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RPD > Mouth Preparation > Flashcards

Mouth Preparation Flashcards

1
Q

skipped
Patient Treatment
• Phase I:
(5)

A

– Relief of pain & infection
– Collection of diagnostic data
• Diagnostic cast, Diagnostic mounting
– Develop treatment plan
• Design RPD
– Patient education & motivation
– Occlusal equilibration

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2
Q

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Patient Treatment
• Phase II:
(6)

A

– Removal of deep caries, temporary
restorations
– Extraction of non-retainable teeth
– Preprosthetic surgery: tuberosity reduction,
etc.
– Periodontal treatment, Plaque control
– Interim prosthesis: function, esthetics
– Occlusal equilibration, may need changes
after extractions

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3
Q

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Patient Treatment
• Phase III:
(3)

A

– Definitive endodontic treatment
– Definitive restorative treatment
• Surveyed crowns, if needed
• Fixed partial dentures, if appropriate
– Occlusal plane correction

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4
Q

Patient Treatment
Phase IV:

A

– Construction RPD

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5
Q

Patient Treatment
• Phase V:
(3)

A

– Post-insertion care
– Periodic recall
– Continued plaque control

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6
Q

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Mouth Preparation
(9)

A

• Relief of pain & infection
• Caries removal
• Extractions, Preposthetic surgery
• Periodontal treatment, plaque control
• Occlusal equilibration
• Endodontics
• Definitive Restorative Treatment:
• Occlusal plane correction
• Enameloplasty for RPD

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7
Q

• Definitive Restorative Treatment:
(2)

A

– Amalgams, composites
– FPDs, crowns, surveyed crowns

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8
Q

Diagnostic Casts
(2)

A

• Preliminary design of RPD
• Identify tooth modification areas

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9
Q

Mouth Preparation
• Perform tooth modifications
(2)

A

– according to RPD diagnostic cast design
– QA Worksheet

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10
Q

Enamoplasty for RPD
(5)

A
  1. Develop Guide Planes
  2. Enlarge embrasure for minor connectors
  3. Lower Height of Contour
  4. Create undercuts if needed
  5. Prepare rest seats
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11
Q
  1. Develop Guide Planes
    (3)
A

– Proximal: adjacent to edentulous areas
– ML: stress-release clasps ML minor connector
– Lingual: reciprocal clasp

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12
Q
  1. Lower Height of Contour
    (3)
A

– Proximal 2/3 Circumferential retentive clasp
– Reciprocal clasp
– Lingual Guide Plate

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13
Q
  1. Prepare rest seats
    (2)
A

• Occlusal
• Lingual: chevron

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14
Q

Guide Planes, Embrasures,
Alter Height of Contour
• Alginate Impression(s)/Snapstone Cast(s)
• Survey interim casts
• Confirm that preparations are parallel to
path of insertion in the following
sequence: (3)
• Confirm that survey line lowered
enough

A
  1. Prepare guiding planes
  2. Enlarge embrasures for minor
    connectors
  3. Reposition the survey line to reduce
    interferences to framework placement and
    enable most ideal clasp placement
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15
Q
  1. Undercut Preparation
    (2)
A

• Used when slightly insufficient retentive
undercut
• Sloped buccal &/or lingual surface,
procedure contraindicated
– Need to reconsider other areas for
undercut or may need surveyed crown

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16
Q

Undercut Preparation
• Indicated:

A

slightly insufficient retentive
undercut with vertical buccal & lingual
surfaces
• Preparation with round-ended tapered
diamond

17
Q

Rest Seat Preparations
• After adequate preparation for GP, Survey
line alterations
• Same procedure as lab projects
• Check adequacy occlusal/embrasure rest
seats:
(3)

A

– Patient close into beading wax
– Measure thickness of wax (Caliper)
• At least 1mm
– If unable to attain adequate depth within enamel
• Remove small amount of opposing tooth structure
– Be sure to remake impression of opposing arch

18
Q

Master Cast: Class III RPD
Impression Techniques
(4)

A

• Residual ridge not provide RPD support
• Alginate/stock tray
• Alginate/custom tray
• Custom tray/elastomeric material

19
Q

Custom tray/elastomeric material
(3)

A

– Preferred technique UMKC
– Not border molded
– Medium-bodied PVS

20
Q

Master Cast: Extension RPD Impression
(2)

A

• Residual ridge important source of RPD
support
• Important to accurately record
maximum tissue support area

21
Q

Broad-stress distribution concept

A

• Distribute occlusal forces over as many teeth &
as much soft tissue as possible
• Not overload teeth or tissue
• Increased stability & retention
• Less frequent reline

22
Q

The Problem with ToothTissue Supported RPDs: (2)

A

The periodontal membrane allows for 0.25 +/- 0.1
mm and the muco-periosteum allows for 2.0 + mm
movement
• Due to the lever
effect of the distal
extension base,
occlusal pressure is
concentrated on the
distal end of the
base

23
Q

The Solution for Tooth/Tissue
Supported RPDs
(2)

A

• Equalize support derived from tissue and
teeth
• To distribute load to both the natural and
artificial dentition & minimize base
movement

24
Q

Master Cast: Extension RPD Impression
• Custom tray/elastomeric material
(2)

A

– Border-molded tray
– One-step impression

25
Q

Master Cast: Extension RPD Impression
• Corrected (Altered) Cast technique

A

– Two-step (Dual) impression
• Step one: Impression of teeth & residual ridge
• Step two: Impression of residual ridge areas
using framework

26
Q

Master Cast: Altered Cast Impression
(2)

A

• Step one: Impression of teeth & residual ridge
– Alginate/stock tray or
Alginate/custom tray
– Framework fabricated on 1st cast
• Framework less precise than with
elastomeric impression
• Step two: Impression of residual ridge areas
only
– Sectional trays added to framework
– Border-molded
– Elastomeric material

27
Q

Master Cast: Altered/Corrected Cast
(2)

A

Complex technique
Prone to operator error
•Lift of distal framework during residual ridge impression
•Framework on final cast not oriented the same as in the mouth

28
Q

Master Cast Impression Techniques
• Leupold, Flinton, & Pfeifer, JPD, 1992
(3)

A

– Compared one-step border-molded
custom tray/elastomer impression &
altered cast impression technique
– Concluded clinically insignificant difference
in the vertical displacement of final RPD
between the 2 techniques
– One-step technique less prone to operator
error than altered cast procedure

29
Q

Master Cast Impression Techniques
• Frank, Brudvik, Noonan, JPD, 2004
Clinical outcome of the altered cast impression
procedure compared withuse of a one-piece cast
Compared the efficacy of an altered cast compared to a one-piece
cast with regard to base support, abutment health, and patient
comfort over time in 72 subjects.
Conclusion:

A

“The altered cast impression
procedure does not offer significant
advantages over the one-piece cast.”

30
Q

skipped
One-step Impression: Custom Tray

A

• Fabricate tray on working / diagnostic
cast
• Apply separating medium to cast
– Liquid foil (not vaseline)
• Tray extensions:
– 2-3 mm coronal to
vestibule depth in
both dentate &
edentulous areas
• Wax spacer placed over tray outline
– ~3 mm over teeth (red rope wax)
– ~1.5 mm over residual ridge (baseplate
wax
• Tray stops
– 3 widely spaced openings in wax spacer
• 3 mm openings
– Tripod support for tray
– Use teeth NOT
contacted with rests
– Residual ridge stops
similar to complete
denture tray
• Aluminum foil over wax spacer (not vaseline)
• Triad tray material adapted over foil/spacer
• Polymerize
• Add finger rests to tray surface over
edentulous areas
– Stability during impression
– Strengthen tray
• Distal tray areas prone to fracture
• Narrow, flat residual ridges
• Add handle

31
Q

Custom Tray Impression
• Determine final tray extension at
impression appointment
(3)

A

– PIP tray flanges: extension & outer surface
– Do border molding movements
– Areas where PIP removed, shorten or thin
tray

32
Q

Custom Tray Impression
• Border mold distal extension residual ridge
areas
• Elastomeric impression material
(2)

A

– Polysulfide: High tear strength, pour within 1 hour
– PVS: Hydrophobic, adequate tissue detail

33
Q

skipped
Master Cast
• Survey

A

– Determine path of insertion
• Guide planes parallel,
Equalize undercut
– Mark abutment height of contour
• Facial & Lingual
– Measure & mark retentive
undercut
• RED line
• NOT red DOT
• Approximate inferior edge of clasp
• Tripod lateral sides of cast

34
Q

skipped
Lab Prescription
(5)

A

• Surveyed cast
• Work authorization
– Lab RX
• Send to QA
for approval
• Send to Lab
• Framework
fabricated

RPD (22 decks)

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