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Removable Prosthodontics > Final Revision > Flashcards

Final Revision Flashcards

1
Q

Which are the main components of an RPD?

A 
saddles
guide planes
reciprocation
type of prosthesis
direct retainers: clasps
artificial teeth
minor connectors
major connector/denture base
rests
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2
Q

Clinical Indications of RPD:

A
  • need for cross-arch stabilisation
  • prophylaxis (TMJ)
  • absence of adequate periodontal support (won’t support fixed prosthesis)
  • long edentulous spans
  • need to replace existing RPD
  • failed fixed bridgework
  • need for an immediate or temporary prosthesis
  • financial limititations
  • patient’s preference
  • implants are contraindicated
  • remaining teeth not suitable abutments for fixed bridge
  • missing large number of teeth on both sides of the arch
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3
Q

Clinical Containdications of RPD:

A
  • several unsuccessful previous attempts to provide satisfactory RPD
  • non complaint patient/poor OH
  • aesthetic demands impossible to satisfy
  • patient expectations are non realistic
  • implants placement may be possible with careful planning
  • remaining teeth not suitable abutments for an RPD
  • missing small number of teeth on one side of the arch
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4
Q

What is the treatment planning sequence?

A
  • listen
  • examine
  • special tests
  • evaluate
  • discuss treatment
  • reach agreement on treatment plan
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5
Q

What should be the No 1 priority when examining a new patient for the first time?

A

-screening for oral cancer and head & neck cancer

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6
Q

What is the treatment provision sequence?

A
  • pain relief
  • perio and endo treatment
  • stabilization/temporization
  • direct/indirect prostho & non-urgent endo
  • prosthodontics
  • maintenance
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7
Q

Anatomical features of maxilla?

Labial / buccal sulci
Residual alveolar ridge
Buccal shelf
Labial / buccal frena
Incisive papilla
Rugae
Labial / buccal lingual sulci
Labial / buccal lingual frena
Genial tubercles
Retromylohyoid fossa
Retromolar pad
Palatine raphe
(Palatine torus)
Palatal gingival remnant
Vibrating line / soft & hard palate junction
(Mandibular tori) 
Mylohyoid ridge
Fovea palatin
Maxillary tuberosity
Hamular notch
A 
Labial / buccal sulci
Labial / buccal frena 
Incisive papilla
Rugae
Residual alveolar ridge
Palatine raphe
(Palatine torus)
Palatal gingival remnant
Vibrating line / soft & hard palate junction
Fovea palatin
Maxillary tuberosity
Hamular notch
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8
Q

Anatomical structures of mandible:

Labial / buccal sulci
Residual alveolar ridge
Buccal shelf
Labial / buccal frena
Incisive papilla
Rugae
Labial / buccal lingual sulci
Labial / buccal lingual frena
Genial tubercles
Retromylohyoid fossa
Retromolar pad
Palatine raphe
(Palatine torus)
Palatal gingival remnant
Vibrating line / soft & hard palate junction
(Mandibular tori) 
Mylohyoid ridge
Fovea palatin
Maxillary tuberosity
Hamular notch
A 
Labial / buccal lingual sulci
Labial / buccal lingual frena
Genial tubercles
(Mandibular tori) 
Residual alveolar ridge
Buccal shelf
Mylohyoid ridge
Retromylohyoid fossa
Retromolar pad
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9
Q

Why is it so important to know all anatomical features of an RPD?

A
  • to avoid them
  • to guide us on setting up the teeth
  • to determine/limit denture extension
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10
Q

What biomechanical considerations do we need to have for an RPD?

A

forces applied to the tissues and to the RPD

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11
Q

Sequalae on using RPD:

A

damage to remaining teeth, periodontium, residual alveoar ridge

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12
Q

RPD design step by step:

A
  • select POI
  • mark teeth being replaced
  • indicate positions and depth of undercuts
  • plan: support, retention, stability
  • join all components to major connector
  • indirect retention
  • direct retainers
  • review
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13
Q

5 hazards in dental laboratory:

A

cross infection, fire, liquids, sharps and rotary instruments, eye injuries

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14
Q

Aims for preliminary jaw relationship registration:

A
  • occlusion for diagnosis and treatment planning

- space for artificial denture teeth and other RPD components

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15
Q

What is MIP?

A

ICP
max intercuspal position
=teeth in max contact for an individual’s occlusion
-> best fit of teeth regardless of condylar position

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16
Q

What is RCP?

A

retruted contact position

=GUIDED occlusal relationship occuring at the most retruted position of condyles in the joint cavities

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17
Q

What is Retruted position?

A

same as RCP when there are no tooth contacts

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18
Q

What do we use to determine vertical dimension of occlusion?

A

wax bases and occlusal rims

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19
Q

Why do we need to establish a specific vertical dimension of occlusion first?

A

first OVD

after Jaw relationship

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20
Q

Surveying of primary casts for RPD design steps:

A
  • preliminary visual assessment
  • initial survey: Horizontal
  • tilting the cast: Ant or Post -> avoid interferences, maximize retention and improve appearance
  • final survey: ensure undercuts present both tilted and horizontal positions
  • mark the tilt
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21
Q

Direct retention definition and example:

A

= prevents dislodging forces

ex: clasp (contains: reciprocal arm, minor connector, occlusal rest, retentive arm)

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22
Q

Indirect retention definition and example:

A

=resistance against rotational movement of a saddle away from the tissues around the major clasp axis
ex: (occlusal) rests

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23
Q

Tooth loss can be associated w/:

A

behaviour

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24
Q

What is risk analysis in relevance to RPD?

A

human error

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25
Q

Never make assumptions and always demonstrate to the patient

A

:)

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26
Q

Where to start if risks are involved?

A

yourself, dental team, patient, treatment outcome

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27
Q

What are the risks to the patient?

A
  • direct injury
  • direct trauma
  • inhalation/swallowing small instruments
  • treatment complications-> unsuccessful treatment outcome, damage to the remaining tissues, damage to the patient
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28
Q

What are the treatment complications specific to RPD?

A
  • unretentive, unstable, poorly supported
  • not well fitting
  • not aesthetically acceptable
  • patient unable to eat w/ the rpd
  • technical complications
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29
Q

Damage to the remaining tissues:

A

bone, soft tissues, abutment teeth, non-abutment teeth

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30
Q

Damage to the patient:

A

swallowing/inhalation or rpd or components, tmj symptoms, allergic reaction, cross infection

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31
Q

SOS

General rules to avoid damage to remaining tissues by RPD?

A
  • correct abutment tooth preps
  • occlusal forces transferred to healthy periodontium
  • only cover as little of tooth surfaces as possible
  • avoid covering gingival margins and soft tissue as much as possible
  • maintain 3mm distance b/w gingival margins and RPD components
  • ensure retention, support, stability to minimize movement of RPD
  • avoid creating food traps
  • ensure occlusion is correct
  • monitor regularly and modify
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32
Q

SOS

Common reasons for RPD failure:

A

failure to:

  • undestand patient’s expectations
  • communicate
  • explain treatment options
  • ensure patient what the treatment plan will involve
  • treatment planning and treatment provision in correct order

specific to RPD:

  • occlusion
  • aesthetics
  • RPD design
  • RPD fabrication
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33
Q

Where can poor nutrition lead to?

A
  • reduced immunity
  • increased susceptibility to disease
  • impaired physical and mental development
  • reduced productivity
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34
Q

What are the short term effects of poor nutrition?

A
  • stress
  • tiredness
  • capacity of work
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35
Q

What is good nutrition?

A

variety of foods from 5 groups each day

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36
Q

SOS

Components of masticatory system:

A

teeth
supporting tissues
jaws
TMJ
muscles involved directly/indirectly in mastication
vascular and nervous systems supplying these

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37
Q

What is the oral manifestation of vitamin A deficiency?

A

decreased salivary flow
dryness and keratosis of oral mucosa
decreased taste acuity

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38
Q

What is the oral manifestation of vitamin K deficiency?

A

increased blood blotting time following surgery

spontaneous bleeding of gingival tissues

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39
Q

What is the oral manifestation of Niacin deficiency?

A

filiform papillae exfoliation
red sore tongue
tongue and B mucosa burning sensation

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40
Q

What is the oral manifestation of Riboflavin deficiency?

A

angular cheilitis

red ‘plebby’ tongue

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41
Q

What is the oral manifestation of Folic Acid deficiency?

A

smooth red tongue
gingival inflammation
tongue and B mucosa erosions

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42
Q

What is the oral manifestation of vitamin C deficiency?

A

delayed healing

easily abraded tissues

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43
Q

What is the oral manifestation of Water deficiency?

A

dehydration of tissues

resulting in xerostomia

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44
Q

SOS

Masticatory ability defintion:

A

= individual’s own assessment of masticatory function

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45
Q

Masticatory efficiency defintion:

A

= time required to reduce food to a certain particle size

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46
Q

Patients w/ assymetric short dental arch:

A

unilateral chewing is prevalent

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47
Q

Masticatory performance definition:

A

=indicated by particle size and food distribution when chewed for a given # of strokes / time

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48
Q

Occlusal force measurements definition:

A

=measure functional forces when biting/chewing

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49
Q

Electromyography definition:

A

records muscle activity during chewing and maximal biting

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50
Q

What is a masticatory system?

A

=functional unit

-> functional and STRUCTURAL DISTURBANCE

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51
Q

ICP cases for Kennedy class IV:

A

avoid anterior contacts in ICP b/c in protrusion it will lose its stability

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52
Q

Non-ICP cases occlusal contact relationships for RPDs:

A

ensure its a non ICP case
wax bases and occlusal rims to establish OVD
the aim is to achieve a balanced occlusion

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53
Q

ICP cases occlusal contact relationships for RPDs:

A

post teeth provide simultaneous bilateral contacts
aim for canine guidance if there are concerns about stability of the RPD
you can ‘discover’ natural tooth contacts by guiding the mandible in RCP

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54
Q

Basic requirements for optimal occlusion:

A
  • as many teeth as possible in ICP
  • any slide from RP to ICP should be small and in a forward direction
  • smooth, unrestricted movement in lateral excursions; any contact should be on the working side
  • anterior tooth contacts bilaterally in protrusion
55
Q

Cross arch stability definition:

A

=resistance against dislodging/rotational forces by teeth on opposite dental arch from edentulous space

56
Q

Major connector definition:

A

=component of RPD connecting parts of it on one side of arch to those on the other side
-> provides cross arch stability to resist functional forces

57
Q

Basic requirement of major connector?

A

rigidity
-ensures occlusal loads are evenly spread throughout the available supporting structures so smaller loads applied per surface area unit so less risk of damaging supporting structures

58
Q

What happens if a major connector is flexible?

A
  • damage to supporting tissues/structures
  • patient discomfort
  • ineffective RPD (eg: lack of retention, stability, support)
59
Q

Basic design considerations of major connector:

A
  • do not extend to moveable tissue (non-attached mucosa)
  • avoid impinging on gingival tissues -> allow 3-4mm distance b/w major connector and gingival margins
  • do not leave unnecessary ‘dead spaces’ of gingival margins
  • avoid bony/soft tissue undercuts in placement/removal
  • provide relief in areas of possible interference
  • SOS consider possible rotation of free end saddle of RPDs
  • biocompatible
  • do not interfere w/ tongue movements
  • do not substantially alter the natural contours of the lingual surface of the mandibular alveolar ridge and palatal vault
60
Q

Mandibular major connectors:

lingual plate
palatal bar
lingual bar
palatal strap
sublingual bar
palatal plate
lingual bar w/ cingulum bar
cingulum bar
labial bar
u-shaped connector
A 
lingual plate
lingual bar
sublingual bar
lingual bar w/ cingulum bar
cingulum bar
labial bar
61
Q

Maxillary major connectors:

lingual plate
palatal bar
lingual bar
palatal strap
sublingual bar
palatal plate
lingual bar w/ cingulum bar
cingulum bar
labial bar
u-shaped connector
A

palatal strap
palatal plate
palatal bar
u-shaped connector

62
Q

Lingual bar properties:

A
  • requires min 7-8mm height b/w lingual sulcus and gingival margins
  • 3-4mm clearance to gingival margins for hygiene (below)
  • 1st choice
  • thicker inf. and tapered sup.
  • trim and polish the inf border but not too much
  • avoid impinging of soft tissues, especially in K class 1
63
Q

Lingual bar ADV:

A

hygienic
aesthetics
rigid
avoids tongue movement interference

64
Q

Lingual bar DISADV:

A

requires sufficient height
not easy to add teeth
doesn’t contribute to support or indirect retention

65
Q

Lingual plate properties:

A
  • LESS than 8 mm height b/w gingival margins and floor
  • inf border placed more superiorly
  • shouldn’t extent above the middle third of the teeth
  • sup. part as thin as possible
  • should incorporate cingulum rests on either end
  • must follow teeth contours
66
Q

Lingual plate ADV:

A
  • can add teeth
  • can be used to splint perio compromised teeth
  • very rigid
  • prevents food trapping
  • contributes to support and retention
  • comfortable
67
Q

Lingual plate DISADV:

A
  • challenging to ensure close fit
  • may become visible
  • covers wider area of teeth and soft tissues
  • requires better OH
68
Q

Sublingual bar properties:

A
  • LESS than 8 mm b/w gingival margins and mouth floor
  • more inf. and post. placement than Lingual bar
  • when there is soft tissue undercut
69
Q

Sublingual bar ADV:

A

aesthetic

more hygienic

70
Q

Sublingual bar DISADV:

A

impression technique sensitive
not used when there is high frenulum / mandibular tori attachement
not easy to add teeth
does no contribute to support or indirect retention

71
Q

Palatal strap properties:

Ant and post palatal strap properties:

A

Palatal strap:
Kennedy class 3 cases
rigid w/o being too bulky
shouldnt extend beyond occlusal rests

Ant and post palatal strap:
very rigid
all Kennedy classes
thin as possible
even when there is maxillary torus
72
Q

Palatal strap ADV:

A

rigidity

midpalatal straps cause little tongue interference; acceptable by patients

73
Q

Palatal strap DISADV:

A

ant straps interfere w/ tongue
difficult to cast and ensure close fit
post straps not well tolerated if extending too far posteriorly

74
Q

Palatal plate properties:

A 
covers more than half of palate
requires close tissue adaptation
thin as possible
aim to replicate natural soft tissue contours of palate
may be extended post w/ acrylic
75
Q

Palatal plate ADV:

A

rigidity
support
well tolerated
easy to add teeth

76
Q

Palatal plate DISADV:

A

increased weight
increased demands for indirect retention
extended tissue coverage

77
Q

Minor connectors definition

A

=components that connect major connector to the clasp assembly, indirect retainers, occlusal and cingulum rests
-> transfer occlusal loads to abutment teeth and STABILIZE components

78
Q

Minor connector location and properties:

A

location: embrasures, proximal surfaces

properties:

  • should be rigid but not bulky
  • reciprocation
  • lingual embrasures need to make space for them in order to place the minor connectors on them to avoid tongue interference
79
Q

Why are rest seat preps necessary?

A
  • ensures V loading (better)
  • avoid H loading
  • avoid occlusal interference (teeth fracture)
  • avoid rotation of base

occlusal rests on molars and premolars
cingulum rests on canines

80
Q

RPD retention definition:

A

=RPD resistance to be displaced AWAY from supporting tissues

81
Q

Which forces tend to displace an RPD from supporting tissues?

A

gravity
tongue
sticky food

82
Q

Which is our primary concern?

retention
stability
support

A

support

-> if an RPD is poorly supported, occlusal forces acting across a fulcrum are conveyed to other parts of the RPD as displacement forces

83
Q

Types of intracoronal RPD direct retainers:

A

precision attachements

semiprecision attachements

84
Q

Types of extracoronal RPD direct retainers:

A

clasps

attachments

85
Q

Disadvantages of Attachements:

A
  • need to place crowns
  • expensive
  • increased difficulty
  • increased maintenance needs
  • require increased interarch space
  • less hygienic (extracoronal)
86
Q

Clasps definition:

A

=RPD components designed to provide mechanical retention through a flexible clasp arm, which engages an external surface of an abutment tooth in a cervical area to the greatest convexity of the tooth

-> direct retainers

87
Q

Rest function and location:

A

=support

occlusal, incisal or cingulum rests

88
Q

Proximal plate function and location:

A

stabilisation + determines path of insertion and removal

proximal surfaces. onto prepared guide planes

89
Q

Clasp function and location:

A

middle third or above the survey line -> first 2/3: stabilization

gingival third, in measured undercut -> final 1/3: retention

90
Q

Reciprocal arm function and location:

A

reciprocation

-middle third of the crown, opposite surface of the clasp

91
Q

Important considerations of clasp design:

A
  • depth of undercut
  • exact position of termination of the clasp into the undercut
  • flexibility
  • visibility
  • support
  • protection of the abutment tooth
  • risk of clasp fracture
92
Q

SOS

What factors does flexibility depend on?

A
  • length
  • thickness
  • shape (cross section)
  • material
  • fabrication method
93
Q

Clasp length:

A
  • gingivally approaching clasps longer than occlusal
  • the longer the clasp, the more flexible
  • stabilizing arm incorporated in acrylic so less flexible
  • reduced flexibility w/ half round form lying in several planes (not a straight line)
94
Q

SOS

Indirect retainer definition:

A

=RPD component which prevents vertical displacement of the distal extension denture base when it tries to move away from the tissues in pure rotation around the fulcrum line

95
Q

Indirect retainers types:

A 
auxiliary occlusal rests
canine rests
canine extension from occlusal rests on premolars
palatal major connector
modification areas
cingulum bars or lingual plates
96
Q

Denture base function:

A

supports artificial teeth
transfers occlusal forces to supporting tissues
aesthetics
stimulation of underlying tissues

97
Q

Metal denture base ADV:

A
  • biocompatible
  • R to fracture
  • thermal conductivity
  • can be thinner
  • rigid
  • close tissue adaptation
  • does not deform over time
98
Q

Metal denture base DISADV:

A
  • expensive
  • increased weight
  • adjustments, modifications and relining difficult/impossible
99
Q

Considerations regarding the dentition prior to RPD provision:

A 
dental charting
perio condition
endo condition
occlusion
occlusal plane
interarch space
amount of teeth 'showing'
100
Q

Decision of extraction or restoring a tooth:

A
  • strategic value of tooth
  • amount of effort to restore/replace it
  • rest of dentition condition
  • objective criteria (ex: DPI)
  • operator ability
  • patient preference
  • patient’s general condition
101
Q

Dental Practiality Index ADV:

A 
structural integrity
perio state
endo state
local factors
general factors
102
Q

Dental Practiality Index:

0
1
2
4
6
>6
A 
0 - no intervention
1 -simple treatment
2 -more complex treatment
4 -denture / bridge abutment
6 -treatment not generally considered practical
>6 -implants
103
Q

When should direct/indirect restorations be done?

A

prior to 2ry impressions
after RPD design
after the treatment plan is finalised

104
Q

Interdigitation:

A

set up the RPD BEFORE the fabrication of opposing occlusal restorations to maintain occlusal anatomy of denture teeth

105
Q

Types of preps on RPD abutments:

A 
temporization
perio treatment
endo treatment
direct restorations
RPD preps
prep for indirect restorations
106
Q

Guide plane preps:

RECIPROCATION

A

3 mm height
remove > 0.5 mm of enamel
diamond bur
as far away from gingival margins as possible

107
Q

direction of seating crown different to RPD POI

A

:)

108
Q

Tooth & mucosa supported RPDs support is gained from:

A

depends on residual ridge

NOT from tooth or direct retention at the distal end
Indirect retention becomes more important

109
Q

Support of a distal extension base:

A
  • residual ridge
  • RPD framework design
  • total occlusal load applied
  • impression technique
  • accuracy of fit of denture base
  • extent of residual ridge coverage by denture base
110
Q

Ideal residual ridge:

A
  • cortical bone covering dense cancellous bone w/ a broad, rounded crest and high vertical slopes
  • firm, dense fibrous CT covering
111
Q

Thinner loading bearing areas in:

A

mandible

112
Q

Unfavourable residual ridge:

A
  • mobile mucosa
  • sharp ridge crest
  • thin traumatized mucosa
113
Q

SOS

Muco-static impression technique:

aim:
impression tray:
material of choice:

A

-no border moulding
aim: record soft tissues in their ‘anatomic form’
impression tray: spaced
material of choice: impression plaster

114
Q

SOS

Muco-compressive impression technique:

aim:
impression tray:
material of choice:

A

-close fitting custom tray
aim: record soft tissues in their ‘functional form’
impression tray: viscous
material of choice: ZOE paste OR impression wax

115
Q

SOS

Selective pressure impression technique:

aim:
impression tray:
material of choice:

A

-spacing of custom tray is different depending on location
aim: compress soft tissues only in main load bearing areas
impression tray: viscous
material of choice: ZOE paste
alternatively: impression wax, polyether

116
Q

Custom made device definition:

A

=manufactured in accordance w/ a written prescription, under his responsibility, specific characteristics as to its design

117
Q

Min requirement for Custom made device:

A
  • device identification
  • features extracted to define the particular device
  • exclusive use by a particular patient
  • ‘custom made device’ label
  • conforms to all relevant essential requirements
  • name of qualified person
  • name and address of manufacturer
118
Q

If you only provide a design sheet, what important info will you fail to convey?

A

POI
undercuts location for finishing clasps
exact major connector outline
flange extension

119
Q

What other adjustments are needed at placement of RPD?

A 
polished surfaces
pink acrylic
small inaccuracies
expansion of plaster/acrylic
occlusion again, before delivery
120
Q

SOS

Interim prosthesis definition:

A

=a dental prosthesis designed to enhance aesthetics, stabilization and/or function for a limited period of time

121
Q

What makes an RPD a temporary one?

A
  • duration of use

- purpose of use

122
Q

If a temporary RPD is used longer than initially intended the risks to the abutment teeth are:

A

lateral forces
excessive occlusal forces
caries

123
Q

If a temporary RPD is used longer than initially intended the risks to periodontal tissues are:

A

denture bearing mucosa
periodontitis
residual alveolar ridge resorption

124
Q

If a temporary RPD is used longer than initially intended the risks to the interim prosthesis are:

A

denture base fracture

artificial teeth fracture

125
Q

If a temporary RPD is used longer than initially intended the risks to the patient are:

A

confidence loss
swallowing/inhalation of fractured part of interim RPD
develop habits

126
Q

SOS

Provisional RPD to maintain space until definitive treatment is completed:
-adult patients: prevent migration of adjacent teeth or overeruption of opposing teeth

A

:)

127
Q

SOS

Provisional RPD to assess and establish occlusal changes:

  • most common: INCREASE in OVD
  • fixed and removable options: RPD vs cast splint vs adhesive techniques
  • overdenture vs overlay denture
A

:)

128
Q

SOS

Never use a mucosa supported RPD to increase the OVD as a definitive treatment option

A

:)

129
Q

SOS

Stability definition:

A

=prosthesis resistance to horizontal displacement

130
Q

SOS

Interim restoration during treatment - typical time frame:

A

perio: 1-2
endo: 1/tooth
fixed: tooth/core built up
removable: 4-5 min
implant: 1-2
ortho: few months-few years

131
Q

SOS

Temporary RPDs as training prostheses for perio patients:

  • unless there are underlying medical conditions and/or aggressive periodontitis cases, these patients often are in denial of severity of their condition
  • dental anxiety
  • easier to accept RPD than CD
A

:)

132
Q

What are the consequences of advanced residual ridge resorption on prostho treatment to replace the missing teeth?

advanced residual ridge resorption DOESNT MEAN loss of denture support

A
  • ve impact on biomechanics of implant restoration
  • reduced RPD support and stability
  • increased RPD bulk

aim: maitain close denture base adaptation

133
Q

SOS

Indications of relining tooth & mucosa supported RPD:

A
  • SUPPORT FOR THE FREE END SADDLES
  • food trapping
  • discomfort
  • denture not fitting well
  • advance residual ridge resorption presence (space underneath the saddle)
134
Q

How do we assess clinically for need for relining?

A

assess the occlusion, assess the rpd support in the free end saddles

Removable Prosthodontics (1 decks)

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