Exam 1

Question 1

List the 5 patient treatment descriptions that would require the “complex” diagnosis and treatment planning procedure covered in this class

Answer 1

4 or more fixed restorations
RPD
Immediate denture opposed by natural teeth
FPD
Implant restoration

Question 2

What is the importance of an accurate diagnostic cast?

Answer 2

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

Question 3

List the pertinent information considered when formulating a treatment plan

Answer 3

Patient History
Chief Complaint
Personal details
Medical History
Dental History
General Exam

Question 4

What is a diagnosis

Answer 4

A typical diagnosis will condense the information obtained during the clinical history taking and exam

Question 5

Differential diagnosis

Answer 5

The most likely cause of condition and are recorded in order of their probability

Question 6

Definitive diagnosis

Answer 6

The actual cause of the condition

Developed after supporting evidence has been assembled

Question 7

What are the General factors that influence the prognosis of treatment

Answer 7

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

Question 8

What are the Local Factors that influence the prognosis of treatment?

Answer 8

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.

Question 9

Describe the facebow procedure in relation to the transverse horizontal axis

Answer 9

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

Question 10

What type of facebow do we use at OSU?

Answer 10

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

Question 11

Describe the arbitrary hinge axis facebow

Answer 11

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

Question 12

What is the puropose of an anterior reference point?

Answer 12

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

Question 13

Non-adjustable articulator

Answer 13

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

Question 14

Semi-adjustable articulator

Answer 14

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

Question 15

What are the two designs of semi-adjustable articulators?

Answer 15

Arcon

Non-arcon

Question 16

Arcon semi-adjustable articulators

Answer 16

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

Question 17

Non-Arcon semi-adjustable articulators

Answer 17

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)

Question 18

What do we use to determine if we should use a semi-adjustable or non-adjustable

Answer 18

It depends on the type/complexity of treatment needs, demands for procedural accuracy, and general expediency

Question 19

What procedures can we use a Semi-adjustable articulator for?

Answer 19

Most routine fixed prostheses

Question 20

What procedures can we use a Non-adjustable articulator?

Answer 20

Many cast restorations

Question 21

Why is it essential that the teeth do no perforate the CR record?

Answer 21

Any tooth contact during record fabrication can cause mandibular translation because of neuromuscular reflexes, rendering the articulation useless

Question 22

Describe the bimanual manipulation technique for making a CR record

Answer 22

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

Question 23

Why is it recommended that CR records be trimmed before articulating casts?

Answer 23

An untrimmed record makes assessment of proper cast seating much more difficult than a properly trimmed record

Question 24

What are examples of anterior programming devices?

Answer 24

Cotton rolls
Leaf gauge
Lucia jig

Question 25

Under what conditions would an anterior programming device be utilized?

Answer 25

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

Question 26

What is the purpose of mounting two sets of casts in the diagnosis and treatment planning of “complex” prosthodontic patienst?

Answer 26

One is prepared to the intended end point of treatment

The other is left unaltered

Question 27

Why is definitive tooth preparation started in one arch only?

Answer 27

So that the occlusal surfaces of the opposing arch are preserved (act as a reference for mounting the definitive cast)
Help establish optimal occlusion

Question 28

Maximal Intercuspal Position

Answer 28

The complete intercuspation of the opposing teeth, independent of condylar position
sometimes referred to as the best fit of the teeth

Question 29

Centric Relation

Answer 29

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

Question 30

Centric Occlusion

Answer 30

The occlusion of the opposing teeth when the mandible is in CR
May or may not coincide with MI

Question 31

What is the significance of examining the amount of horizontal overlap of the max and man incisors before making a CR record?

Answer 31

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)

Question 32

When is a centric relation record recommended?

Answer 32

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

Question 33

What are the Advantages of a Leaf Gauge for making a CR record?

Answer 33

Do not need to manipulate patient into CR - eliminating operator error
Do not have to make an acrylic resin jig
Easy to use

Question 34

What are teh Disadvantages of a Leaf Gauge for making a CR record?

Answer 34

Patient may bite too hard, making it not representative (strained position)
Leaf gauge is not transferable to the cast to aid in mounting procedure

Question 35

What are the advantages of using an anterior acrylic resin jig for making a CR record?

Answer 35

Customizable

Question 36

What are the disadvantages of using an anterior acrylic resin jig for making a CR record?

Answer 36

Takes longer to fabricate

Pt could bite through it