Framework Try-in & Tooth Selection Flashcards
What are the 3 scenarios of a framwork trail?
1 - Framework only: Best option at early stage of training and with tricky cases. This is what you will normally do in GDH
2 - Framework with wax block: Often first option in practice as it saves a visit (most times). Always good to record occlusion using framework and master cast. Necessary when prescribing many teeth anteriorly
3 - Framework with try-in (teeth): Usually the next stage after framework with wax-record blocks
You can go straight to tooth trial without record blocks if enough index teeth to provide a stable occlusion.Not recommended
What are the aims that need to be assessed at the visit?
- Fit
- Retention
- Occlusal issues
What should you do before the patient arrives for trial?
Framework is returned from the lab on the master cast
Check the patient details
Check that your design has been followed to prescription
Look for any damage to the cast e.g reglued single standing teeth (teeth may have broken off)
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
What should you do with the patient when they arrive for the trial? ?
- 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
What should you do if the framework is not sitting?
- Look in the patients mouth for any changes to abutment teeth
- 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- ? Discuss with the technician you may need a new impression and a remake
What should you check in regards to retention?
do the clasps all engage? are they too tight or too loose
What should you check in regards to occlusion?
Check the Occlusion
1. with no denture in place / old denture
2. 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
How thick are rests?
1.5mm
If just a framework is trialed, what is usually prescribed to the technician?
probably no adjustment as proper trial has not been tested
In regards to the tooth, what needs to be selected?
shade
size
shape
What brands are used or shade selection?
vita
senator (in GDH)
What should be considered when selecting the shade?
Natural light
Hold teeth from shade guide next to natural teeth
Canine is always more yellow due to more dentine
Get a second opinion include the patient when down to last 2 or 3 shades
Why are partial dentures easier to select teeth for?
The fewer teeth missing the easier the selection
Easier to see tooth position as usually good alveolar ridges
What are the shapes of the anterior teeth moulds?
square
ovoid
tapering
What is the most likely cause of the framework fitting an undamaged cast but not the patient?
Faulty/distorted impression
