Framework and tooth selection

Question 1

What types offramework trials are there

Answer 1

Frame-work only
Frame-work with wax block
Framework with try-in

Question 2

When is a framework with wax block useful

Answer 2

Always good to record occlusion using framework and master cast

Necessary when prescribing tooth position anteriorly​

Question 3

When can you go straight to tooth trial without record blocks

Answer 3

When there isnt enough teeth to provide a stable occlusion

Question 4

What are the aims of the framework trial

Answer 4

To assess the fit, retention and occlusion

Question 5

What should be checked before a patient arrives for a framework visit

Answer 5

Framework is returned from the lab on the master cast​

Check the patient details​

Check that your design has been followed​

Look for any damage to the cast e.g reglued single standing teeth

If mounted on an articulator check the pin is on the table​

Look again for any wear to the cast specifically from clasps or minor connectors rubbing ​

Feel the surfaces of the denture with a gloved finger to check for sharp areas​

Put in “Perform” disinfecting solution

Question 6

How is the framework assessed with the patient

Answer 6

Look in the patients mouth ​
-Are the tissue healthy​-Any changes in dental condition​
-path of insertion​

Seat carefully in the mouth​

Do not force it in – what goes in does not always come out!​

Check the adaptation of clasps to the teeth – sometimes the technician will deactivate them​

Check the adaptation to the tissues ​
-The framework should not touch the mucosa​
-Free end saddles may rock

Question 7

What should you do if the framework wont seat

Answer 7

Look in the patients mouth for any changes to abutment teeth​

Carefully seat and try to identify problem areas ​

Use an articulating spray (e.g. Occlude)​

Spray onto the fit surface of the framework and re-seat. Occlude will have rubbed off areas of rubbing ​

Small areas can be adjusted with a straight handpiece and bur​

Big problems? - master impression distorted​

Discuss with the technician you may need a new impression and a remake​

Question 8

What factors of rentention should be assessed

Answer 8

Is framework retentive
Do all the clasps engage

Question 9

How is occlusion assessed

Answer 9

Check the Occlusion ​
-with no denture in place / old denture​
-With new denture seated fully

If occlusion has changed​
-Position of rest seats planned incorrectly at design stage ​
-rest seat not prepared deep enough​
-Chrome made in too thick section

Treatment​
-Identify area of early occlusion (articulating paper or spray)​
-Small adjustment chairside, removal in lab…..or remake!
​

Rests are only 1.5mm thick – thin them too much and they fracture in function

Question 10

Once framework is accepted or adjustments are made what is the next step

Answer 10

Determine:
-tooth shade
-tooth size
-tooth shape

Question 11

When sending framework back with wax blocks what should lab be told

Answer 11

Please articulate to occlusion and produce try in for next stage

Question 12

What shade guide is used in GDH

Answer 12

Vita shades/senator brand

Question 13

What are the arrangement of Vita shades

Answer 13

A1 - A4 (reddish-brownish)​

B1 - B4 (reddish-yellowish)​

C1 - C4 (greyish shades)​

D2 - D4 (reddish-grey)

Question 14

Which shades arent ideal when replacing many teeth

Answer 14

B1 and A1 as they are very light

Question 15

How is a shade selected

Answer 15

Natural light​

Hold teeth from shade guide next to natural teeth​

Canine is always more yellow​

Get a second opinion include the patient when down to last 2 or 3 shades​

Females are better at shade matching​

Question 16

How is tooth shape selected

Answer 16

Measurements are good starting points​

Natural teeth help with mould and shade selection​

Tooth shape does not correspond to face shape​

No proven male or female characteristics​

Use existing teeth and previous denture as a guide

Use your vision and common sense​

Question 17

Is tooth selection easier for partial or full dentures

Answer 17

Having natural teeth makes tooth selection easier.​

The fewer teeth missing the easier the selection​

Easier to see tooth position as usually good alveolar ridges​

Question 18

What are mould guides

Answer 18

Picture cards with different sizes and shapes of teeth (life sized)

Question 19

What shapes of teeth are available

Answer 19

Square
Ovoid
Tapering

Question 20

What posterior teeth are better for partial dentures

Answer 20

Deep cusp angles for some articulation