Midterm Flashcards
Complete denture indications: (6)
- When all else has failed
- When systemic health is declining
- When adaptability is declining
- Restore function (chewing and speech)
- Restore facial appearance
- Maintain health
Goal of complete dentures:
To preserve what remains, not replacement for the missing teeth
Resistance to vertical movement toward the underlying tissues:
Support
The support from bone and mucosa when bilateral simultaneous contact of opposing posterior teeth
Initial support
Initial support is from _____ and _____ with bilateral simultaneous contact of opposing posterior teeth
bone and mucosa
Load the tissue area most resistant to resabsorption:
long term support
Resistance to horizontal/lateral or rotational movements:
stability
What facets affect stability?
- shape of alveolar ridges
- size of alveolar ridges/vestibular depth
- flange length and shape (best adaptation)
- intimate fit of prosthesis
What is the best adaptation for stability?
Flange length and shape
resistance to displacement of the denture base away from the ridge:
retention
What facets affect retention?
- adhesion
- cohesion
- interfacial surface tension
- intimate tissue contact
- border seal
- atmospheric pressure
- neuromuscular control
attraction between unlike molecules:
adhesion
force between molecules of same material:
cohesion
thin fluid film between two closely contacting objects:
interfacial surface tension
Impression technique affects the:
intimate tissue contact
Prevent ingress of air:
border seal
a learned phenomenon by the patient which the external contour denture base promotes
neuromuscular control
The denture problem:
Dentures move around in the mouth and create pressure on:
supporting mucosa/bone
The denture problem:
Pressure from dentures causes:
bone reabsorption
The denture problem:
Bone reabsorption results in decreasing:
decreasing horizontal stability and retention
The denture problem:
Retention of complete dentures requires _____, however, most patients takes meds that cause ____.
saliva of good quality and quantity; xerostomia
The denture problem:
Percentage of dentures that will have at least 1 major deficiency
60%
The denture problem:
Deficiencies in dentures include:
- integrity
- excessive tooth wear
- adhesive or liner present
- instability (2mm)
- poor retention
The denture problem:
Dentures are made by lab techs instead of dentists (now legal in 6 states)
denturism
The denture problem:
Dentures are not an alternative ______ or _______.
expensive restoration treatments; unaesthetic dentition
The denture problem:
Dentures are a substitute for:
NO TEETH AT ALL (not better than natural teeth)
The useful life for a set of dentures:
7-10 years
Complete dentures fabrication steps:
What is the first step?
- oral exam, treatment plan, preliminary impressions (clinical)
Complete dentures fabrication steps:
- oral exam, treatment plan, preliminary impressions (clinical)
- ?
- make custom trays on preliminary casts (lab)
Complete dentures fabrication steps:
- oral exam, treatment plan, preliminary impressions (clinical)
- make custom trays on preliminary casts (lab)
- ?
- border molding and secondary impressions (clinical)
Complete dentures fabrication steps:
- oral exam, treatment plan, preliminary impressions (clinical)
- make custom trays on preliminary casts (lab)
- border molding and secondary impressions (clinical)
4.?
- master casts, record bases, and occlusion wax rim (lab)
Complete dentures fabrication steps:
- oral exam, treatment plan, preliminary impressions (clinical)
- make custom trays on preliminary casts (lab)
- border molding and secondary impressions (clinical)
- master casts, record bases, and occlusion wax rims (lab)
5.?
- maxillo-mandibular relations, teeth selection (clinical)
Complete dentures fabrication steps:
- oral exam, treatment plan, preliminary impressions (clinical)
- make custom trays on preliminary casts (lab)
- border molding and secondary impressions (clinical)
- master casts, record bases, and occlusion wax rims (lab)
5.?
- maxillo-mandibular relations, teeth selection (clinical)
a. facebow transfer
Complete dentures fabrication steps:
- oral exam, treatment plan, preliminary impressions (clinical)
- make custom trays on preliminary casts (lab)
- border molding and secondary impressions (clinical)
- master casts, record bases, and occlusion wax rims (lab)
- maxillo-mandibular relations, teeth selection (clinical)
- ?
- arrange maxillary and mandibular anterior teeth (lab)
a. casts mounted with record bases and wax rims
Complete dentures fabrication steps:
- oral exam, treatment plan, preliminary impressions (clinical)
- make custom trays on preliminary casts (lab)
- border molding and secondary impressions (clinical)
- master casts, record bases, and occlusion wax rims (lab)
- maxillo-mandibular relations, teeth selection (clinical)
- arrange maxillary and mandibular anterior teeth (lab)
- ?
- anterior trial placement (clinical)
Complete dentures fabrication steps:
- oral exam, treatment plan, preliminary impressions (clinical)
- make custom trays on preliminary casts (lab)
- border molding and secondary impressions (clinical)
- master casts, record bases, and occlusion wax rims (lab)
- maxillo-mandibular relations, teeth selection (clinical)
- arrange maxillary and mandibular anterior teeth (lab)
- anterior trial placement (clinical)
- ?
- arrange maxillary and mandibular posterior teeth (lab)
Complete dentures fabrication steps:
- oral exam, treatment plan, preliminary impressions (clinical)
- make custom trays on preliminary casts (lab)
- border molding and secondary impressions (clinical)
- master casts, record bases, and occlusion wax rims (lab)
- maxillo-mandibular relations, teeth selection (clinical)
- arrange maxillary and mandibular anterior teeth (lab)
- anterior trial placement (clinical)
- arrange maxillary and mandibular posterior teeth (lab)
- ?
- trial placement in wax and patient approval (clinical)
a. make new interocclusal/CR record and check on articulator
Complete dentures fabrication steps:
- oral exam, treatment plan, preliminary impressions (clinical)
- make custom trays on preliminary casts (lab)
- border molding and secondary impressions (clinical)
- master casts, record bases, and occlusion wax rims (lab)
- maxillo-mandibular relations, teeth selection (clinical)
- arrange maxillary and mandibular anterior teeth (lab)
- anterior trial placement (clinical)
- arrange maxillary and mandibular posterior teeth (lab)
- Trial placement in wax and patient approval (clinical)
- ?
Process dentures, lab remount (lab)
Complete dentures fabrication steps:
- oral exam, treatment plan, preliminary impressions (clinical)
- make custom trays on preliminary casts (lab)
- border molding and secondary impressions (clinical)
- master casts, record bases, and occlusion wax rims (lab)
- maxillo-mandibular relations, teeth selection (clinical)
- arrange maxillary and mandibular anterior teeth (lab)
- anterior trial placement (clinical)
- arrange maxillary and mandibular posterior teeth (lab)
- Trial placement in wax and patient approval (clinical)
- process dentures, lab remount (lab)
- ?
- clinical remount, occlusal corrections, insertion (clinical)
Complete dentures fabrication steps:
- oral exam, treatment plan, preliminary impressions (clinical)
- make custom trays on preliminary casts (lab)
- border molding and secondary impressions (clinical)
- master casts, record bases, and occlusion wax rims (lab)
- maxillo-mandibular relations, teeth selection (clinical)
- arrange maxillary and mandibular anterior teeth (lab)
- anterior trial placement (clinical)
- arrange maxillary and mandibular posterior teeth (lab)
- Trial placement in wax and patient approval (clinical)
- process dentures, lab remount (lab)
- clinical remount, occlusal corrections, insertion (clinical)
- ?
- post-insertion recalls (clinical)
What are the patient classifications?
- philosophical
- exacting/critical
- hysterical
- indifferent
What types of patients is the easiest to treat?
philisophical or indifferent
What types of patients are the hardest to treat?
hysterical or exacting/critical
A patient who is the mechanical engineer type, they want to know EVERYTHING about what you are doing:
exacting/critical patient
A patient that is nervous all of the time and is overly emotional, they can’t seem to adapt to losing their teeth:
hysterical
A patient that comes in because his wife wants him to fix his teeth, he personally does not care:
indifferent
The intraoral exam is both:
visual and tactile
When doing an intra oral exam, what should you look at?
mucosa, basal seat, arch form, and inter-arch space
When looking at the mucosa in an intraoral exam, you should note:
colors and contours
When looking at the basal seat during an intraoral exam, you should note the:
height, contour, ridge, parallelism, palatal vault shape
When looking at the arch form during an intraoral exam, you should note whether the arch is:
square, tapering, or ovoid
Allows for the intraoral soft tissues to form the length, width, and shape of custom tray borders prior to making secondary impression:
border molding
Where attached mucosa is: (albumin mucosa)
border
Posterior teeth are removed; denture placed immediately after the removal of natural teeth:
immediate denture
All of the teeth are removed the day of denture placement
complete denture
_____ people are edentulous in atleast 1 arch
36 million
_____ complete dentures are done each year
5.5 million
Edentulous patients are more likely to be:
obese and nutrient deficient
If you smoke you are _____ to be edentulous
3x as likely
______ of gross income in the average general practice comes from partial and complete edentulism
27%
Causes of denture movement:
- resiliency of tissue
- instability of dentures
Almost all principles of complete denture fabrication have been formulated to ____ of dentures or to _____ transmitted to the supporting structures
decrease movement; minimize forces
A problem with dentures is that in the edentulous state, there are few natural _____ left. The dentures rest on tissues that will:
adaptive mechanisms; change progressively and irreversibly
In natural dentition, where does our support come from?
dentin, cementum, PDL, alveolar bone
Support in the natural dentition:
______ area of PDL in each arch
45cm squared
Mean denture-bearing areas:
Maxilla=
Mandible=
23cm squared (maxilla)
12cm squared (mandible)
What happens to the mean denture-bearing areas as the ridges resorb?
they decrease
Living bone responds to functional stress by depositing bone in areas of stress:
Wolff’s Law
Edentulous have very little _____ to functional stress on alveolar bone
adaptation
Wearing dentures is almost always accompanied by:
undesirable loss of bone
Residual ridge resorption occurs because:
bone is not a static tissue
Pressure on the ridge causes blood supply to be ____ which in turn causes _____
interrupted; bone reabsorption
Partly covered by a layer of cortical bone after teeth are extracted
maxillary ridge
Crest remains spongy, trabeculated and not resistant to resabsoprtion:
mandibular ridge
Where is the primary denture support area on the mandibular arch:
buccal shelf
Resorption is 4x more severe on the ______ arch
mandibular
To minimize residual ridge resorption, we want to minimize the _____ by _____.
minimize the pressure ; spreading pressure out onto a wider support base
Dentures should be removed from the mouth for atleast ______ hours per day to allow the tissues to rest
8 hrs
Proper impression techniques include:
- record tissues _____
- Extend denture base using ___ within _____.
- Placement of pressure on those tissues ____.
- record tissues at rest
- extend denture base using maximum support area, within physiological limits
- Placement of pressure on those tissues best able to tolerate it
To help minimize residual ridge resorption, there should be no contact of ______ in centric relation closure.
opposing anterior arches
To help minimize residual ridge resorption, _____ & ______ at delivery in order to reduce occlusal discrepancies (ensure occlusal harmony)
clinical remount and equilibration
Decrease the pressure per unit area by extending the denture base to cover the maximum area within physiological tolerance
snowshoe principle
The snowshoe principle deals with what aspect
support
More saliva contact=
more contact adhesion
More saliva contact= more contact adhesion
This deals with what aspect?
retention
Proper peripheral extension =
good border seal
Proper peripheral extension = good border seal
This deals with what aspect?
retention
Quantity and quality of saliva affect:
denture retention
Dryness presents much difficulty for denture wearers- discomfort, ulcerations, retention loss, and chewing problems
xerostomia
Autoimmune and inflammatory conditions
Graft vs. host disease
IgG G4- related sclerosing disease
Amyloidosis
Sarcoidoisis
Infections such as HIV, AIDS, Hep C
Salivary gland aplasia or agenesis
What do all these have in common?
Associated with xerostomia
Anticholinergic drugs
Antihistamines
Antihypertesnive agents
Opioids
Psychotropic agens
Skeletal muscle relaxants
What do all these have in common?
All cause xerostomia
Amount of retention is directly proportional to the ____ of the denture base material, to the ___ covered by the denture base, and to the ____ of the saliva.
wettability; area; viscosity
RETENTION DIRECTLY PROPORTIONAL TO THESE
Maxilla has _____ retention than the mandible
MORE
Dentures do not cure _____
edentulism
Dentures are not substitutes for _____, they are substitutes for ____.
natural teeth; no teeth
The patient personality and _____ plays a major role in the overall complete denture success
relationship with the dentist
A patients mismatched perceptions and expectations may mean:
treatment failure
Well-adjusted, positive self image (psychological, social, and interpersonal) is an important determinant of:
denture satisfaction
The presence of ______ does not significantly affect ability to achieve a successful outcome with complete dentures
less-than-ideal intra-oral anatomy
Mucosa that is highly keratinized, and the best denture support:
masticatory
Mucosa that is thin, non-keratinized; mucosa of the lips and cheek
Lining
Lining mucosa forms a seal against dentures but does not:
resist stress
Keratinized mucosa found on the dorsal surface of tongue, contains taste buds
specialized
What are the 3 types of mucosa?
- masticatory (best denture support)
- lining
- specialized
Characteristics of idea denture-bearing tissue:
- firmly bound, keratinized masticatory mucosa
- zone of connective tissue and submucosa
- underlying cortical bone
muscle attachments near by
Routine reabsorption pattern following extraction of teeth results in smaller maxilla when compared to dentate arch:
Centripetal resoprtion
Centripetal resorption is the is the routine reabsoprtion pattern _____ resulting in _____ when compared to dentate arch.
following extraction of teeth; smaller maxilla
In centripetal resoprtion, the maxilla shrinks:
this can result in going from a class ____ to class ___
inward and upward
class I to class III
The labial frenum: (maxillary)
- Must be accommodated during _______
- Contains no _____
- Inserts in _____ direction
- Little ____ movement and function
- _____ in denture should be narrow
- impression
- muscle fibers
- vertical direction
- lateral movement
- notch
The labial vestibule: (maxillary)
- Space between _____ and ______.
- Reflection contains no ____.
- labial frenum and buccal frenum
- muscle fibers
The space between the labial frenum and buccal frenum:
labial vestibule
The buccal frenum: (maxillary)
- Single or multiple- located in area of ______
- _____ direction of reflection
- May contain few fibers of _____
- Notch in denture is broad since movement of frenum is affected by ____ and ______.
- premolars
- anti-posterior
- caninus muscle
- buccinators and orbicularis oris msucle
Notch in the denture is broader at the _____ frenum than at the _____ frenum
Buccal; labial
Buccal vestibule may also be called: (2)
corono-maxillary space; retrozygomatic space
The space between the buccal frenum and hamular notch:
buccal vestibule (retrozygomatic space)
In the buccal vestibule, you can palpate _____ just buccal to 1st maxillary molar
zygomatic process
____ affects the retrozygomatic space (buccal vestibule) when moving the jaw side to side
coronoid process
The buccal vestibule (retrozygomatic space) must be filled vertically and laterally by ______ to prevent ingress of air and loss of retention of maxillary denture
denture flange
Extension of denture into the border:
denture flange
What is commonly incompletely captured in preliminary impressions?
Buccal vestibule (retrozygomatic space)