Exam 1 Flashcards
List the 5 patient treatment descriptions that would require the “complex” diagnosis and treatment planning procedure covered in this class
4 or more fixed restorations RPD Immediate denture opposed by natural teeth FPD Implant restoration
What is the importance of an accurate diagnostic cast?
Accurate casts transferred to an articulator permit:
- Static and dynamic relationships of the teeth to be examines without interferences from the neuromuscular reflexes
- Unencumbered views from all directions reveal aspects of occlusion not always detectable intraorally
- Occlusocervicl dimension of edentulous spaces can be examined, as well as the relative alignment and angulation of proposed abutment teeth, and detailed analysis of the occlusal plain
List the pertinent information considered when formulating a treatment plan
Patient History Chief Complaint Personal details Medical History Dental History General Exam
What is a diagnosis
A typical diagnosis will condense the information obtained during the clinical history taking and exam
Differential diagnosis
The most likely cause of condition and are recorded in order of their probability
Definitive diagnosis
The actual cause of the condition
Developed after supporting evidence has been assembled
What are the General factors that influence the prognosis of treatment
Age of pt
Lowered resistance of the oral environment
Patient’s understanding and comprehension of plaque control measures
Physical ability to perform tasks
Systemic problems analyzed with patient’s age
Diabetes
Hx of success of previous dental procedures
What are the Local Factors that influence the prognosis of treatment?
Forces applied to a given tooth
Access for oral hygeine measures
Observed vertical overlap of how anterior teeth impact on load distribution
Tooth mobility, root angulations, tooth morphology, C-R ratios, etc.
Describe the facebow procedure in relation to the transverse horizontal axis
Facebows record the A-P and M-L spatial position of the maxillary occlusal surfaces relative to this transverse opening and closing axis of the patient’s mandible.
The facebow is then attached to the articulator to transfer the relationship of the patient’s maxilla to their mandible, and the mandible is attached in relation to the maxilla
What type of facebow do we use at OSU?
Denar Slidematice Quick Mount arbitraty hinge axis facebow (not kinematic)
Uses a 43mm superior to the incisal edge of maxillary central incisor as an anterior reference point
Describe the arbitrary hinge axis facebow
These facebows approximate the horizontal transverse axis
The relationship to the true axis falls within an acceptable degree of error
An easy landmark such as the external acoustic meatus stabilizes the bow, and is aligned with the ear pieces that go in the ear
They are self centering and give an accurate relationship for most diagnostic and restorative procedures
A minimum of 5 mm error from axis can be expected
Arbitrary facebows are less accurate than the kinematic ones, but they suffice for most routine dental procedures
What is the puropose of an anterior reference point?
It enables the clinician to duplicate the recorded position on the articulator at future appointments, thus saving time
Points such as the inner canthus of they eye or a freckle, or mole on the skin can be used
You can mount other casts without having to redo the facebow process and average values for posterior articulator controls can be used without having to readjust the instrument
Non-adjustable articulator
Does not reproduce the full range of mandibular movements
The distance between the hinge and the tooth to be restored is significantly less in the patient
Arcing on the non-adjustable articulator results in steeper travel
Error when set with protrusive interocclusal records because the condylar path is not fixed in relation to the maxillary occlusal plane
Semi-adjustable articulator
Articulated casts can be positioned with sufficient accuracy so that arcing errors are minimal
Adjustable condylar inclination/side shift mimic patient movements
Error when set with protrusive interocclusal record, that is the maxillary occlusal plane and condylar inclination can become more parallel
What are the two designs of semi-adjustable articulators?
Arcon
Non-arcon
Arcon semi-adjustable articulators
Condylar spheres are attached to lower conponent and mechanical fossae are attached to the upper member
Angulation of mechanical fossa is fixed in relation to the occlusal plane of the maxillary cast
More anatomically correct
Non-Arcon semi-adjustable articulators
Led to some inaccuracies because the movements are “backward” (angulation of the mechanical fossae is fixed in relation to the occlusal plane of the mandibular cast)
What do we use to determine if we should use a semi-adjustable or non-adjustable
It depends on the type/complexity of treatment needs, demands for procedural accuracy, and general expediency
What procedures can we use a Semi-adjustable articulator for?
Most routine fixed prostheses
What procedures can we use a Non-adjustable articulator?
Many cast restorations
Why is it essential that the teeth do no perforate the CR record?
Any tooth contact during record fabrication can cause mandibular translation because of neuromuscular reflexes, rendering the articulation useless
Describe the bimanual manipulation technique for making a CR record
Dental chair is reclined
Patient’s head cradled with both thumbs on the chin and fingers resting firmly on inferior border of the mandible
Downward pressure on thumbs
Upward pressure on the fingers
(These pressures manipulate the condyle-disk assemblies into their fully seated positions in the mandibular fossae)
Next, the mandible is hinged along the arc of the terminal hinge closure
Why is it recommended that CR records be trimmed before articulating casts?
An untrimmed record makes assessment of proper cast seating much more difficult than a properly trimmed record
What are examples of anterior programming devices?
Cotton rolls
Leaf gauge
Lucia jig
Under what conditions would an anterior programming device be utilized?
Used when CR doesn’t coincide with MI, where resistance is encountered when hinging the mandible because of well-established protective reflexes
These patients don’t allow their mandibles to be manipulated easily
Anterior programming devices prevent tooth contact so that the patient “forgets” these reflexes
What is the purpose of mounting two sets of casts in the diagnosis and treatment planning of “complex” prosthodontic patienst?
One is prepared to the intended end point of treatment
The other is left unaltered
Why is definitive tooth preparation started in one arch only?
So that the occlusal surfaces of the opposing arch are preserved (act as a reference for mounting the definitive cast)
Help establish optimal occlusion
Maximal Intercuspal Position
The complete intercuspation of the opposing teeth, independent of condylar position
sometimes referred to as the best fit of the teeth
Centric Relation
The maxillomandibular relationship in which the condyles articulate with the thinnest avascular portion of their respectie disks with the complex in the most anterior-superior position against the shapes of the articular eminences
This position is independent of tooth contact
The position is clinically discernable when the mandible is directed superior and anteriorly
Restricted to a purely rotary movement about the THA
Centric Occlusion
The occlusion of the opposing teeth when the mandible is in CR
May or may not coincide with MI
What is the significance of examining the amount of horizontal overlap of the max and man incisors before making a CR record?
The amount of horizontal overlap will remain the same or increase slightly depending on the amount of discrepancy between a patient’s CR and MI position
A reduction in amount of horizontal overlap will ONLY occur if the patient is biting in a protrusive position (most common reason for CR record error)
When is a centric relation record recommended?
Restoring all posterior teeth (in one or both arches)
Minimal opening of vertical dimension of occlusion
Restoring all teeth in once arch
Complete dentures
Occlusal equilibration
What are the Advantages of a Leaf Gauge for making a CR record?
Do not need to manipulate patient into CR - eliminating operator error
Do not have to make an acrylic resin jig
Easy to use
What are teh Disadvantages of a Leaf Gauge for making a CR record?
Patient may bite too hard, making it not representative (strained position)
Leaf gauge is not transferable to the cast to aid in mounting procedure
What are the advantages of using an anterior acrylic resin jig for making a CR record?
Customizable
What are the disadvantages of using an anterior acrylic resin jig for making a CR record?
Takes longer to fabricate
Pt could bite through it
