Insertion, checks and maintenace

Question 1

Denture faults

Answer 1

Px related
Lab related
Clinician related

Question 2

Patient related faults

Answer 2

Systemic disease
-Parkinsons, dyskinesia, hormonal
Local pathology
-Atrophy, fibrous replacement, undercuts, anomalies

Question 3

Lab related faults

Answer 3

Technical errors
-investment - tooth movement
-processing - flash, post dam
Damage to the model
-air bubbles in plaster (surface defect)
-weak plaster (movement of teeth)
-flash (general defect)

Question 4

Clinician related faults

Answer 4

Impression defects e.g. debonding

Registration errors

Question 5

Placement technique

Answer 5

1. Inspect fitting surface
2. Insert - Correct faults
3. Check occlusion - correct faults
4. Fitting surface - remove pressure spots
5. Security - correct faults

Question 6

Inspect fitting surface (1)

Answer 6

Check fitting surface for rough areas (cotton wool test)

Question 7

Insert and correct faults (2)

Answer 7

Soft tissue trauma by extension of base beneath mylohyoid ridge
Remove undercut, but maintain non-undercut extension

Question 8

Check occlusion and correct faults (3)

Answer 8

Using Detex (articulating paper impregnated with ink)
-can use occlusal indicator wax

Question 9

Steps when seeing px

Answer 9

1. Check denture is for your px
2. Insert denture - any pain?
   - if no try in other denture
   - if yes, find source of pain using pressure stop indicator paste, then make adjustments
3. 4 quadrants PSI test
4. Check occlusion - which side touches first

Question 10

The pre-centric check record

Answer 10

-a method for re-registering coincidence of retruded and intercuspal positions

Question 11

How should contacts be identified?

Answer 11

Using articulating paper

• then using bur, deepen fossae and repeat until contact includes first molars at least
• repeat in lateral excursions

Question 12

Bull rule

Answer 12

Empoyed to ensure maintenance of balancing side contact

Lateral guidance: buccal, upper, lingual, lower)

Question 13

Fitting surface (4)

Answer 13

Remove pressure spots using Coltene PSI paste
Do 1 quadrant at a time
Mix quickly and apply evenly
Remove PSI before adjustment

Question 14

Correct faults of security (5)

Answer 14

Check for overextensions of periphery by traction on muscles - adjust if denture displacement occurs

• if there is a defect of peripheral seal, place functional post-dam in autopolymerising resin
• loss of security anteriorly may be consequence of insufficient fraenel relief

Question 15

Patient instructions

Answer 15

1. Wearing
2. Cleaning
3. Pain

Question 16

Pain when wearing dentures

Answer 16

Incredibly common
Reassure that you are always contactable and this is normal
If must be removed, wear for 24h prior to next appt.

Question 17

Soaking and cleaning dentures

Answer 17

Brush at least once (twice) a day with something meant for mouth
-modifications to handle make denture cleaning easier (e.g. arthritis)
Use Poligrip: 99.9% effective
-soak dentures for 2-5 mins
-then they might get away with wearing them at night
Try to prevent denture stomatitis

Question 18

Denture fixatives

Answer 18

Generally for pxs with loose lower dentures, but may give other pxs more confidence
Don’t work very well

Question 19

Dry mouth adjuncts

Answer 19

Biotene

Question 20

Advice on your new dentures

Answer 20

You are likely to have 
1. pain
2. looseness
3. chewing problems
4. speech problems
5. aesthetic problems
6. nausea (gagging)
Use fixative, wear old ones to eat, practice