Denture Insertion and Adjustments Flashcards
When do you do a lab remount?
Right after the dentures come back from processing
The insertion appointment is the process of eliminating…
errors
Patient should leave out old dentures for at least _____ hours prior to insertion appointment.
24 hours
Before the insertion appointmetn what should you inspect on the dentures?
- put the denture in a cup with water
- make sure there are no imperfections on surface
- borders are round/no sharp angles
- cameo surfaces are smooth
What do you need to do before insertion appointment for accurate remount?
- Accurate maxillary remount cast already attached to articulator
- Mandibular remount cast is prepared for clinical remount
What are you looking for when you place pressure indicator paste on the underside of the denture during the insertion appointment?
- undercut areas
- accuracy of tissue contact
- places where the paste has show through
What is zinc oxide paste used for?
a pressure indicating paste (PIP) to detect improper adaptation
What is the sequence for using pressure indicating paste (PIP)?
- dry denture surface
- brush a thin even layer of PIP onto the surface of the denture
- seat the denture with pressure in the first molar region
- remove immediately
- inspect and adjust bearing surface as necesary
When using pressure indicating paste (PIP) what are you looking to remove?
- remove islands of pink in the sea of white
What should you look for when evaluating borders during the insertion appointment?
- Are dentures stable during speech and swallowing?
- Are borders and contours compatible with available space in vestibules?
- Borders properly relieved at frenal attachments?
What paste is used on the intaglio surface?
pressure indicating paste (PIP)
What paste is used on the dental flange?
disclosing wax
What is disclosing wax used for during the insertion appointment?
- carefully adjust the denture flange as necessary
- reapply, border mold, and adjust until areas of overextension are eliminated
Why would gagging occur during the insertion appointment?
- palate excessively thick
- palatal extension too long (or short)
- lack of tongue space (teeth set too far to the lingual)
What are the possible problems with phonetics during the insertion appointment?
- check the thickness of the maxillary palatal portion (common problem)
- reevaluate the position of the maxillary anterior teeth
- if everything appears normal it may be a matter of time for the patient to adapt
- open vertical dimension of occlusion
What are the sources of occlusion errors during the insertion appointment?
- Resin shrinkage when processed
- ill-fitting temporary record bases
- Change of OVD on the articulator
- Inaccurate max-mand. records by dentist
- Incorrect arrangement of teeth
- Overheated when polished
- Water absorption (expands 1-3%)
What are the three parts of occlusal harmony?
- patient comfort
- efficient function (20% of natural)
- preserve supporting tissues
What percent of natural teeth function do dentures have?
20%
Why should you hand occlude the completed dentures first before trying in the patient?
look for posterior flange contracts beyond tooth contacts
Prior to making the record you should…
place two cotton rolls between the posterior teeth and have the patient bite down for 5 minutes (deprograms them)
What are the simple steps to do a clinical remount?
- make interocclusal record
- remount dentures on articulator
- refine occlusion on articulator
Clinical remount and occlusal refinement are done before what?
final delivery of the dentures
Occlusal errors will deform the supporting tissues & conceal the errors if what is postponed?
clinical remount and occlusal refinement
What can interfere with paper markings during occlusal adjustment?
saliva
What can be some problems that can occur with doing an intraoral occlusal adjustment?
- resiliency of tissue allows dentures to move
- misleading articulating paper marking
- saliva interferes with markings
- patient cooperation is a must
What are the advantages of a clinical remount?
- Reduces patient participation
- Dentist sees better what to do
- Stable working foundation; bases not shifting on resilient tissues.
- Absence of saliva = more accurate marks with articulating paper.
- Grinding may be done away from patient. This prevents patient
objections to “mutilating my new teeth.”
What is the desired occlusion for the insertion appointment?
- Simultaneous contact of all posterior teeth in the retruded mandibular position (CR)
- Absence of contact on anterior teeth
- Absence of deflective interferences in eccentric movements
What should you evaluate on the cameo surface acrylic?
- thickness intraorally and extraorally
- Use pressure indicator paste
- Make measurements
- Seek patient feedback
What are some instructions you should give to the patient at the denture insertion appointment?
- strange feeling of fullness in lips and cheeks
- mandibular denture more difficult to use than maxillary CD
- increased flow of saliva for the first few days
- speaking improves practice
- learning to chew takes about 2 months (begin with softer foods)
- be patient
- use denture adhesive powder for extra security
- expect sore spots
- remove dentures at night and store in water
- return to clinic for adjustments
How long does it take to learn how to chew properly with dentures?
2 months
What is the oral hygiene needed for dentures?
- Care of the prosthesis-brushing (over a sink with water or a washcloth in it), soaking in a container, remove any adhesive
- Care of the mouth-gingival massage, tongue brushing with a soft toothbrush
