IMPLANT AND DENTURE Flashcards
secondary stress bearing area of a md complete denture
crest of the residual ridge
Biomechanical factors are associated with long-term implant success.
What is a common cause of vertical or angular bone loss around a dental
implant? page 421
Occlusal trauma
For balancing 33° teeth with a 30° condylar guidance and 0° incisal guidance , what would the horizontal and vertical overlap be?
For balancing 33° teeth with a 30° condylar guidance and 0° incisal guidance – horizontal and vertical overlap would be between 33 and 0°
Has undercut features so that the impression post remains in the impression after removal from the mouth
Direct impression Post (open tray)
name some works that can help evaluate phonetics
sixty-six, church, seashells, seashore, count from 60-70
2/3 the height of RMP
Factors that have a role in screw loosening
Inadequate torque and preload
Non- p a s s i v e p r o s t h e s i s
O c c l u s i o n : P a r a f u n c t i o n a l h a b i t s - l o n g c a n t i l e v e r s
P a t i e n t s n o t b e i n g a w a r e ( o r i g n o r e ) t h a t s c r e w s a r e l o o s e
S c r e w f r a c t u r e
a greater than ______crown to implant ratio did not influence peri-implant crestal bone loss
but ____________was observed on non-splinted side.
a greater than 2:1 crown to implant ratio did not influence peri-implant crestal bone loss
but screw-loosening was observed on non-splinted side.
Adequate Mesial - Distal Width:
________is needed to place implant : ______ minimum between adjacent teeth
Adequate Mesial - Distal Width:
Interradicular space is needed to place implant : 7 mm minimum between adjacent teeth
ID green
palatine aponeurosis (tensor veli palatini, levator veli palatini) palatopharyngeus, palatoglossus, and musculas uvale
______ more difficult to achieve with splinted restorations
Framework accuracy more difficult to achieve with splinted restorations
Ball abutment for Overdenture placed where
1mm supragingival
benefits of clinical remounts
save chair time
reduce post insertion time
where should finger rests be for the custom tray
1st molar and 2nd premolar
In vertical growth of the mandible, how can we observe it and measure it
During 9-15 years, increase in height measured from cusp tip to inferior border of mandible
the maxillary and mandibular occlusion wax rims are adjusted to ______
meet evenly
classify the cross sectinonal ridge form
V-shaped
ID 1
labial frenum
how large should the handle of a custom tray be
9mm height
10 mm width
what happens in failure to correct occlusion before the patient wears
the dentures
destruction of the residual alveolar ridges
Laboratory has limited ability to correct any part of abutment
Abutment level impression
what severely compromises a denture regarding retention and stability?
if FOM is near the level of the ridge crest
Magnitude of horizontal overlap
In Class II patients
-the mandible tends to travel farther _______________ in function than the typical Class I
patient and consequently more ________is necessary to allow for this functional movement.
Magnitude of horizontal overlap
In Class II patients the mandible
tends to travel farther anteriorly in
function than the typical Class I
patient and consequently more
horizontal overlap is necessary to
allow for this functional movement.
Any single unit implant crown needs to incorporate an ______
Any single unit implant crown needs to incorporate an anti-rotational feature
When can you use two implants to support an FPD?
>10 mm in length Chap 13, Rosenstiel)
what is recommended prior to starting interim complete denture?
ID 10
alveololingual sulcus
Implant supported (“assisted”) Overdenture need _______ support
Posterior ridge
Three Types of Complete Denture fracture
what remains during border molding
WAX SPACER
Residual Ridge Arch Form (House)
Class 1: square
Use care in adjusting these retentive areas of a maxillary complete denture
hamular notches
lateral aspects of tuberosities
retrozygomatic areas
the difference between the rest vertical dimension and the occlusal vertical dimension
interocclusal distance
what interferes with retention in a md complete denture
tongue and floor of mouth
during try-in of a complete denture, a dentist notes that a protrusive excursion movement results in the separation of posterior teeth, the problem can be corrected how
by simply increasing the compensating curve
in a lingualized denture occlusion set up, This means that from centric occlusion, there should be at least _____of unrestricted movement in any excursive movement.
This means that from centric occlusion, there should be at least 2 mm of unrestricted movement in any excursive movement.
Indirect transfer of impression
Closed tray
what is indicated in a patient who has excessive tooth contact during speech
excessive OVD
id dark red
hamular notch
8
pterygomandibular notch
determine prognosis
excellent
where should contacts be avoided on denture teeth set up
no contacts on inclines
•minimum implant diameter is
3.0mm
physiologic rest position of the mandible
vertical dimension of rest
• increased stress concentration in
middle of complete denture can cause
midline fracture
what is a non anatomic tooth form
0
denture teeth are arranged with minimal horizontal and vertical overlap to ___________
are arranged with minimal horizontal and vertical overlap to minimize dislodging forces during excursive movements
Where are the margins placed for a cement retainer provisionals posteriorly?
Level of gingival in the posterior
When to adjust interproximals of a screw-retained implant crown
After removing the healing abutment and rinsing with peridex. First thing you do!
denture tooth material
polymethylacrylate (PMMA)
HANAU’S QUINT (FIVE FACTORS AFFECTING BALANCED OCCLUSION)
- Condylar inclination
- Incisal Guidance
- Occlusal Plane
- Compensating Curve •
Cusp Inclination
CCCOI
What is an option if the implant is well positioned?
Screw retainers provisionals
how to estlablish the occlusal plane for maxillary teeth
Mediolateral orientation of the occlusal plane parallels the pupils Anterior portion of rim must be parallel to inter pupillary line
how to determine the hard palate-soft palate junction
pinch the pt’s nose and have them attempt to blow air through their nose
have the patient pronounce the word aah or cough
Vertical space requirements for bar and Clip Overdenture for hader Clip and metal
1.5mm
If a screw is sufficiently tightened, a blank is developed between the _____
Clamping or preload
ID 14
displaceable soft and hard palate
in the md denture, the central fossa must
the central fossa of md teeth should coincide with the center of the residual ridge
the incisal angle varies depending on the
vertical overlap
horizontal overlap
occlusal plane
condylar inclination
what is the problem with this CD pt
pt needs surgical reduction of maxillary tuberosities to create adequate interocclusal space for dentrue basaes and teeth
Patients with skeletal Class I relationships
Why horizontal and vertical overlap?
- We desire to minimize the
forces applied to the
mandibular and maxillary
anterior ridges in centric
occlusion. - Create the appropriate
relationship of the maxillary
and mandibular anterior teeth
during the production of sibilant
speech sounds.
ID 5
residual alveolar ridge
physiologic, stable orthopedic position
CR
phonetic determinant of anterior tooth positioning using
phonetic determinant of anterior tooth positioning using “f” & “v” sounds
incisal edges are within the “wet/dry junction of the lower lip”
an interim denture base used to support the record rim material for recording maxillo-mandibular records
record bases
Single-tooth implant predicted to have __________and ________ than tooth-supported prosthesis over ________ period
Single-tooth implant predicted to have lower lifetime cost and higher success rate than tooth-supported prosthesis over 20 year period
how much clearance between the depth of the tray and the vestibule
2mm
what is the benefit of a single tooth implant over an FPD
conservation of tooth structure
Which area of the mouth is in general the most straightforward area for
treatment planning and requires the least amount of time for integration?
page 388
Anterior mandible
______ at Margin will irritate tissue for implants
Subgingival cement
The base of the cast should be __________ at the mid-palatal area (maxillary) and at the disto-lingual area (mandibular)
15mm
Healing Abutment
When lateral forces cannot be completely eliminated from the implant crown, they should be
As evenly distributed as possible
can mask a soft tissue defect with pink porcelain:
FPD
RPD
ID 12
lingual notch
The original Branemark success rate in the mandible over 15 years has
become the standard against which other implant systems are judged. What is the success rate?
91 percent
Main advantage of screw retained implant crown
Retrievability
ID 12
incisive fossa
An implant crown with excessive interproximal contacts can
Place pressure on adjacent teeth that resembles orthodontic forces
how long should denture patients keep out their denture for the final impression appointment
24 hours
this allows tissue recovery and keratinization of the edentulous mucosa
Recommended for less than ideal implant angulation
Direct impression post (open tray)
in denture teeth, when the laterals are nearly as wide as the CI, indicative of a ______________
when the laterals are nearly as wide as the CI, indicative of a strong, masculine appearance
if there is great ridge resorption what is seen intraorally regarding an edentulous pt
sublingual and mylohyoid regions spills over the ridge
How to verify passive fit with hybrid prosthesis (fixed detachable denture)
Verify passive fit with the one screw test
Prior to obtaining the new centric relation record…
for a clincal remount of a denture delivery
Place two cotton rolls on the first molar denture teeth and have the patient close on these cotton rolls for 5 minutes. This allows optimal denture adaptation and seating the PPS area.
4GOQWPVKPIRTQEGFWTGUWUKPI #NWYCZ
debilitated systemically compromised elderly edentulous pt
non-anatomic teeth zero degree
id what attaches here
superior pharyngeal constrictor
ID 12
labial frenum
when selecting an edentulous stock tray for the maxilla what movements should the patient make
pucker and smile while seating
relax while it sets
Patients are historically treated with a ______ during years of active growth
Removable prosthesis
Need to order correct abutment
Disadvantage of abutment level impression
What are two requirements of a fixture level impression
Requires placing transfer coping/impression post or fixture mount. Requires hex tool
May require some chair side modification for this impression technique
Abutment level impression
advantages of maryland bridge
requires minimal tooth preparation
for the laboratory remount, how to equilibrate in centric
Equilibrating in centric: confine your initial reductions to cusp inclines, central fossae and marginal ridges.
Residual Ridge Form Cross Sections
flat
inadequate interocclusal distance = what
excessive VDO
Minimal resorption of edentulous mandible with an 8-9 mm crown will allow for what types of prosthesis
Metal ceramic restoration
- impression post
- laboratory analog
GOALS OF COMPLETE DENTURE OCCLUSION
Bilateral contacts in centric occlusion
Bilateral eccentric contacts (balance) to provide stability of the denture bases during function
Vertical space requirements for bar and Clip Overdenture
15-18mm
Indirect impression post
Closed tray
what is the secondary stress bearing area of the edentulous mandible
crest of the residualr ridge
ID 7
lingual frenum
Keys to Osseointegration
Atraumatic surgery (<47 degrees) 1 mm, B and L at crest No micromovement Adequate healing time (3-6 months)
Anterior implant restorations can share ________
Anterior implant restorations can share some anterior
guidance.
6
genioglossus
ID 13
lip musculature
depressor labi inferioris
incisivus labii inferiorus
mentalis and obicularis oris
ID 6
residual alveolar ridge
____________cannot be maintained without __________of the denture on the PPS area
Retention of the denture cannot be maintained without tissue contact of the denture on the PPS area
the expected average interocclusal distanve is _____ but may be _____ in retrognathic patients
or _____ in prognathic patients
3mm
greater-retrognathic
less-prognathic patients
ID 13
rugae
most favorable residual ridge form
U0-shaped
a line drawn through the posterior extent of the incisive papilla, perpendicular to the midline is what
cusp tips of the canine
Local vertical growth of anterior maxilla can be inhibited my implant placement t
FALSE
Most common soft tissue complication of early implant placement
Fistula
___________ should be the primary
option when replacing a single missing
tooth, especially when the adjacent
teeth are sound.
Dental implants should be the primary
option when replacing a single missing
tooth, especially when the adjacent
teeth are sound.
Advantage of cement retained crown
Corrects the angulation of an implant
Splint or Not to Splint? Implant length
Earlier clinical studies reported lower success rates for implants at how many mm.
Splint or Not to Splint? Implant length
Earlier clinical studies reported lower success rates for implants < 10 mm.
fixed factor affecting balanced occlusion
condyle path
what is stable centric
simultaneous bilateral contacts of opposing posterior in centric occlusion
(any remaining natural posterior and artifical teeth contact simultaneously)
maxillary record base must be ___________
maxillary record base must be retentive stable (no rocking) rigid
ID 13
region of mylohyoid eminence
how much horizontal overlap b/w maxillary wax rim and mandibular wax rim
1-2mm
Disadvantage of cement retained crown
If the crown needs removal it cannot be removed and it may need to be sectioned and removed
_______is an ideal option for distal extension
•______ is definitely not an option
Implant is an ideal option for distal extension
•FPD is definitely not an option
In the natural dentition, the anterior teeth disengage the posterior teeth in _____________ thus establishing a ____________________.
In the natural dentition, the anterior teeth disengage the posterior teeth in all mandibular excursive movements thus establishing a mutually protected articulation.
Implant fixtures remained stable and did not move with adjacent teeth
True
Importance of an acceptable surgical guide
Proper depth for emergence profile
what is this an example of
lingualized occlusion
analyze diagnostic casts for an immediate denture using
- undercuts
- exostoses -
torus
establish facial contours by providing propher support of the lips and cheeks
R E C O R D B A S E S
Occlusion Wax Rims
Where to place lining if TNE
Thin lining on the axial walls of the internal surface of the crown
Why is establishing bilateral balancing contacts so important in complete dentures?
to lessen the displacement and rotation of the denture bases in relation to the supporting structures, as these lead to soreness, inflammation and accelerated bone loss of the residual ridges.
ID 11
sublingual caruncles
Screws directly into fixture
Abutment
what is this an example of
fixture level final impression
what is this
Ball Abutment Overdenture
The cuspid has two planes on the labial surface – a __________ and a ___________. When viewed from the anterior only the_______________should be visible.
The cuspid has two planes on the labial surface – a mesial plane (yellow line) and a distal plane (red line). When viewed from the anterior only the mesial plane should be visible.
anterior portion of the maxillary rim is adjusted for ____________
anterior portion of the maxillary rim is adjusted for phonetics and esthetics
CDs opposing natural dentition
require _______ to in order to grind in the occlusion.
CDs opposing natural dentition
require a cusped to in order to grind in the occlusion.___
the function of the compensating curve during denture teeth set up is what
it provides a balanced occlusion
Regular impression can be done with or without retraction cord
Advantage of abutment level impression
Most implant systems recommend torque in the range of
25 NCm. However verify with system used
denture reline
green areas should be
orange areas should be
green areas 0.5mm
orange areas 1mm
well-adapted dentures move ________ which is consistent with tisssue displaceability
1-2mm
classify angle
retrognathic
lab analog
Contraindications to implants in younger PT
Child unable to perform oral hygiene Not enough bone Parents unrealistic Prior to skeletal maturity except in complete anodontja in the ectodermal dysplasia pt Presence of adjacent primary teeth
_______ dictates the treatment options for the edentulous patient.
Bone resorption
Maxillary Occlusion Wax Rim Measurements
Frontal View:
Frontal View: 22 mm
distal limit of the buccal vestibule
hamular notches
major inadequacies in what needs a new denture should be made
What type of cement is recommended for a cement-retained implant
crown to allow for future retrieval of the restoration if needed?
Interim cements, although an unpredictability of the interim luting agents can
lead to a difficult retrieval or premature displacement
what negative effect can happen with ill-effects of excessively displaced impression
bone resorption, tissues are deprived of normal blood supplh
ID this specifically
ball abutment overdenture
ID 7
area of tuberosity
what two areas in the mandible dont resorb
retromolar pad
buccal shelves
both are dense cortical bone and have muscle attachements
ID 8
pterygomandibular raphe
CAD/CAM guides may make a bigger difference compared to conventional implant guides when
CAD/CAM guides may make a bigger difference when several implants are treatment planned.
Splint or Not to Splint? Conclusion
Splinting may be significant for very _______implants featuring _________ clinical evaluation was recommended
Splint or Not to Splint? Conclusion
Splinting may be significant for very short implants featuring internal connections, clinical evaluation was recommended
Complete Dentures: 5th Appointment
(Wax try-in) Check List (4)
Check teeth set-up (esthetics, occlusal plane and phonetics)
• Verify vertical dimension of rest, function, occlusion
- Verify centric relation registration (same as on articulator)
- Obtain patients’ final approval
Occlusal plane parallel to the ala-tragus line also known as
Camper’s line
Ball abutments (O-Rings) require _______ plus the prosthesis.
10mm vertical height
triangular pad of tissue at the distal end of the residual ridge
retromolar pad
the distance between the occluding surfaces of the maxillary and mandibular teeth when the mandible is a specified position
interocclusal distance
describe older males line of curvature
older males: less curvature, flatter smile line
LAB ANALOG
edentulous pt with poor residual ridges (flabby ridges) what type of teeth
non anatomic teeth (0 degree)
Screws onto impression post
Lab analog
name angle
33 degrees
a doulbe phase surgical schedule
extractions are staged with posterior extracted first
leave one definitive tooth contact on either side-1st PM (maintain VDO)
what are risks of having casts that dont follow the recommended requirements
THEY BREAK
Eliminate ________ on posterior
implants
Eliminate working and balancing contacts on posterior
restorations.
Clinical Vertical Space for Implant Restoration:
posterior
> or equal to 8mm occlusal plane of the opposing arch to crest of the ridge
how short should the custom tray be
2-3mm short of the vestibule
DIRECT IMPRESSION POST FOR OPEN TRAY
Splint or Not to Splint? Abutment connection?
Internal connections:
increased ______
Splint or Not to Splint? Abutment connection?
Internal connections:
increased joint stability
Accepts laboratory analog
Impression post
most favorable ridge form for retention and stability
U-shaped
OCCLUSION OF MAXILLARY COMPLETE DENTURES OPPOSING RPDS
• Bilateral contacts of opposing posterior teeth in centric
occlusion
• Bilateral balanced occlusion in eccentric positions
• Simultaneous protrusive contacts when possible but
not at the expense of appearance, phonetics or
favorable occlusal plane
maxillary lingual cusps should be centered over this line
center of the posterior residual line
One potential complication with implant crowns is screw loosening. What
are the possible causes of loose restoration retaining screws? page 421 (Box 13-4)
• Excessive occlusal contacts not in the long axis of the implant body
• Excessive cantilever contacts
• Excessive lateral contacts
• Excessive interproximal contacts
3
• Inadequately tightened screws
what types of tooth contacts should be seen on the balancing side in a lingualized denture tooth set up
maxillary lingual cusps and the lingual inclines of the mandibular buccal cusps.
how do we pick teeth based on the lingualized tooth scheme for denture occlusion
The basic scheme is to use a steeper cusped tooth on the maxillary and a lower or flat plane tooth scheme on the mandibular
what are alll of these
abutment
it is the position to which the mandible returns to at the end of chewing and swallowing strokes
centricl relation
what lesions are commonly seen in the buccal mucosa of edentulous patients
fibroms, cheek biting
in denture teeth when the laterals are narrower than
average, indication of a__________
when the laterals are narrower than
average, indication of a feminine or delicate arrangement
Historically, reports of screw- loosening at high frequency with ________
Historically, reports of screw- loosening at high frequency with external hex connection
Vertical space requirements for bar and Clip Overdenture for denture teeth
8mm
Maximizing ______ without exceeding the ______ of the screw stabilizes the screw joint and offers protection against _______
Maximizing preload without exceeding the yield strength of the screw stabilizes the screw joint and offers protection against screw loosening.
name angle
20
Domed screw in place only after second stage surgery and before prosthesis placement
Healing Cap/Abutment
what is wrong with this implant
and how to avoid this in the future
Excessive cantilever contacts
Minimize occlusal table width
ID 6
alveolar groove
Single tooth RPD:
why not a great idea to use?
•large amount of metal for the functional
replacement of one tooth
•compliance is historically not favorable
Treatment planning for a single tooth implant, particularly in the esthetic
zone (anterior maxilla), can be one of the most challenging situations. What is the ideal relationship of interdental bone to position of interproximal contacts to predict whether interdental papilla will be present or not? page 393 Fig. 13-19
• If interdental bone to interproximal contact distance is short (5 mm or less), a
papilla is usually present. • If interdental bone to interproximal contact distance is long (8 mm or greater),
a papilla is normally not present without additional soft tissue grafting.
Disadvantages / Cantilever bridge
l tooth preparation required
l introduces lateral forces
l biomechanics more stabile with support on two ends of FPD
how are the distal aspects of canines matched on edentulous patients
canines
are transferred to the occlusion rim as lines through the pupils of the eyes or as lines extending from the ala of the nose
over extension of the hamular notches causes what
imflammation, pain
classify angle
1, normal
this plane of occlusion is at or slightly below the corners of the mouth
md rim height
FPD negatives
expense
ridge resorption
requires preparing adjacent teeth
When to adjust cement retained implant crown
After seating the crown and exposing a pA.
Shade Selection
for anterior teeth
• Look at shade tabs under upper lip for 10-15 seconds at a time
what is the issue here
impingement of the coronoid process in lateral excursive movements
intereferences lead to pain and dislodging of the denture
Clinical vertical space for implant restoration posteriorly
>= to 8 mm (measured by occlusal plane of the opposing arch to the crest of the ridge)
Option 1-Implants
positives
§ Fixed
§ Maintain bone
§ Esthetic
§ No damage to adjacent teeth
goals of selective grinding of a denture
obtain evenly distributed centric contacts on central fossa and marginal ridges
what is fully balanced occlusion
simultaneous posterior/anterior contacts in lateral/protrusive excursions
secondary centric holding cusps for complete dentures
md buccal cusps (only grind if there is a balancing side interference)
In most patients the labial surface of the mandibular incisors should be roughly_________
In most patients the labial surface of the mandibular incisors should be roughly perpendicular to the occlusal plane.
for a mandibular preliminary impression, what movement should the patient make
protrude tongue and touch upper lip
Accepts laboratory analog
Indirect impression post (closed tray) Direct impression post (open tray)
ID 10
buccinator
for a edentulous pt with good residual ridges and good neuromuscular control what type of teeth should be selected
anatomic and semi anatomic teeth
which occulsal scheme can be balanced or non-balanced
monoplane
Determination of Midline & Width of Six Maxillary Anterior Teeth
• Measure from canine line to canine line to determine the width of
the anterior 6 teeth on a curve
Select anterior teeth that correspond to this measurement
whats wrong with this impression
ID 2
labial vestible
ID 8
pytergomandibular raphe
how far should the mandibular stock trays extend
slightly posterior to the retromolar pad
What conditions are important for follow up regarding complete dentures
uncontrolled HTN, DM II
what develops the preload
applied torque develops the preload
What achieves clamping or preload
Torque wrenches
What is difficult to achieve with cement retained provisionals
Marginal integrity
Direct transfer of impression
Open tray
which implant is indicated with a reduced interarch distance
screw retained implant
variable factors affecting balanced occlusion
incisal guidance
cusp height
compensating curve
How does the posterior growth compare to the anterior growth at the midpalatal suture
4 years to adult Increase in posterior 3x greater than anterior
What can compromise esthetics
Improper alignment of implants
Restorative doctor may receive case from surgeon with abutment in place with this impression procedure
Abutment level impression
How does the maxilla grow vertically
Passive displacement of maxilla by lowering of the sutures Apposition of bone on the maxillary alveolus as permanent teeth erupt
5
mylohyoid muscle
he ____________must be filled in completely to enhance the peripheral seal of the record base and improve retention for record base fabrication
he depth of the vestibules must be filled in completely to enhance the peripheral seal of the record base and improve retention
UCLA abutment
Retention of the mx denture cannot be maintained _____________
Retention of the denture cannot be maintained without tissue contact of the denture on the PPS area
Where are the margins placed for cement retained provisionals in the anterior
1mm subgingical in the anterior
confirming
low incisal guidance
slight contact (without real interference) should be observed when the articulator latch is released and the teeth are moved into a protruded position
FPD positives
§ Prevents shifting of
adjacent teeth
§ fixed
§ Esthetic
2
buccinator
requires placing the impression post in the implant fixture
fixture level impression
solution to a midline fracture of maxillary Complete denture
ID 9
masseter
how does the maxilla resorb
upward and inward
in a complete denture set up, the The incisal edges of the maxillary centrals must be ______below the mandibular wax occlusion rim. This will result in a_____vertical overlap with the mandibular central incisors.
1 mm
1 mm vertical overlap w
ID 11
buccal frenum
An open interproximal contact can lead to
Food impaction Resulting periodontal concerns
Hyperactive FOM has what effect on an ednetulous pt receiving dentures
reduces retention and stability
ID 12
lingual frenum
Adjusting/verifying occlusion for cement retained crowns begins with
Shin stock
advantages of implant
more stable
longer life expectancy
easier for pt to keep clean
WHAT IS THE KEYSTONE TO POSTERIOR OCCLUSION IN THE 33 DEGREE SETUP FOR DENTURE TEETH
33° SETUP – THE FIRST MOLAR RELATIONSHIP IS THE KEYSTONE TO POSTERIOR OCCLUSION
tapered abutment
6
genioglossus muscle
______ allows for tissue replacement with acrylic
RPD allows for tissue replacement with acrylic
Why in some cases are Panoramic or PA’s not sufficient to implant placement?
• Critical bone height • Mandibular canal course unclear • Knife edge ridge
- 4-5 mm
- 15mm
what type of set up is this
balanced 0 degree
The three landmarks used to determine the
plane of occlusion are :
• The midpoint of the retromolar pads bilaterally as
previously marked on the mandibular cast.
• The incisal edge of the maxillary central incisors
For mandibular denture stability, tooth contacts
must be placed on the
For mandibular denture stability, tooth contacts
must be placed on the RR parallel to the OP
residual ridge
OP: occlusal plane
ID
metal-resin fixed maxillary denture
maximum posterior extent of the maxillary denture
hamular notches
When delivering an implant crown, the restoration screw should be
tightened with sufficient force to seat the crown, but not so much as to
affect the bone implant interface. What instrument is used to achieve this?
page 421
Torque wrenches
MAXILLARY NATURAL DENTITION OPPOSING MANDIBULAR DISTAL EXTENSION
4) MAXILLARY NATURAL DENTITION OPPOSING MANDIBULAR DISTAL EXTENSION • Working side contacts – simultaneously with existing
natural teeth •
Balancing and protrusive contacts are avoided since
they do not help stabilize a lower RPD
indicated when acrylic
will improve appearance
(excessive bone loss)
RPD
what are 0 degree teeth undesirable for maxillary
0° Maxillary teeth leave a step behind the canines and a flat buccal corridor which looks unnatural.
Any single unit implant crown needs to incorporate an
an anti-rotational feature
How much transverse growth is measured in the mandible in the 2nd molars
2mm
Hybrid prosthesis 1, 2, 2.7mm, and 3mm times AP spread requires what length implants
7mm, 15mm, 18mm, and 20mm
what length implants get a benefit from splinting
<10mm
lines through the pupils of the eyes dictate what
canines
Vertical height required for ball and locators
18mm vertical height required
resin retained fixed partial denture
(Maryland bridge)
denture base convexities lead
to _____________
denture base convexities lead to healing defects
temporary reline material
tissue conditioner
a prominent compensating curve is required when there is a ________ associated with a ___________
a prominent compensating curve is required when there is a steep condylar path associated with a low degree of incisal guidance
Mandibular growth anterior posteriorly
Grows in length at condyle and Ramus
Directly supports prosthesis
Abutment
Conylar Guidance is dictated by
Conylar Guidance is dictated by Patient Anatomy
ID 4
buccal vestibule
ID
standard abutment
Everyday implant prosthetic dentistry complications
Screw loosening Screw fracture Abutment fracture
Screw access is sealed how
By placing a composite
what type of position should the pt be in when determining the VDO
patient must be in upright position
ID 2
retromylohyoid
what should the land area be for a complete denture final impression
4-5mm
LINGUALIZED 0 DEGREE SETUP
What may reduce the potential for soft tissue irritation in cement retained provisional?
Non-Eugenia cements
ID 3
temporalis m.
Inadequate irrigation can lead to
Inadequate irrigation can lead to overheating bone and implant loss
What are considered debilitating diseases regarding complete dentures?
Parkinson’s, Dyskenisias
a retracted or retruded tongue is seen in what % of edentulous patients
35%
When do we develop soft tissue contours for implants
Stage 2 (uncovery) stage
On average, the distance from the center of the incisive papilla to the labial surface of the central incisor is
On average, the distance from the center of the incisive papilla to the labial surface of the central incisor is 8-10 mm
The occlusal portion of the rim
should have the following width:
a) Molar region -
b) Premolar region -
c) Anterior region -
a) Molar region - 8-10 mm
b) Premolar region - 5-7 mm
c) Anterior region - 3- 5 mm
Fixed Detached Implant Supported Denture (hybrid) dictates how many implants in mandible
4-5
2
labial flange
the md occlusal plane is located a t a height near the corners of the mouth such that the md teeth are slightly
visible with a “lips apart/mouth breathing” posture
When is transverse growth completed in females
15
This type of implant prosthesis uses cantilever length
Hybrid prosthesis (fixed detachable denture)
what is wrong with this picture
inadequate relationship between maxillary and mandibular wax rims
posterior “heeling”
RPD negatives
1) alot of metal to replace 2 teeth
ridge resorption
rest seat prep on natural tooth
does not feel permanent
FIXTURE (IMPLANT BODY) •
Restoration options for edentulous mandible
Ball/Locator Overdenture Bar Overdenture Hybrid Restoration Fixed (PFM) Restoration
epulis fissuratum (denture epulis) AKA inflammatory fibrous hyperplasia
what is a non-balanced occlusal scheme
canine guidance/group function
anterior guidance
what is this an example of
implant failure
OCCLUSION FOR TOOTH-SUPPORTED RPDS
• Bilateral contacts of opposing posterior teeth in centric
occlusion
• Excursive movements similar to a natural dentition
(canine guidance or group function) Balance not
important here.
Skips the abutment and attaches restoration directly to the fixture
UCLA abutment
rebasing
requirement: denture teeth must be in good condition and have adequate tooth contacts
md anterior teeth positioned beyond the center of the vestilbe will result in
Positioned beyond this point will result in
denture instability and undesirable cantilever
forces.
Id 4
buccal vestibule
What radiographic images are required?
for implants
•panorex (initial screening)
•periapicals (proximity of adjacent roots)
•CBCT (detailed assessment of ridge
width and proximity to vital structures)
What area in the mouth has more destructive lateral forces
Posterior
Splint or Not to Splint? Implant length
Earlier clinical studies reported lower success rates for implants < _____
Splint or Not to Splint? Implant length
Earlier clinical studies reported lower success rates for implants < 10 mm.
what is this and how much height does it need
locator overdenture abutment
locators require 7mm vertical height + the teeth
Radiographic measurements from a CBCT: _____ buccal and _____ lingual cortical plate plus the smallest diameter implant ___) = _____ radiographic width required
Radiographic measurements from a CBCT: 1mm buccal and 1mm lingual cortical plate plus the smallest diameter implant (3mm) = 5 mm radiographic width required
distance between maxilla and mandible when teeth or wax rims contact in centric position
vertical dimension of occlusion (VDo)
Complete dentures receive their retention, stability, and support from the ______________
Complete dentures receive their retention, stability, and support from the soft tissues overlying residual bone.
what type of treatment does this dicate
RPD
Accelerated Implant Loading Protocols
EARLY LOADING
EARLY LOADING Less than 3 months
What do we do when we have an accurate VDO but inaccurate centric relation record?
for esthetic try in of a denture
Take a new CR record at the VDO & R E M O U N T
SEATING
of a surgical stent
Reduce areas of __________: indicate ___________still needed
SEATING
of a surgical stent
Reduce areas of blanching of the ridges: indicate bone removal still needed
Lingualized Occlusal Scheme
Dominant Centric Contact:
• Maxillary lingual cusp articulates with
central fossa/ margin ridge of mandibular
posterior teeth
determine prognosis
good
How long do resin retained bridges last?
(maryland bridge)
5-year survival rate (loss of retention)
approx 70%
Attached prosthesis to implant in UCLA
Retaining screw
Vertical growth of mandible occurs as
Permanent teeth erupt
As viewed from the lateral
perspective, the rim should
project _____________
As viewed from the lateral
perspective, the rim should
project anteriorly to just beyond
the outer edge of the land area
of the cast
Flat sides orient anti-rotational feature
Impression Post
When to adjust occlusion of screw retained implant crown
After adjusting interproximal contacts, then taking Pa
whats wrong with this impression
nothing it’s beautiful1
what type of teeth should be selected for the edentulous patient with Severe arch discrepancies (severe
Class II and Class III-reverse articulation)
non anatomic teeth 0 degrees
Check denture base with ___________
Check denture base with pressure-indicating paste (PIP)
in wax occlusion rim fabrication the borders______________________
the borders fully extend into the depth of the vestibule without any voids
Position Implants in______
Position Implants in Line with Force
Antirotation is required for this implant system
Screw retained implant crown
waxing sleeve
ID 10
fovea palatinae
what type of tooth contacts should be seen on the working side on a lingualized denture tooth arrangement
lingual inclines of maxillary lingual
buccal inclines of md lingual csups
which occlusal schemes should be balanced
anatomical and lingualized occlusion
Abutment collar height for ball abutments
2mm, 4mm, 6mm
id area
labial and buccal vestibule
The lingual concavity also facilitates ______ of the mandibular denture.
This lingual concavity also facilitates stability of the mandibular denture.
Accuracy of maxillomandibular relationships: Clinical Checks for Centric Relation Verification
The maxillary and mandibular midlines coincide
Absence of premature/deflective contacts
• Equal amount of posterior horizontal overlap, bilaterally
Posterior teeth contact simultaneously, bilaterally
________ is common
in buccal mucosa for edentulous patients
Loss of muscle tonicity & overlapping is common
What material are most root form implants made from?
Titanium or titanium alloy with or without hydroxyapatite coating
Clinical should delay implants in growing pts until what phase
Post pubertal phase
•in general, the minimum implant length
8mm
Lingualized Occlusion: ____________________ is the dominant functional element occluding against the corresponding portion of the mandibular tooth.
Lingualized Occlusion: Maxillary lingual cusp is the dominant functional element occluding against the corresponding portion of the mandibular tooth.
what is this
“Lingualized occlusion
OCCLUSION OF MAXILLARY COMPLETE DENTURES OPPOSING RPDS
Bilateral contacts of opposing posterior teeth in centric
occlusion
• Bilateral contacts of opposing posterior teeth in centric
occlusion • Bilateral balanced occlusion in eccentric positions
• Simultaneous protrusive contacts when possible but
not at the expense of appearance, phonetics or
favorable occlusal plane
Requires that the tray used for the impression be modified to allow for the screw to extend through the tray
Direct impression post (open tray)
List potential complications that can occur during the surgical phase of implant treatment
Poor healing Improper angular ion Damaging a nerve Swallowing/dropping a part
what is a semianatomic tooth form
Semianatomic
• 10°, 20°, 22°
LABEL 1-5
- HARD -SOFT PALATE JUNCTION
- HARD PALATE
- AREA OF SOFT PALATE COVERAGE
- VIBRATING LINE
- HAMULAR NOTCHES
Usually brass, aluminum or steel
Lab analog
in a lingualized denture tooth arrangement, what type of contact should be seen on protrusive
In a protrusive movement, the potential for contact should exist between the
maxillary lingual cusps and the occlusal of the mandibular teeth.
md anterior teeth placement
not be placed beyond the center of the vestibule
Accelerated Implant Loading Protocols
IMMEDIATE LOADING
IMMEDIATE LOADING First Week
Maxillary Occlusion Wax Rim Measurements
Posterior View:
8mm
classify the residual ridge arch form (house)
class 2: tapered
ID 11
median palatal raphe
Single tooth implant vs FPD: •_________ appears more natural
Single tooth implant vs FPD: •emergence profile appears more natural
what to make sure that the custom tray covers for the mandibular edentulous impression
retromolar pad
buccal shelves
what movement to tell a patient when making a centric relation record
curl your tongue all the way back on the roof of your mouth and closed slowly
ID 9
area of posterior palatal seal
Represents either top of implant or top of abutment in cast
Lab analog
classify the residual ridge arch form (house)
class 3: ovoid
classify the cross sectional residual ridge form
rounded
if maxillary tuberosities are too enlarged with fibrous tissue for a CD pt, what needs to be done
surgical reduction
ID 4
buccal notch
No Intra oral preparation of this impression
Fixture level impression
2
buccal shelf
Implants are usually contraindicated prior to skeletal maturity except for one condition
Complete anodontja in the extodermal dysplasia patient
Healing Abutment
anatomical landmarks for occlusal plane determination and tooth position
mark a line on the land area that bisects the middle of the retromolar pad and is continuous with the center of the residual ridge
mark a line of the land area that represents the mandibular occlusal plane, should be placed at the 1/2-2/3 the ht of the RMP
HAMULAR NOTCHES
how should the handle of a custom tray be designed
45 degrees (so it doesnt impinge on the vestibule or lips)
formula for balanced occlusion
(CONDYLAR GUIDANCE X INCISAL GUIDANCE)
____________________________________________________
OCCLUSAL PLANE X CUSP INCLINATION X COMPENSATING CURVE
Component that is surgically placed into bone
Implant fixture
what type of set up is this
balanaced 0 degree set up
what is the equation for VDR
VDO + interocclusal distance
What is an important factor in fabrication of provisional crowns
Implant position
Shimstock works best with
Placed in pair of hemostats
how deep should the peripheral roll be
2-3 mm
Single tooth implant cost an average of $261 more than FPD in US, but success rate at 10 years was _____________ higher
Single tooth implant cost an average of $261 more than FPD in US, but success rate at 10 years was 10.4% higher (91.7 % vs 81.3%)
When two or more implants are connected together (splinted), what is selected
A non-engaging abutment is selected that does not engage the antirotational features of the abutment
ID 5
coronoid contour
During the production of the Sibilant sounds during esthetic try in of a denture
During the production of the Sibilant sounds:
a) The anterior and posterior teeth should not touch b) Incisors should approach an end to end relationship c) There should be no hissing or air loss
Denture Reline Procedures using Tissue Conditioner
Its main faults include:
rapid deterioration
discoloration
rapid loss of resiliency
•Following the loss of teeth, bone resorption is from l____________
l •Therefore anterior teeth should NOT be placed____________
•Following the loss of teeth, bone resorption is from labial towards the lingual •Therefore anterior teeth should NOT be placed directly over the ridge
the conylar inclination measures the steepness of the
articular eminence
what gender has a greater curvature of a smile line
females
BALANCED 0° SETUP - LATERAL MOVEMENTS
RT LFT
immediate dentures
_____________ surfaces are desired on the master cast
do not create _________________on cast!
smooth + convex surfaces are desired on the master cast
do not create socket concavities on cast!
what can causes errors in denture occlusion
inaccurate maxillomandibular relation records
errors in transfer of maxillomandiublar relation records to articulator
ill-fitting temporary record bases
1
retromolar pad
3
4-6mm
Moderate resorption with space like 10-14 mm in edentulous patients will allow for what type of prosthesis
Resin to metal restoration
Which denture do we reline first? Maxillary or mandibular?
the less stable of the two is relined first
if a record base is slighlty loose, what to do?
Use denture adhesive if slightly loose
the primary reason for a PPS
the primary reason for a PPS is to compensate for the shrinkage of the acrylic resin (7%) that occurs during denture processing procedures
whats wrong with this impresssion
excessive burnthrough
what resorbs faster, edentulous mx or md? by how much
md resorbs 4x faster
helps establish occlusal plane anteriorly and posteriorly
during wax rims
Trubyte Fox Occlusal Plane Plate
ID area
labial and buccal frena
what is a lingualized balanced occlusion
Lingualized – a balanced occlusion that uses the
lingual cusp of uppers to guide all contacts in lateral
and protrusive excursions.
Vertical space requirements for bar and Clip Overdenture for ____ bar
3mm
what is key in edentulous final impressions
AADEQUATE RETRACTION
Medical history contraindications for single tooth implant
Acute terminal illness Uncontrolled metabolic disease Pregnancy IV anti-resorption drugs Previous irradiation of implant site APP U and I
For cement retained crowns, what common material of choice is used
A material called Fermit-single component composite, easy to remove
when recessing a socket for a immediate denture on a cast, how much to do?
1mm
primary centric holding cusps in dentures
mx lingual cusps
Viewed from the facial perspective, the maxillary central incisor is placed so that the long axis shows a ________________to the perpendicular.
Viewed from the facial perspective, the maxillary central incisor is placed so that the long axis shows a slight distal inclination to the perpendicular.
how to determine mandibular rim height (2) (second one is useful)
1) use of the retromolar pads (half to 2/3ds the height) as the posterior landmark
2) corners of the mouth (lower) as the anterior landmarks for reference points
5) MAXILLARY BILATERAL DISTAL EXTENSION OPPOSING NATURAL TEETH OR LOWER RPD
Bilateral Balanced Occlusion when possible
• Helps stabilize the maxillary RPD where teeth are often
set lateral to the ridges
18mm
ID 1
mylohyoid m.
When diagnosing and treatment planning a single-tooth implant supported restoration, what are the basic requirements?
Space for planned restoration Hard tissue quantity/anatomy Soft tissue health
determine prognosis
very poor
ID
maryland bridge
the higher the steepness of the articular eminence the
the higher the cusp degree the for the posterior teeth selected
wax display at rest of maxillary oclcusal rim in men
0-1mm
Lab has options for constructing final restoration of this impression
Fixture level impression
residual ridges resorb and remodel -
palatal bone does not resorb can cause what in complete dentures
midline fracture
10 degree tooth semi anatomic
name 2 materials used for border molding
polyvinyl siloxane
polyether rubber
how far should maxillary stock trays extend
labial vestibule to the hamular notch and slightly beyound the vibrating line
abutment fracture
ID 9
retromylohoid fossa
ID black
ptyerogmandibular raphe
5 key actions of mandibular impressions for edentulous pts
- ask pt to create suction around finger and tray handle
- pucker/pooch lips + maximal smile line
- pronounce “Christmas” and “Q” and “U” and pull lower lip and cheek supeirorly over the impression tray
- place a finger on the top of each side of the impression side and ask the patient to close the mandible against resistance using one second intervals of applied force
- ask pt to raise tongue to top of their mouth, anterior to vermilion border, and then to corners of their mouth. ask patient to swallow
When is transverse growth completed in males
17-19
_____seemed to be a positive factor for very short implants
Splinting seemed to be a positive factor for very short implants
For dentate patients, the anterior teeth should contact in_______
For dentate patients, the anterior teeth should contact in MI
-remaining dentition with severe periodontal disease (undercuts) + grade III mobility
what type of impression material should be used
alginate
as definitive impression material
Screws into fixture or onto abutment to facilitate transfer impression
Impression Post
Splinting may be significant for very ________ featuring_________, clinical evaluation was recommended
Splinting may be significant for very short implants featuring internal connections, clinical evaluation was recommende\
Attached to abutment by retaining screw
Waxing sleeve
Accelerated Implant Loading Protocols
IMMEDIATE PROVISIONAL
no load
what is wrong with this denture
sublingual crescent area is overextended
name anatomic tooth form
zero degrees
how is the occlusal scheme for complex cases determined
THE OCCLUSAL SCHEME USED FOR COMPLEX REMOVABLE CASES WILL DEPENDS ON THE THE NUMBER AND LOCATION OF REMAINING TEETH
ID top and bottom
top: implant fixture
bottom: impression post
SEALING SCREW (COVER SCREW)
1
coronoid process and temporalis muscle/tendon
define lingualized occlusion
“Lingualized occlusion can be defined as, the form of denture occlusion that where the maxillary lingual cusps articulate with the mandibular occlusal surfaces in centric working and non-working mandibular positions.”
Dental implants most effectively resist forces directly along
Long axis
ID 10
foveae palatini
ID blue
lip musculature/buccal vestibule
define partially balanced occlusion
balanced posterior but non-balanced protrusive
For edentulous patients, the anterior denture teeth do not contact in ________
For edentulous patients, the anterior denture teeth do not contact in CO
primary stress bearing area of md complete denture
buccal shelves
on flat teeth with compensating curve, posteriors are set to contact on at least ______________________
on flat teeth with compensating curve, posteriors are set to contact on at least 1 point on nonworking or balancing contact
Waxing sleeve can be what two types of materials
Plastic -burns out Precious metal which is “cast to”
1
labial notch
ID 4
buccal vesibule
*Minimum bone dimensions: ____ height for implant
*Minimum bone dimensions: 10 mm height
Functions of Occlusion Wax Rims
(3)
- To establish and maintain the VDO
- To serve as a means of transferring jaw relations from
the patient to the semi-adjustable articulator - To serve as a trial denture base
how long should a pt wear an immediate denture at first after insertion
24 hours, the dentist will remove it at the check
ID 3
buccal frenum
secondary stress bearing area of a maxillary complete denture
palatal rugae area
Single tooth implant vs FPD: • preservation of______
Single tooth implant vs FPD: • preservation of bone
how to mark the high lip line
patient is asked to give an exaggerated smile line and a horizontal line is scribed on the wax rim to record maximum elevation or retraction of the upper lip
Accepts retaining screw or a cemented prosthesis
Abutment
when decreasing the VDO for an esthetic try in of a denture, If decrease is greater than 2 mm a ____________________
when decreasing the VDO for an esthetic try in of a denture, If decrease is greater than 2 mm a new interocclusal record must be made at centric relation at the newly proposed VDO
what is this specifically
Open Tray Impression Transfer
Direct Impression Post
a linear in 0 degree setup has posterior contacts? yes or no
No Posterior Contacts in Protrusive
3 factors that influence soft tissue profile
Osseous levels Volume of connective tissue/biotype Interproximal support of crown
position of facials of centrals relating to mx cast
7-9mm anterior
whats wrong with this impression
wax spacer not moved
implant overdentures are ________ retained and ______ supported
implant retained
tissue supported
When replacing a single missing tooth with a dental implant, what is the basic bone requirement for proper placement in all directions?
Width 6mm Vertical 10mm Adjacent tooth 2mm Adjacent implants: 3mm
what is wrong with this implant for #30
and what is the potential cause of this
Excessive lateral contacts
Steeper cusp inclines increase resultant force on implant components
Anterior Guidance is dictated by
Anterior Guidance is dictated by esthetics, phonetics, etc.
minimum distance from nasal cavity for implant
1mm
Flat sides orient anti-rotational feature to reorient the post into the impression
Indirect impression post (closed tray)
Step 5: Check Denture Occlusion
Clinical Checks for Centric Relation Verification
The maxillary and mandibular midlines coincide
Absence of premature/deflective contacts
• Equal amount of posterior horizontal overlap, bilaterally
• Posterior teeth contact simultaneously, bilaterally with equal
intensity
What systemic conditions may have an impact on complete dentures
Sjogren’s Syndrome, Bell’s Palsy, Diabetes
With no overbite and some overjet, canines does not in a linear zero degree set up
With no overbite and some overjet, canines does not disclude posterior teeth on working side movements
Treatment options and cost for OSU
OSU student clinic estimates:
RPD option: $680
FPD option: 8 x $500= $4000
Implants: 4x $2000= $8,000
what is the biggest disadvantage for multiple tooth implants
$$$$$
Growth in the palate is symmetrical
False, growth is not symmetric at the midlalatal suture
define bilateral balanced occlusion
Protrusive Movements
• Simultaneous anterior and posterior contacts
- Lateral Movements
- simultaneous working and balancing contacts
T/F. anterior guidance in complete denture occlusion is necessary
False. anterior guidance in complete denture occlusion should be avoided to prevent dislodgement of the denture bases
in denture construction CR=
CR=CO=MI
Implant and Tissue Borne Overdenture dictates how many implants
2
When viewed in profile the cuspid has a _______________from the perpendicular and the incisal tip touches the _______________.
When viewed in profile the cuspid has a slight distal inclination from the perpendicular and the incisal tip touches the occlusal plane (arrow).
what is Linear or Non-balanced Occlusions
Centric contacts, No contacts in excursive
movements
Check Denture Peripheries: Posterior Palatal Seal
steps
- Use Thompson stick to mark
posterior extension of denture - Ensure correct position of PPS
- Evaluate posterior extension of
denture in relation to PPS
when patient is smiling, the incisal edges follow the
when patient is smiling, the incisal edges follow the contour of the lower lip
Retention of the denture cannot be maintained without
Retention of the denture cannot be maintained without tissue contact of the denture on the PPS area
THATS WHY ITS SUPER IMPORTANT FOR POSTERIOR PALATAL SEAL TO BE TOO THICK THEN TOO THIN
evaluate 1, 2, and 3
- normal contact
- show though
- no contact
excessive interocclusal clearance =
inadequate VDO
Hybrid prosthesis (fixed detachable denture) requires what vertical space requirements
15-18mm
What type of impression material to be placed in the plastic tray?
Heavy bodied PVS
Bar and Clip Overdenture require ______ horizontal space between implants
8-10mm horizontal space
ID 7
retromolar pad
For hybrid prosthesis why should all the screws not be placed and tightened
Gaps between the abutment and poorly-fitting framework close, giving the appearance of an acceptable fit
Locators require ______vertical height plus the teeth = _____ mm
7mm, 15mm
RPD positives
least expensive option
what is a concern when examining an edentulous patient if the FOM is near the level of the ridge crest?
retention and stability is SEVERELY COMPROMISED
what happens if you leave excess wax on the denture teeth for processing
the wax leaves spaces for teeth to move
what type of treatment does this dictate
RPD
how to determine how many implants needed for edentulous maxilla
ID 3
buccal frenum
Shows the presence of absence of a contact
Shimstock
6
buccal shelf
what is the issue here
Non passive fitting frameworks in hybrid prosthesis can lead to what
Bone loss, screw loosening, screw fracturing and implant failure
what to do if you notice an error in occlusion upon denture delivery
clinical remount
anatomical upper teeth with only lingual cusps, not buccal cusps touching
lingualized occlusion
where should you avoid grinding for equilbirating in centric for the laboratory remount of a denture
Avoid grinding on stamp/functional cusps (maxillary lingual cusps; mandibular buccal cusps) unless absolutely necessary to reduce the incisal pin to 0.
Bar and Clip Overdenture require _____ vertical ht
15-18mm
Shimstock is first used to evaluate
Patients existing occlusion without implant crown in place
for the laboratory remount of a denture, how to evaluate occlusion
Use thin articulating paper to identify centric prematurities! NO HORSESHOE!
for a denture opposing natural teeth, why type of teeth should be selected
anatomic and semi anotomic teeth
Options for edentulous maxilla
4 implant and tissue Overdenture 4 four implant bar and Clip Overdenture 4-6 fixed metal resin (hybrid) 4-6 fixed porcelain-fused-to-Metal or zirconia
Buccal Mucosa
Draping of the cheeks over
the buccal flanges essential
• Draping of the cheeks over
the buccal flanges essential
for peripheral seal
what is stable centric relating to RPDs and dentures
1) Simultaneous bilateral contacts of opposing posterior
teeth in centric occlusion. (Stable Centric)
• This means both any remaining natural posterior
teeth and artificial teeth contact simultaneously.
• This distributes the load more evenly
- depth
1-2mm
A raised acrylic resin area at the posterior border of the maxillary denture
posterior palatal seal
Steeper cusp inclines increase resultant _______
Steeper cusp inclines increase resultant force on implant components
what is indicated when the loss of VDO is excessive on a complete denutre
new dentures are indicated
junction between the mobile and non-mobile portions of the soft palate
Vibrating Lineposterior border
Cap attachment above the ball abutment collar is ______
4.28mm
It is generally advisable to keep the incisal angle to a________complete dentures.
It is generally advisable to keep the incisal angle to a minimum in complete dentures.
With the lips at rest, a youthful appearance of an unworn dentition may display between
With the lips at rest, a youthful appearance of an unworn dentition may display between 2 and 4 mm of the central incisors
what is this an example of
Impression Post
how does balanced occlusion work on the non-working side
maxillary lingual cusps of the posterior teeth on the non-working side contact on the lingual incline of facial cusps of mandibular posteior in conjunction w
what procedure does this pt need and why
ridge alveoloplasty
for accomondation of CD and reduce pressure ulcers
what is a secondary stress bearing area of the maxilla
lateral aspects of the hard palate
ID this area
retromylohyoid space (lateral throat form)
determines posterior extension of the mandibular denture lingual flange
influences denture stability and retention
What parameters for perio disease are used for single tooth implant checklist
PSR?
PD?
BOP?
PSR < or equal to 2 probing depths < or equal to 4mm BOP less than or equal to <20%
what is the importance of low incisal guidance
Minimizes dislodging forces and prevents heavy anterior forces from concentrating on the maxillary anterior residual ridge
ID top and bottom
TOP: impression post
BOTTOM: lab analog
Abutment can be categorized as what
Standard, tapered, angles, cementable, or UCLA
what does this pt need
ridge alveoloplasty
with a two stage surgical approach for immediate dentures, how long should they wait for healing
8-12 weeks
as condylar inclination increases, what must also increase a denture tooth set up
compensating curve must increave to keep a balanced occlusion
All implant restorations incorporate at least
All implant restorations incorporate at least 1 screw
what is the primary stress bearing area in the edentulous mandible
buccal shelves
Clinical Vertical Space for Implant Restoration anteriorly
Anterior >8mm (incisal edge of the opposing arch to the crest of the ridge)
indirect impression post
for tissue conditioners, the best results are obtained if the dentures are worn for___________as the material continues to flow slightly
and the patients functional movements will aid in obtaining well defined borders.
best results are obtained if the dentures are worn for 24 - 48 hours as the material continues to flow slightly
and the patients functional movements will aid in obtaining well defined borders.
the postural position of the mandible when an individual is resting comfortable in an upright position and the associated muscles are in a state of minimal contractual activity
vertical dimension of rest
poor neuromuscular control ednetulous pt. what type of teeth
non anatomic teeth (zero degree)
name the 3 types of occlusal schemes for RPD and dentures
non-balanced
full balanced occlusion
partially balanced occlusion
9
lingual flnage with extension into retromylohyoid fossa
name the type of screw seen in the picture
retaining screw
ID 3
buccal frenum
Implants are rarely indicated in children under what age
7mm
the interocclusal distance may be greater in _____ patients
retrognathic patients
minimum distance from maxillary sinus for implant
1mm
It a patient has 15mm implants and an anterior posterior distance that measure 9mm. Which of the following is correct regarding the cantilever length for the mandibular hybrid prosthesis
18mm
Fundamental differences of naturall and complete denture occlusion
- Sensory Feedback
- Derivation of retention, stability and support
for complete denture occlusion
the most common frenum to be irritated from denture overextension
maxillary frenum
ID 8
pterygomandibular raphe
Indirect Impression Post (Closed Tray)
Cemented implant materials use what cement
Interim/provisional cements are recommend like TNE temrex temporary cement
do anterior teeth contact in CR
NO
what is prognosis based on for complete dentures
Bearing surface anatomy
ability to reproduce CR
tongue position
floor of mouth posture
neuromuscular control
dental history
psychological classification
ID 8
hamular notch
Stone dies are not as accurate as the actual abutment
Abutment level impression
Impression Procedures are at what two different levels
Fixture Level Abutment Level
Accepts waxing sleeve
Lab analog
what should be checked first on a 24 hr visit after a denture delivery
occlusion
ID 3
buccal notch
Labial surface centrals _____ from posterior of incisal
papilla – posterior location stable over time
Labial surface centrals 12 mm from posterior of incisal
papilla – posterior location stable over time
22mm
What is this showing
Open Tray (Direct) Impression Technique
The more teeth that remain the more the occlusion
The more teeth that remain the more the occlusion will reflect natural dentition (non-balanced)
in denture occlusion, contacts should be confined to
central fossa or maringal ridges
whats wrong with this impression
significant burnthrough
thin undercut peripheries: ive gotten this before!
what are concerns with anti-hypertensive meds with complete dentures
dryness and postural hypotension
ID 7
maxillary tuberosity
multi-morbird patients with complex polypharmacy are common for treating this
complete dentures
a raised area that will maintain intimate contact with the tissues. This maintains a border seal!
posterior palatal seal
what are predisposing factors to inflammatory papillary hyperplasia in a complete denture wearere
continuous denture use
poor oral hygiene
smoking
implant placement ______apical to the free gingival margin of contralateral tooth needed for the crown to transition from ______ mm w/o over-contour.
lacement 3 mm apical to the free gingival margin of contralateral tooth needed for the crown to transition from 4 mm to 8 mm w/o over-contour.
goal of evaluating the denture borders and coronoid processes
goal is to observe an even, uniform contact with disturbed brush lines of pressure indicating medium
Clinical Vertical Space for Implant Restoration:
anteriorly
anterior : > 8mm or equal to incisal edge of the opposing arch to crest of the ridge
ID 10
lingual flange
generally what indiciates a need for reline
denture movement or “rocking”
Single-tooth implant predicted to have __________ than tooth-supported prosthesis over 20 year period
Single-tooth implant predicted to have lower lifetime cost and higher success rate than tooth-supported prosthesis over 20 year period
How is anterior posterior distance is determined by whAt
Anterior posterior distance is determined by a line drawn form the center of the implant to the distal extent of the posterior implant
what is wrong with this implant
Excessive occlusal contacts not on the long axis of the implant body
HEALING CAP (HEALING ABUTMENT)
How does survival of resin- retained FPD compare to FPD or implant?
Single tooth implant , FPD success rate at 10 years: 91.7 % and 81.3%
(resin-bonded bridges: 70 % at 5 years)
tissue stops for the mandibule should be placed where
buccal shelves and posterior alveolar ridge
what type of setup is this
linear 0 degree setup
tissue stops for maxillary custom tray should be placed where
posterior alveolar ridge
2 and 4
0.5mm
in an edentulous pt who was recently delivered a denture, the pt is having difficulty closing lips and swallowing. what is the potentially issue?
excessive OVD
VDO is usually how much less than VDR
3-4mm less
what is the tipping force
occlusal load x distance = tipping force
Record Base Fabrication
Block out using baseplate wax undercut areas to PROTECT the master cast:
MAXILLARY
- labial surfaces of anterior ridge
- Frenum areas
- Rugae
- Lateral areas of tuberosities
CLASSIFICATION OF POSTERIOR TOOTH FORMS
• Anatomic
• 30° or greater
Biomechanical factors are associated with long-term implant success.
What is a common cause of vertical or angular bone loss around a dental
implant? page 421
Occlusal trauma
how much space should 1 be
3-4mm
severely worn occlusion on previous denture. what type of teeth
zero degree
what is affected by the shape of the residual ridges in the md denture
support and retention
what is necessary to produce an F or V sound when determine phonetics of an edetulous patient
edge of maxillary rim much touch “wet-dry” junction of lower lip during pronunciation of “F” or “V”
what type of bone are the buccal shelves
dense cortical bone
A properly adjusted occlusion displays
Even contacts with natural dentition in CO
Shows the location of the contact
Accufilm
The lingual contours of the mandibular denture should be ________and there should be a slight gingival roll to prevent ________ and to anchor the denture teeth within the acrylic resin
The lingual contours of the mandibular denture should be concave and there should be a slight gingival roll to prevent tongue biting and to anchor the denture teeth within the acrylic resin
what angle should this be
90 degrees to 115
Albrektsson Smith Zach Proposed Success Criteria (2)
No mobility/radiolucency Bone loss
ID red and black
red-coronoid process
black: ptyergomandibular raphe
name 5 meds to be concerned with regarding making dentures (6)
anti-hypertensive meds
corticosteroids
anti-parkinson agents
diuretics
antihistamines
atropine
Splinted multiple unit implant prosthesis should engage
Splinted multiple unit implant prosthesis should engage no more than 1 anti-rotational feature
serves as a means of transfer on the facebow
Occlusion Wax Rims
The hex feature of the screw retained implant crown must be
Protected before sealing the screw across with composite with cotton pellet, strip of gauze, or Teflon tape
ID 6
buccal shelves
When should we use cone-beam computed tomography (CBCT)?
- Sinus lift
- Narrow ridges
- Proximity to critical landmarks such as
inferior alveolar nerve
Patients with skeletal Class I relationships
• Vertical overlap=
• Horizontal overlap (=
* • No contact is =
Patients with skeletal Class I relationships
• Vertical overlap (1-2 mm)*
• Horizontal overlap (1-2
mm)*
• No contact is centric
occlusion
Impression multiple implant
Direct impression post (open tray)
waxing sleeve
mandibular occlusal rims are adjusted until
interocclusal distance is 2-4mm
flat even contact along entire occlusal surface
How much vertical space is required when considering a locator assisted Overdenture for the edentulous mandible
15mm
Hex Driver
biomechanically preferred to cantilver in what direction
anterior
Implant Bar and Clip Overdenture requires how many implants
4
imflammatory papillary hyperplasia
Most challenging part of delivering a screw retained implant crown
Adjust/verify interproximal crowns
Flat ripped screw placed directly in fixture only during 3-6 month healing phase
Sealing Screw (Cover Screw)
In the maxilla, the midface grows how anteriorly posteriorly
Downward and forward
Objectives of a surgical guide in a partially edentulous patient
Delineate the embrasures Locate the implant within the restoration contour Align the implant with the long axis of the completed restoration Identify the level of the planned CEJ or tooth emergence from the soft tissue
a steep canine in a linear zero degree set up for denture teeth will cause what
Steep canine rise will cause working side to disclude
Screw-loosening is often the first sign of
Screw-loosening is often the first sign of Biomechanical overload
ID 8
ptyergomaxillary seal in area of hamular notch
determine prognosis
poor
Minimum ______ for denture acrylic for ball and locator
2mm
Disadvantages / Maryland bridge
l loss of retention or debonding
l emergence profile looks like a pontic
l abutments can not have large carious lesions or restoration
Regarding implants and framework fit: When connecting multiple implants
together, the fit of the framework should be checked with only one screw
in place. If the framework does not display an acceptable fit, what clinical
procedure should be performed?
- Framework should be sections and soldered and reassessed for passive fit
- A relation record should be made
The maxillary lateral incisor should be positioned with a___________ and is usually _________above the plane of occlusion.
The maxillary lateral incisor should be positioned with a slight distal inclination and is usually ½ to 1 mm above the plane of occlusion.
When tightening the abutment screw what order of instruments are use
Manual hex driver Mechanical wrench- torque driver
3
zygomatic process
what should be done to the mandibular occlusal rim prior to determining the centricl relation record
ID 5
residual ridge
selective grinding in balancing side relation for complete dentures
grind inner inclines of md buccal cusps
NEVER GRIND THE MX LINGUAL CUSPS
ID 7
retromolar pad
Lingualized Occlusal Scheme
uses what type of teeth
Anatomic teeth (usually 30-33°) used in maxilla and non- anatomic teeth (0°) in the mandible
disadvantages of implant
surgery
healing time
additional planning
ID 4
superior constrictor muscle
With the lips at rest, wax rim should project _______below the lip line depending on age and sex of the patient
8”9%*41-“:”53&45
With the lips at rest, wax rim should project 1-2 mm below the lip line depending on age and sex of the patient
what is a traditional balanced occlusion
Traditional – cusp fossa bilateral balanced occlusion
No ordering of components of this impression
Fixture level impression
With high occlusion on the implant crown, what complications can occur
Screw loosening Screw fracture Porcelain fracture Bone loss
with a tooth overdenture, how should the remaning teeth be shaped
Shorten teeth with a domed shape 1-2 mm above the tissue
The abutment and crown are together as one unit
Screw retained crown
The primary complication with dental implant treatment is bone loss
around the implant. What is the amount of bone loss per year that would lead to concern? page 424
• Any loss exceeding 0.2 mm per year
Severe resorption in edentulous patients (15-20mm) dictates what type of prosthesis
Only implant supported overdentures for optimum esthetic results
what area creates the peripheral seal in the md denture
retromolar pad
A clinically acceptable interproximal contact exhibits
Firm snap when dental floss is used
what is indicated on a complete denture when the loss of VDO is moderate?
relining may be indicated
Vertical space requirements for bar and Clip Overdenture for hygiene
2mm
ideal ratio for implant supported prosthodontics:
1:1 crown to root ratio is considered a minimum
iMPLANT
may be completed as an indirect transfer or a direct transfer
fixture level impression
expected average interocclusal distance is _____
3mm
Projects from impression before pouring
Lab analog
what are these examples of
IMPRESSION POST
advantage of cantilever FPD
may prepare only one abutment tooth
What type of material is syringed around the implant impression post
Light bodied PvS
IMPLANT
AIer the final impression is removed from the mouth, the ______ is removed and a\ached to the ________ using the ________ The en,re assembly is the placed into the final impression using the flat sides of the _________ for orienta,on.
AIer the final impression is removed from the mouth, the impression post is removed and a\ached to the laboratory analog using the hex driver. The en,re assembly is the placed into the final impression using the flat sides of the impression post for orienta,on.
Dentures
intraoraly, there must be a ________ space between the rims
3-4mm
what is this an example of
retruded tongue
Attached prosthesis to abutment
Retaining screw
under extension of the hamular notches causes what
NON-RETENTIVE DENTURE
Temporary abutments come packaged with two what
Two separate screws
Why is it important to have a well contoured implant provisional?
It can redirect the existing volume of soft tissue to optimal form and level
what is OSUs protocol to splinting implants
<11mm = splint the crown
>11mm dont splint
Crown to implant ratios up to _____ did not influence peri- implant crestal bone loss.
Crown to implant ratios up to 2:1 did not influence peri- implant crestal bone loss.
if the maxillary tuberositie is enlarged with fibrous tissue what is a consequence
the maxillary occlusal plane may be placed too low
wax display at rest of maxillary oclcusal rim in women
1-3mm (very important for practicing!)
ID this area
does it resorb?
buccal shelves
no bc of muscle attachements
dentate primary impressions for an immediate denture should use what material
using alginate + periphery wax
Block out using baseplate wax undercut areas to PROTECT the master cast:
MANDIBLE
retromylohyoid fossa
frenum areas
facial aspect of anterior ridge
buccal and lingual regions of residual ridge
The fewer teeth that remain, the more the occlusion will
The fewer teeth that remain, the more the occlusion will reflect complete denture occlusion (balanced)
Vertical space requirements for bar and Clip Overdenture for denture acrylic
2mm
clinical assessment of ridge width for implant placement
> or equal to 7mm measured facial – lingual clinically
the curtain of soft tissue turns down abruptly 3 to 5 mm anterior to a
line dine across the palate at the distal edge of the tuberosities.
Class 3 Soft Palate (Palatal Throat Form)
ID 12
incisive papilla
the lingual extent of mandibular posterior teeth is dictated by
a line extending from the retromolar pad
what do we want the incisal guidance angle to be
For dentures you want this to be low (15°)
ID 9
posterior palatal seal region
classify the cross sectional ridge form
U-shaped
how to mark the midline of an edentulus patient
Marked by bisecting the long axis of the face and scoring a notch on the maxillary wax rim. This not must coincide with the patient’s facial midline ignoring any deviation of the nose
classify angle
prognathic
buccal and lingual contours of a denture should be
concave
Do long term denture wearers or pts with recent extractions require less retention?
Long term denture wearers require less retention
clear, rigid external surface form that duplicate the tissue surface (intaglio) of an immediate denture and is used as a guide to ensure that the prescribed bone trimming is done adequately
surgical guide
Loose screws may
loose screw may break under occlusal load if not tightened
Dental implant can have what destructive interferences
Lateral excursions in both working and non-working
ID 11
median palatal groove
is the mandibular height correct?
no it is too height
iD 2
labial vestibule
occluding surfaces fabricated on record bases for purposes of making MMR and arranging denture teeth
occlusion wax rims:
What is the proper cuff height for abutments selected for an Overdenture or a hybrid prosthesis
Optimal cuff height should be approximately 1mm above (supragingival) the soft tissue
whats wrong with this impression
nothing its beautiful
what is a concern about this implant
Implants shorter than 7-8 mm
Crown to implant ratio?
Has long screw which extends through the impression tray
Direct impression post (open tray)
CR= maxillomandibular relationship in which the ________ articulate with the __________ portion of othe respective discs with the complex in the ___________position against the shapes of the ______s
CR= maxillomandibular relationship in which the condyles articulate with the thinnest avascular portion of othe respective discs with the complex in the anterior superior position against the shapes of the articular eminences
ID 13
area of premylohyoid eminence
after denture delivery, pt complains of soreness on crest of ridge
adjust occlusion, (heavy occlusal contacts)
HIGH YIELD TQ
primary stress bearing area of a maxillary denture
crest of the residual ridge
what concerns are with corticosteroids, anti-parkinson agents regarding making complete dentures
dryness, confusion and behavioral changes
what is this specifically
Indirect Impression Post
what produces F or V sounds during wax rim appointment
This will usually allow the rim to contact the wet- dry junction line of the lower lip during the soft enunciation of the fricative sounds (F, V).
treatment options and cost at OSU
RPD option: $680
FPD option: 4 x $500= $2000
Implants: 2x $2000= $4,000 (OSU clinic estimate)
ID this
locator abutment
Pronounced looseness of record bases. what to do?
REMAKE record base
the expected average interocclusal distance is 3mm, but may be __________ in prognathic patietns
less
Is CR dependent on tooth contact
no, independent of tooth contact
negatives of implants
§ expense
§ Healing time
if maxillary tuberosities are hypermobile in an edentulous patient, what happens?
allows denture movement
DENTURES
the incisal edge position is clinically determined how
assessment of the dynamic position of the anterior teeth during speech
what is the reule of selective grinding in working side relation for complete dentures
BULL
buccal cusp inner incline of upper teeth
lingual cusp inner incline of lower teeth
Landmarks on the maxillary bite rim
- Midline
- Corners of the mouth/ ala of the nose (canine tips)
- High smile lip line (tooth show)
How are anterior teeth implants placed
placed 2-3 mm apical to the free gingival margin of contralateral tooth
(any remaining natural posterior and artifical teeth contact simultaneously)
stable centric
best treatment plan option
implant
ID 2
labial flange
how to determine the physiological rest position (VDR)
insert maxillary record base + wax rim
using a black/red marker, place a dot on the nose tip and most prominent aspect of chain.
pt is instructed to gently bring their lips together, hum the letter “m”
gently lick their upper lip, relax and gently bring their lips together
MAXILLARY AND MANDIBULAR UNILATERAL DISTAL EXTENSION RPDs
Working Side Contacts Only
• No balancing contacts since opposite side is stabilized
by clasping
Since implants are integrated with the bone, they will not
Compress with occlusion
how are anterior implants placed compared buccally/palatally
1mm palatally to adjacent teeth
what occurs if the denture is overextended in the md
displacement
Fixed Porcelain Fused to Metal Implant Supported Denture dictates how many implants
6-8
ID 3
sublingual crescent areas
overextended
In mild to moderate hypodontia, what does the clinical literature state regarding complications for implants in growing patients
Shortening on the implant crowns reported due to continued eruption of adjacent teeth in some implants
ID 14
butterfly outline of posterior palatal seal
what is the closest speaking space
s sounds (count 60-70(
The maxillary and mandibular dentures are fitted ______
invidividually before any attempts to evaluate their occlusion
VDR= what
VDO + interocclusal clearance
2
0.5mm
What is the major concern regarding making dentrues for patient with complex polypharmacy?
therapies leading to xerostomia compromise the overall prognosis of complete denture therapy
maxillary impression borders-key actions
- ask patient to create suction around a finger and impression tray handle
- pucker or pooch their lips and produce a maximal smile line
action 3. ask patient to open mouth wide and move md side to side to stretch the pyterogmandibular raphe and allow the coronoid processes to shape thei impression
Abutment Driver
large and normal in form; with a relatively immovable band of
resilient tissue 5-12 mm distal to a line drawn across the distal edge of the
tuberosities.
Class 1 Soft Palate (Palatal Throat Form)
in denture occlusion, where should no contacts be seen
no contacts on inclines
What if we exceed the limit and overtighten the screw
screw may break over time due to fatigue
What is recommended for multiple unit prosthesis
Tapered abutment
Screw is removed before the impression can be removed from the patients mouth
Direct impression post (open tray)
how to determine vertical dimension of occlusion (VDo)
instruct patient to gently close until rims touch
measure distance between dots
angular cheilitis
why is making sure the midlines match important
if they dont match it is likely the patient deviated during closer-retake CR record
what is a primary stress bearing area of the maxilla
crest of the residual ridge
what is camper’s line
(inferior border of ala of nose to the superior border of the tragus of the ear)
A line passing through the posterior extent of the incisive papilla, (perpendicular to the midline) will define where the _______________
A line passing through the posterior extent of the incisive papilla, (perpendicular to the midline) will define where the cusp tips of the canines should be placed
ID
angled abutment
ID 13
palatal rugae
what is an implant option for completely edentulous patients who have minimal bone resorption
metal-ceramic fixed dental prosthesis
what is an implant option for completely edentulous patients who have moderate bone resorption?
complete metal-resin fixed dental prosthesis
what is an implant option for completely edentulous patients who have severe bone loss?
implant supported overdentures
id 1
preload
id 2
clamping force
what potentially happened here
Broken acrylic components, teeth-limited space for prosthetic components-Thin framework, and potential flexure of the cantilever
what is this and what are they used for
tapered abutments
multiple unit restorations
what is this
healing abutment
how much space mesially-distally is preferred for 2 implants
13mm
what is a concern here seen in the picture?
Mesial inclination of a molar decreases occlusal table and may compromise or even preclude restoration
When can you use two implants to support FPD?
>10 mm in length
what is wrong with this implant
Implant not placed apical enough: poor emergence profile
this pt presents to your office and would like something right away. what is an option
Requirements for immeidate provisionalization for implant
implant must be _____ at time of placement
stable
Requirements for immeidate provisionalization for implant
no ________ defiency
no buccal plate deficiency *ideally 1mm buccal bony plate
Requirements for immeidate provisionalization for implant
eliminate all
occlusal contacts, centric, and eccentric
Requirements for immeidate provisionalization for implant
pts have to be cooperative an no ____________ for ____ mo.
no biting with anterior teeth for 4-6 months
Requirements for immeidate provisionalization for implant
no _________ on the crown. patients has to prevent ____ with crown
no parafunctional habits on the crown
prevent habitual tongue contact with crown
Calculus and plaque can
accumulate on an implant
especially if there are
_________
Calculus and plaque can
accumulate on an implant
especially if there are
threads exposed
what are you probing when you are on am implant crown
No tissue attachment to
crown or implant
Circular fibers create a
seal
Ailing implants includes what two conditions
Peri-implant mucositis (reversible)
Mild peri-implantitis
Failing implants describes what
Moderate Peri-implantitis (bone loss) No mobility
Three categories of implant complications
Ailing Implants
Failing Implants
Failed Implants
what is this an example of
healthy peri-implant mucosa
what is this an example of
peri-implant mucositis
what is this an example of
peri-implantitis
what is this an example of
ailing implant
what is this an example of
Failing Implants
Failing Implants
Progressive__________
Clinically __________
Failing Implants
Progressive loss of supporting bone
Clinically immobile
what is this an example of
failed implant
what is this an example of
Failed Implant
Failed Implant
Two characterisitics
Loss of supporting bone
Clinical mobility
COMPLICATIONS Causes of Implant Failure
Major etiological factors are:
Infection
Impaired Healing
Overload
if an implant shows suppuration, what should be prescribed
systemic antibiotics
dequate Mesial- distal width is present in edentulous site( minimum of 7mm. between the adjacent teeth)
dequate Mesial- distal width is present in edentulous site( minimum of 7mm. between the adjacent teeth)
no load is used for this accelerated implant protocol
immediate provisional
what time frame is used for early loading of an implant
3 mo.
what implant time frame is used for immediate loading
one week
what is this an example of and how many implant does it usually use
porcelain fused to metal
4-6
Lingualized – a balanced occlusion that uses the
lingual cusp of uppers to guide all contacts in ________________
Lingualized – a balanced occlusion that uses the
lingual cusp of uppers to guide all contacts in lateral
and protrusive excursions.
Linear or Non-balanced Occlusions
• Centric contacts, No contacts in
Linear or Non-balanced Occlusions
• Centric contacts, No contacts in excursive
movements
Factors that lead to posterior separation
this is dictated by patient anatomy and CANT BE CHANGED
what type of set up is this
what movement?
zero degree -linerar
protrusive movements
This type of occlusion has No Posterior Contacts in Protrusive
LINEAR 0° SETUP - PROTRUSIVE MOVEMENTS
With no overbite and some overjet, canines does not disclude posterior teeth on working side movements
LINEAR 0° SETUP - LATERAL MOVEMENTS
this is a picture or border molding what is wrong with this picture
If border molding material extends onto the wax spacer, then removal of wax prior to the impression disrupts the border molding
note image: done correctly
what is this and how to mark it
Pinch the pt’s nostrils closed and ask the pt to attempt to blow air through their nose.
Make sure that the tongue is held down using a mouth mirrow.
hard-soft palate junction
what is this and how is it marked
have the pt cough or pronounce the world ah
what is wrong with this maxillary occlusal rim
excessive lip support
what is wrong with this occlusal rim
deficient lip support
the anterior occlusal plane for jaw relations record for making a denture should be parallel to what
