth prior to placement
- Rapidly changing supporting tissue
How will the maxillary immediate move as the anterior ridge heals after extractions?
Will move upwards and rotate backwards
What impression technique is indicated within the anterior arch and teeth are prominent, glaring labially making it impossible to seat the tray and record tissues accurately?
Combined impression technique
What is the problem with the combined impression technique?
The relationship of the borders of the first and second impression
What is a denture constructed before the removal of the teeth and is intended to be the final denture and will be relined at some point in the future, but is not meant to be replaced?
Definitive immediate denture
What is the most common denture made in the dental school and is done exclusively for the maxillary arch and is intended to give the person some facial contour and hold, but is intended to be replaced in the future?
Immediate interim denture
What is the biggest disadvantage of an immediate denture?
Absence of anterior try-in
What is the immediate denture of choice when the patient has few remaining maxillary teeth with adequate occlusal surfaces allowing for predictable jaw relations, the remaining teeth are stable, and esthetics are not a primary concern?
Definitive immediate denture
What increases the level of difficulty when constructing an immediate denture?
More teeth remaining in the mouth
What impression material is used when doing custom tray impressions for immediate dentures?
Alginate
What is the advantage of the combined impression?
Allows posterior edentulous area to be border molded, making a better flange in that area
What is required for an immediate if there will be remaining natural teeth after the extractions?
Wax try in
What perpetuates deformities?
Protuberances
When should protuberances be removed from the master cast?
After boil out stage of flasking
What is a means to make sure the denture fits, especially when alveoplasty has been done, before placing the interim
Surgical template
How long should an immediate denture stay in once it has been placed and why?
24 hours. If taken out, inflammation will occur that will prevent replacement of the immediate denture
When and for how long post-op can the patient start to remove the immediate denture?
48 hours post-op for 6-8 hours
What is the main function of the immediate denture in the first 24-48 hours?
Bandage
When should the immediate be remounted and a complete equilibration be done?
10-14 days post op
What is difficult in the 24 hours and 72 hours recall appointment?
To distinguish between surgical trauma and denture trauma
What is one place to consider denture trauma over surgical trauma?
Areas of undercuts
Are articulated diagnostic casts required if space between the maxillary tuberosity and the retromolar pad is greater than or equal to 6mm at VDO?
No
For a C/C can dentures be made immediately following extractions?
No. Must wait a few months
For an immediate C/C, what is the treatment sequence?
EXT posteriors, leave anteriors, allow healing, EXT #6-11, place immediate C/C at this time
For an immediate interim C/natural, what is the treatment sequence?
EXT all teeth, wait 2 weeks, deliver interim C/, wait for healing, deliver /C
For immediate complete / immediate complete, what is the treatment sequence?
EXT all teeth and deliver ImC / ImC
To resurface the tissue side of a denture with new base material to make it fit more accurately?
Hard reline
Which are definitive: soft or hard relines?
Hard reline
What is the process of refitting a denture by the replacement of the entire denture base material without changing the occlusal relations (term is not used much)?
Rebase
What are some diagnostic consideration for reline?
- Adequate denture coverage of the supporting tissues
- Minimum loss of VDO
- Harmony b/w centric relation and centric occlusion
- Dentures in useable condition
- Edentulous ridges in healthy Acceptable esthetics
Relines deal with the effects of what only on the fit of the denture?
Effects of minimal bone loss only
Will a reline alter esthetics?
No
People with bone loss have what skeletal look due to the maxilla resorbing up and back and the mandible resorbing down and out?
Class III
What are the objective of a reline?
- Readapt denture base to tissue base
- Establish plane of occlusion in harmony with maxillary and mandibular ridges
- Obtain a pleasing esthetic result
- Obtain an acceptable VDO
- Establish CO in harmony with CR
- Have occlusal forces exterted over the crest of the mandibular ridge
What is the impression tray for the complete denture reline?
The denture itself
What must the patient be at for the reline?
Correct VDO
What must be done to the denture before you reline the impression
Remove undercuts lateral and posterior to tuberosity on one side and reduce flange height 2mm
How is tissue contact and flange height reestablished on the adjusted denture for reline?
Border mold with green stick compound while controlling occlusal harmony
How is the denture modified after the border molding is completed?
Trim off labial extensions of green stick compound cut out palate (do not have to cut out the palate)
Does border molding have to be done every time with a reline?
No, if borders are good
What is used to protect the denture base when doing the reline?
Masking tape
Can a hard reline be used to increase VDO?
No, the goal is to return to the original VDO
What should be done after the reline impression is taken?
Check occlusion
How long will the patient have to wait for their reline?
Minimum of 1 day because denture must be processed at 165 degrees F for 9 hours
Do we separate the reline impression from the stone?
No, it could break the denture used to make the impression. Send it to lab as one piece.
What is the adjustment protocol for a denture reline?
Same as C/C: tissue side PIP and adjust cheek, labial flanges adjust with disclosing wax. Occlusion done on a CJR record verified articulator
What is the recall for the reline?
24 hours
7-10 days
6 months
