Finishing and delivery of RPDs

Question 1

what are the aims of the delivery visit?

Answer 1

• denture is a good and accurate fit
• denture is comfortable
• patient is able to insert and remove denture
• patient knows how to clean denture
• patient knows what to expect when wearing a new denture
• patient knows the risks if denture is not maintained properly

Question 2

how are finished dentures usually returned?

Answer 2

• returned in a sealed bag with water to keep moist
• can ask for the master casts to be returned with it and ideally on the articulator

Question 3

why are casts often broken?

Answer 3

casts are hard unlike soft tissues so the cast is sometimes broken in order to remove the denture from them

Question 4

what is the procedure before the patient arrives?

Answer 4

• check it is the correct patient’s lab work
• check there is no damage to the framework following acrylic processing
• check the acrylic for porosity or plaster inclusions
• look for areas of undercuts or where it may rub
• check the fitting surface for **rough edges **or acrylic nodules and remove
• check for acrylic flash at junction with CoCr (when acrylic extends over intended boundary)
• place in perform to disinfect

Question 5

what is the procedure when the patient arrives?

Answer 5

• let them know what you are going to be doing
• explain that dentures may need adjusted to get them to fit and this is normal
• look in the mouth with old dentures in place and with dentures and look at occlusion

Question 6

what should you be wary of when inserting the denture?

Answer 6

• carefully seat one at a time
• don’t force it in - large undercuts may make it hard to remove

if it doesnt go in:
* are you following the path of insertion
* is it touching a tooth or gum? ask patient
* adjust with a straight handpiece and acrylic bur

Question 7

what should you do once the denture is fully seated?

Answer 7

1. check adaption of major connector to soft tissues and teeth
2. check fit of rests, clasps and flanges
3. listen to patient, they will tell you about: denture not seating, painful areas, movement, dislodgement, problems with bite
4. check the frenal attachment has space to move - adjust v shape in denture with handpiece
5. check the extensions for rubbing (blanching) - use presssure indicating paste if you can’t see where and patient reports pain
6. check retention - Adam’s pliers can adjust clasps to tooth surface
7. check the occlusion - use articulating paper to identify premature contacts and deflective contacts and adjust chairside with acrylic bur or re-record occlusion, remount and adjust in lab
8. check appearance - centre line, shade, incisal plane, blending with matural teeth
9. check speech - assessed when talking to patient and asking how denture is

Question 8

how do you use pressure indicating paste?

Answer 8

1. dry the denture
2. put some paste where the patient feels it is rubbing or where you want to check
3. carefully insert denture and manipulate tissues
4. in areas of excess pressure (overextension), there will be bare spots
5. relieve these areas slightly - adjust chairside with straight handpiece
6. rub off old paste and repeat

Question 9

where do you get retention from?

Answer 9

• soft tissue undercuts
• adhesion (saliva and palate)
• path of insertion vs. path of displacement
• clasps
• correct denture extension into sulci

Question 10

how do you check appearance of a denture in a patient?

Answer 10

• stand behind the patient when they look in a mirror
• get them to say ‘f’ to see how much tooth is showing

Question 11

what lab adjustments can you make after delivery of dentures?

Answer 11

• place in perform
• make adjustments chairside or in lab with a handpiece
• smooth the smooth surface with pumice and water, slow speed and brush
• polish the smooth surface with a high speed, wool mop and rouge

Question 12

what instructions should you give the patient?

Answer 12

• what to expect from dentures
• how to clean and store them
• how to contact you if there is a problem
• refer to patient information leaflets

Question 13

what information should you give a patient about what to expect?

Answer 13

1. pain - take denture out and use old denture
2. eating - start with soft foods and build way up to harder foods, bite with the canine area not the incisal area
3. talking - may have a lisp for a while and it is normal for speech to be altered initially
4. cleaning - clean morning and night, and clean teeth as dentures are a plaque trap
   write in notes if verbal or written instructions given

Question 14

when should the review appointment be? what can be brought up in this appointment?

Answer 14

• usually 1-2 weeks after delivery
• patient will present concerns
• pain
• loose
• bite feels different
• appearance
• speech
• OVD