Exam, Diagnosis and Treatment Planning for Edentulous Patients Flashcards
3 DENTURE OCCLUSION
ARRANGEMENTS
- BALANCED
- NON-BALANCED
- LINGUALIZED (can be used with 1,2)
Balanced occlusion (Balanced articulation)
“the bilateral, simultaneous, anterior and posterior occlusal contact of
teeth in centric and eccentric positions” GPT
anatomic, balanced occlusion indications (2)
young, healthy alveolar ridges
good neuromuscular control
hanaus quint (5)
incisal guidance- anterior influence condylar guidance- posterior influence cusp hight (0, 20, 30 degrees) plane of occlusion compensating curve
Condylar guidance is determined
by
the patient’s anatomy
monoplane occlusion: indications (5)
excessive inter-ridge distance skeletal class 2, class3, crossbones successful previous F/F were monoplane limited oral dexterity severely resorbed ridges
Complete edentulism has differing
degrees of —
severity
patient psychological classification (4)
philosophical
extracting/critical
hysterical
indifferent
philosophical (4)
rational, calm, sensible, confident
“you make them, ill wear them”
the majority of patients
prognosis is good
extracting/critical patient (5)
methodical, precise somewhat difficult to please may try to dictate treatment may demand a written guarantee should make a special effort to be neat and organized when treating
hysterical patient (5)
generally in poor health
oral conditions neglected
may blame dentist for poor oral condition
dont make promises
indifferent patients (4)
unconcerned with appearance and chewing
often persuaded by relatives to seek treatment
diet often poor
prognosis poor unless education successful
Make — of the mouth
as the patient presents! Measure
existing —.
impressions
VDO
dental history (2)
chief concerns or why the patient is in the chair
history of previous treatment
medical history (2)
overall health and current medications
interactions causing xerostomia
Radiographic Exam (3)
Panoramic preferred
Evaluate pathosis : root tips, foreign bodies, impacted teeth
Evaluate mucosal thickness, foramen location
“the relationship of oral examination to dental diagnosis” (3)
MM House
a 12 page article describing a classification system of the biologic conditions found in edentulous mouths
13 intra oral items classified
MM House, 1958 (2)
classified biological conditions of inter arch space, muscle tone, arch size, arch form, ridge relations, ridge contours, border tissue attachments, muscles and frenum attachments, palatal throat form, saliva, tongue form, sensitivity of palate, and condition of mucosa class 1, 2, 3
oral exam: ideal to unfavorable (3)
class 1: ideal class2 class 3: unfavorable
oral exam: ridge size
Ideal
large enough for denture stability, small enough to leave room for denture bases and teeth
oral exam: ridge size
unfavorable
too large for positioning of teeth, too small for any stability or support
Small ridge size
House Class —
III
Large ridge size
House Class —
III
oral exam: inter arch space
ideal
space accommodates teeth and bases with esthetic result
oral exam: inter arch space
unfavorable
too little space or too much space (torque lever is applied to denture bases)
oral exam: ridge form
ideal
square to gently rounded
oral exam: ridge form
unfavorable
tall, thin, undercut
Tuberosities (5)
Space ? Dental mirror thickness –a guide Dental mirror handle –2 denture bases Ideal = 5-6 mm (Choy E., General Dentistry, May-June, 1977) Minimum = 4 mm
Tuberosity/ridge exam
Look and Feel! (2)
Use your gloved first finger to feel the buccal and lingual ridge contours
Mark (draw on) the diagnostic casts for communication with the patient
and surgeon
bony undercuts: unilateral
may be ok
bony undercuts: bilateral
may need surgical correction
sharp area of ridge: — needed
surgery
Palatal Torus (4)
Bony enlargement at midline of hard palate
20 - 25% of population
More prevalent in women
Maximum size in 3rd or 4th decade
Palatal torus
surgical removal when: (4)
Large and fills palatal vault
Is undercut
Encroaches on vibrating line
Pnt is concerned that it is cancer
mandibular tori (3)
dense cortical bone covered by a. very thin later of mucous membrane
extremely susceptible to irritation from denture base
best treatment is surgical removal
Palatal vault form
Ideal is
medium depth with well-formed rugae
Palatal vault form
Flat =
poor resistance to horizontal movement of denture
Palatal vault form
High, narrow, deep =
rapid break of peripheral seal and poor retention
Soft Palate
Class I =
Class II
Class III =
ideal (5 –12 mm available)
——– (3 - 5 mm tissue available)
unfavorable(< 3 mm available)
Border attachments:
Ideal =
muscle/ frenum attachments are 10 mm or
more from crest of ridge
Border attachments:
Unfavorable =
attachments near crest of ridge and
may interfere with peripheral seal
The tongue and complete dentures
major impact areas: (3)
Border seal
Tooth placement
Speech
Normal tongue position (3)
Fills floor of mouth
Lateral borders lie on post. alveolar ridge
Apex approximates ant. alveolar ridge
Retruded tongue (4)
25% of edentulous pnts
Border seal is absent
Stabilizing influence of tongue is absent
Retention/ function of mandib. CD difficult
tongue size
enlarged tongue- (2)
exerts constant dislodging force on mandibular denture
adaptation to denture may require months of dedicated effort
saliva (4)
plays important role in denture retention
quantity and quality important
xerostomia from meds and systemic diseases
xerostomia patients- prognosis for CD success is guarded to poor
denture history (5)
years edentulous? previous dentures/current dentures successful? expectations? attainable? multiple sets of dentures made in a short time- not a good sign
Evaluate existing dentures and make
impressions of them as reference (6)
Phonetics, esthetics, stability, retention, lip support, OVD
prognosis (3)
advise patient of findings and discuss the prognosis: good, fair, poor
educate patient about his/her role in mastering the use of dentures
chewing efficiency: 20-25% natural teeth
Complete edentulism has differing
degrees of —.
severity
Classification system for complete edentulism Class I --- Class II -- Class III -- Class IV –
straightforward
denture-supporting anatomy degraded
anatomy degraded; surgical revision needed; additional factors present
most debilitated edentulous condition
Classification system for complete edentulism
Diagnostic criteria are organized by their
objective nature and not in their rank of significance.
Bone height –
mandibular only
Residual ridge morphology –
maxillary only
Muscle attachments –
mandibular only
classification system for complete edentulism
in those instances when a patients diagnostic criteria are mixed between two or more classes, any single criterion of a more complex class places the patient into the more complex class ACP 1 ACP 2 ACP 3 ACP 4
