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Partial Dentures > Diagnosis & Tx planning > Flashcards

Diagnosis & Tx planning Flashcards

1
Q

5 visits for CD and PD

A
  1. primary impressions
  2. secondary impressions
  3. inter-occlusal records
  4. try-in
  5. insertion/adjustments
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2
Q
  1. primary impressions
  2. secondary impressions
  3. inter-occlusal records
  4. try-in
  5. insertion/adjustments
    for complete
A
  1. primary impressions
    - compound or alginate
  2. secondary impressions
    - PSR or PVS
  3. inter-occlusal records
    - record bases and occlusion rims
  4. try-in
    - record bases and teeth
  5. insertion/adjustments

-denture bases and teeth

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3
Q
  1. primary impressions
  2. secondary impressions
  3. inter-occlusal records
  4. try-in
  5. insertion/adjustments
    for partial
A
  1. primary impressions
    - alginate
  2. secondary impressions
    - PSR or PVS
  3. inter-occlusal records
    - frames and occlusion rims
  4. try-in
    - frames and teeth
  5. insertion/adjustments
    - denture bases and teeth
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4
Q

other considerations why removable PD’s may be good tx option other than list from before

A

can replace missing teeth AND BONE.

specialized esthetics-diastemas, unusual tooth arrangements are easier with removable (wax try -ins with diagnostic denture teeth) – which can then be transitioned into fixed

Great intermediate prosthesis to determine final VDO and esthetics, preserve space and act as a prototype to extensive full arch restorations

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5
Q

RPD a good intermediate prosthesis?

A

YES-
Great intermediate prosthesis to determine final VDO and esthetics, preserve space and act as a prototype to extensive full arch restorations

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6
Q

tx options for missing teeth

A
  1. implants
  2. fixed partial dentures
  3. removable cast partial dentures
  4. removable provisional partials
  5. complete dentures
  6. no replacement*
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7
Q

contra-indications for fixed/ implant restorations

A
  1. existing oral diseases
  2. high caries rate/ poor oral hygiene
  3. periodontal issues
  4. medical conditions / risk factors
  5. cost
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8
Q

partial denture design must be completed when? why?

A

PRIOR to treatment planning REGARDLESS of who will fabricate the partial denture or even when …

what if one of the selected primary abutments needs a restoration or a crown first? – this must be completed prior so you can survey it / locate undercuts/ tell lab information regarding the framework placement and clasps

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9
Q

6 main purposes of the diagnostic cast

A
  1. pre-treatment record
    - diagnostic and legally need it
  2. visual aid for the patient
  3. preliminary design
  4. custom tray fabrication
  5. practice abutment preparation
  6. occlusal and spce analysis **
    - need for bases/rims
    - counter models
    - check for anterior modification spaces
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10
Q

T/F preliminary survey and design may be surveyes after mounting as well

A

TRUE

- you can survey with the cast mounted on a cookie

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11
Q

describe custom tray fabrication for PVS and PSR

A

PVS
- must do a double tooth blockout and a single blockout on the edentulous ridges and palate

PSR
- single tooth blockout and no blockout on the edentoulous ridges or palate

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12
Q

diagnostic impression requires you capture all occlusal surfaces/ incisal edges because

A

need this for articulation and occlusion

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13
Q

diagnostic impression requires you capture all surfaces of abutments because?

A

needed for the framework

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14
Q

diagnostic impression requires you capture all of the edentulous spaces because

A

needed for location and approximation of the denture base

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15
Q

diagnostic impression requires you capture all folds to be restored

A

for the flange of the denture

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16
Q

diagnostic impression requires you capture all buccal vestibules and lingual vestibules

A

for the approach arms –

for the major connectors

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17
Q

diagnostic impression requires you capture all of retro-molar pad

A

needed if doing a mandibular distal extension

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18
Q

diagnostic impression requires you capture all hamular notch

A

needed if doing a maxillary distal extension

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19
Q

diagnostic impression requires you capture all of palate and tongue space

A

need this IN FUNCTION for pt. comfort and knowing they can still be comfortable

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20
Q

what does a design diagnosis require

A
  1. diagnostic casts
  2. opposing cast or counter model
  3. diagnostic mounting – unless opposing an edentulous arch in which you will be restoring with a complete denture
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21
Q

when do you not need to have a diagnostic mounting for designing

A

if opposing is an edentulous arch in which you will be restoring with a complete denture

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22
Q

service life of complete denture

A

roughly 7 years but will likely need a reline or rebase

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23
Q

describe an interim complelte denture. is this definitive or non-definitive tx?

A

non definitive tx

  • SHORT TERM full arch replacement of teeth, bone, and soft tissue used as A DIAGNOSTIC TOOL or when an immediate complete denture is not possible
  • they are inserted immediately after extractions or while healing is still occurring
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24
Q

three main characteristics of cast partial dentures

A
  1. use CAST METAL SUBSTRUCTURES consisting of rigid major connectors, clasps, rests, and guide planes to distribute forces to remaining teeth
  2. can be supported entirely by remaining teeth or a combination of teeth and tissue
  3. rigid major connector provides CROSS ARCH STABILIZATION
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25
Q

which partials are likely to flex

A

horsheoes and bridges

  • so horshoes must be tooth borne to minimize this flexing and the horizontal rotations – use as many guide planes as possible
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26
Q

what prevents flexing from occuring

A

posterior bars prevents flexing

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27
Q

definition of provisional partial

A

A SHORT TERM fixed or removable dental prosthesis designed to enhance esthetics, stabilize, provide occlusal support, maintain space and diagnose problems and/or function for a limited period of time, after which is to be replaced by a DEFINITIVE PROSTHESIS

syn; interim prosthesis

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28
Q

definition of transitional partial

A

a provisional (serving as an interim) where teeth are added, often to “transition” a patient from some remaining teeth to an interim CD

purpose - trying to diangose dentition and we can add teeth to provisional/ transitiona;
* so key here is we can add teeth

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29
Q

definition of flipper/ type

A

provisional

- common term for a provisional replacing a SINGLE tooth for esthetic considerations / reasons

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30
Q

how long can you assess patient for tolerance on increases their VDO?

A

1 week maximum

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31
Q

indications for using a provisional partial

A
  1. assess patient tolerance of VDO ; 1 week maximum
  2. supply posterior occlusion during periodontal long term restorative therapy
  3. decrease forces on anterior teeth (by providing posterior occlusion)
  4. after recent extractions
  5. space maintenance
  6. treatment prosthesis (tissue conditioner, ortho)
  7. esthetics
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32
Q

biggest difference between a provisional partial and cast

A

RESTS

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33
Q

how long is provisionals designed to function for

A

1 week to 6 months

*when worn longer than 1 month must be supported by BALLA OR ADAM CLASPS

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34
Q

if provisional is worn longer than 1 month what must be done

A

needs to be supported by balls or adams clasps

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35
Q

wrought wire ball and occlusal embrasure clasps prevent?

A

preventing vertical DISPLACEMENT in provisional partials

  • want to limit the gingival movement
  • so primarily used as rests NOT direct retainers

(direct retainers use clasps)

36
Q

major reason for using provisional partial

A

used for developing or maintaining VDO and Occlusion while other restorative procedures are being performed

37
Q

adams clasps also called

A

occlusal embrassure clasps

38
Q

even though the wrought wire ball and occlusal embrassure clasps may provide direct retention, the PRIMARY use of these critical components is to protect the tissue from?

A

VERTICAL DISPLACEMENT of the prosthesis

39
Q

use of a flipper is likely for?

A

emergency treatment
fractured
avulsed
missing tooth/ teeth (usually single)

40
Q

problems occuring with all acrylic provisional partials

A
  1. no rests / vertical displacement
  2. no guide planes/ undercuts/retention
  3. cold cure acrylic
  4. alginate ‘final’ impression
41
Q

describe the ‘nesbit’

A

NOT RECOMMENDED

  • a single tooth unilateral posterior partial
  • can be swallowed or aspirated
42
Q

how is bone lost in edentulous arches? for maxilla and mandible

A

maxillary anterior region
- anterior to posterior

mandibular anterior region
- posterior to anterior

*vertical height and width in both arches lost

43
Q

in complete dentures does bone resorption happen if patient not wearing denture?

A

yes- resorption occurs even if no denture made/worn

44
Q

how does a complete denture have the potential to drastically increase rate of bone loss?

A

movement

45
Q

how do we minimize movement in complete dentures?

A
  1. adhesion
  2. cohesion
  3. posterior palatal seal
  4. CO=CR
    * * denture rules like no anterior contact in CR and no anterior guidance in protrusion and no cuspid guidance in lateral
46
Q

long term use of provisional partials can lead to? why do we see this?

A
  1. periodontial breakdown
  2. bone loss
  3. increased caries

why?

  1. poor adhesion
  2. cohesion
  3. border seal
  4. poor distribution of forces
    - no cross arch stabilization and may even be flexible
47
Q

what is the result of poor fitting acrylic brought close to the necks of remaining teeth?

A

results in damage to the free gingival margin and recession – resulting in root caries more likely

48
Q

problems wih thermoplastic* flexible partials

A
  1. flexible major connectos ABSORB the stress so does not distribute occlusal load
    - no rests
    - no guide planes
    - clasps interfere with gingiva
    - difficult to adjust
49
Q

disadvantages of flexible partial dentures

A
  1. may not help supprt the patients vertical dimension of occlusion
  2. little or no splinting for weak teeth
  3. the patient’s soft tissue provides virtually all support during funcion
  4. little research available concerning the clinical performance of their effects on soft issue
50
Q

limited indications for flexible removable partial

A

in certain isolated situations

  • allergies
  • obturators
51
Q

T/F you can combine material from the flexible partial and metal clasp assemblies from a conventional partial

A

TRUE

52
Q

why are CAST partials a better choice? for non-rotating?

A

non-rotating
- PREVENT vertical and horizontal movements with rests, clasps, rigid major connectos and guide planes so the minimum movement occurs thus minimum PROSTHESIS -CASUED bone loss occurs

53
Q

why are CAST partials a better choice? for rotating?

A

LIMIT vertical and horizontal movements with rests, clasps, rigid major connectos and guide planes so that horizontal rotation and vertical rotation are prevented and limited

limited movement = limited PROSTHESIS- causes bone loss

54
Q

proper design keeps the prosthesis away from what? benefits?

A

away from free gingival margin
reduces risk of
- periodontal disease and root caries
- protects the remaining teeth and bone

55
Q

posterior bite collapse may lead to..

A

loss of VDO

56
Q

bite collapse potential occurs with?

A

no natural occlusion

  • so patient could have natural upper anteriors and natural lower posteriors but no teeth in contact
  • unlikely to occur if patient has natural occlusion
57
Q

what must be present BEFORE considering increasing VDO

A

evidence of bite collapse

58
Q

evidence of bite collapse includes

A
  1. absence of all posterior occlusion
  2. flaring of remaining anteriors + diastemas
  3. wear facets on posteriors
  4. poor esthetics
59
Q

how do you determine VDO (even when patient has teeth)

A
  1. freeway space
  2. closest speaking space
  3. space of donders
  4. esthetics
  5. phonetics
  6. swallow
60
Q

in the presence of NATURAL occlusion it is acceptable to restore/ increase VDO with…

A

FIXED (including IMPLANTS )ALONE

*only time this is acceptable

61
Q

tx choices for loss of VDO

A
  1. alone with fixed if there is natural occlusion
  2. fixed with removable combined
  3. never removable alone ***
62
Q

describe fixed and removable together for tx

A

open with fixed so that it is permanent

- so when take removable out vertical is still being held by fixed

63
Q

keeping naturally occluding teeth APART can cause…

A
  1. tooth extrusion
  2. TMD
  3. Ridge resorption
64
Q

provisional partial PD to increase VDO for how long?

A

MAXIMUM one week

65
Q

if there is no room to restore and some natural teeth are in contact what are tx options?

A

CANNOT open the occlusion because whatever natural teeth are in contact must stay in contact so other options for restoring must be considered

  • crowning all teeth in contact?
  • extracting all uppers and making a complete upper denture?
66
Q

three main ways (more detail) for increasing VDO by restoring

A
  1. one arch with complete denture
  2. with fixed partials dentures
  3. combination of FPD’s and RPD

*never RPD’s alone

67
Q

if posterior contact does exit we must use?

A

patients current vertical

68
Q

in the absence of posterior occlusion what is required for mounting?

A

record bases and occlusion rims

aluwax and notch

69
Q

in absence of sufficient (anterior or posterior) teeth in contact what do you need for mounting?

A

record bases and occlusion rims

aluwax and teeth

70
Q

occlusal plane with mized dentition - where do you get it from in the maxilla? mandible?

A

maxilla –>get the plane from the neighbors

mandible–> get it from the RM pad

71
Q

main reasons for needing pre-prosthetic surgery? when do you usually figure out the need?

A
  1. Torus / extosis removal
  2. frenal attachments
    - if attached to the crest of ridge
  3. extractions
  4. redundant tissues
  5. tuberosity reduction

When you look at your diagnostic casts **

72
Q

when do you survery restoration crowns whether is it full golf, gold onlay, or PFM?

A

survery BEFORE CEMENT

73
Q

only part of abutment on PFM crown that is okay in porcelain?

A

CLASP TIP OKAY IN PORCELAIN – because it has good compressive strength

rests seats –> in metal
guide planes–> in metal
*because porcelain has poor edge strength

74
Q

all porcelain for restortation abutment material?

A

contra-indicated

75
Q

sequence of restorations..
Before PD?
After PD?

A

ideally all ABUTMENT RESTORATIONS – should be completed BEFORE PD fabrication to ensure accurate fit of PD framework

After PD
- some restorations can be ‘RETRO-FITTED’ or made to a pre-existing PD, as long as enough RESTS remain to reposition the frame

76
Q

only way we can obtain a successful retro-fit?

A

the framework must have sufficient RESTS

77
Q

how to sequence combined fixed/remo cases

A
  1. PD design BEFORE TX PLAN
  2. PD design before crown fabrication
  3. PD design accomodations in crown prep
  4. PD tripod registration for crown casting
  5. PD survey of crowns before cementation
78
Q

material of choice for our framework

A

chromium cobalt

79
Q

is an immediate cast partial denture a definitive tx?

A

YES – but will be relined as the bone and soft tissue heal

80
Q

immediate cast partial denture definition

A

removable DEFINITIVE cast partial denture fabricated for placement IMMEDIATLEY following the removal of a natural tooth/teeth
- acrylic denture base overlyying the extracted teeth will be relined as the bone and soft tissue heal

81
Q

immediate cast partial denture have meshwork?

A

no using LOOPS instead on lingual aspect

- allow us to try in framework

82
Q

can you use steele’s facings with immediate cast partial denture?

A

no

83
Q

after try in (@framework try in) for a immediate cast partial denture what is next?

A

teeth to be extracted are removed from master cast, and the loops are BENT to simulate meshwork and the denture teeth are set in place

and the processing incoprorates the loops as meshwork

84
Q

when are immediate cast partial denture usually done?

A

when there is no time to wait for healing after anterior extractions, where a flange will be used (no facings) and a definitive cast partial prosthesis is required

85
Q

what do the bendable loops provide?

A

retention for the acrylic

Partial Dentures (9 decks)

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