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nae teeth Flashcards

1
Q

What are the options for replacing missing teeth?

A

No tx
Removable prosthesis
Fixed prosthesis
Implants
Orthodontic space closure

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2
Q

What are the pros and cons of no tx?

A

+ conservative and not destructive
- poor aesthetics
- loss of speech and masticatory function
- deterioration of occlusion

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3
Q

What are the criteria for SDA?

A

Dental problems limited to posterior teeth
Good prognosis for approx 8-10 pairs of anterior and premolar teeth
Pt limitations preventing extensive restorative care - finances, ill-health
Absence of parafunction or mandibular dysfunction
When biological cost of fitting an RPD will be too high

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4
Q

What is an SDA?

A

The retention throughout life of a functional, aesthetic, natural dentition of not less than 20 teeth and not requiring a prosthesis

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5
Q

What are the advantages of an RPD?

A

Appearance
Conservative - no/minimal tooth prep
Additions possible
Maintains masticatory function
Less expensive
Can be removed for cleaning
Good if multiple edentulous regions

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6
Q

What are the disadvantages of RPDs?

A

May be bulky and adaptation can be difficult
Multiple appointments required
May cause gagging or retching
Retention and stability may be a problem
Soft tissue coverage may result in plaque retention
Clasps may be unattractive

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7
Q

What are the advantages of bridges?

A

Better pt acceptance
Superior stability with chewing hard foods
Minimal soft tissue coverage
Easier plaque control
More natural appearance
RBB cantilever - minimally invasive

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8
Q

What are the disadvantages of replacing an edentulous gap with bridgework?

A

Less conservative - tooth prep may be required
With conventional bridges - 5-10% of preparations will result in pulp necrosis if crown prep is required
Abutments must be in good alignment and functionally adequate
More difficult to repair if damaged
More expensive

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9
Q

What are the advantages of replacing an edentulous gap with an implant?

A

Excellent aesthetics
No prep of adjacent teeth
Good maintenance of supporting bone
Simplified plaque control
Good restoration of speech, function and aesthetics
High long term survival

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10
Q

What are the disadvantages of replacing an edentulous gap with an implant?

A

Expensive
Needs long term maintenance care or risk of peri-implantitis
Not indicated in all pts - bone levels, MH
Risk of perforation into nasal cavity, maxillary sinus
Lengthy tx time
Technique dependent
Surgical procedures required

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11
Q

What are the advantages of restoring an edentulous gap with orthodontic space closure?

A

No tooth prep required
Aids in plaque control once space closure has been achieved

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12
Q

What are the disadvantages of restoring an edentulous gap with orthodontic space closure?

A

Movement is slow - long tx time
Requires good compliance and stable perio condition
May require tooth prep/restoration/indirect work following repositioning teeth
May not provide aesthetic appearance
Risk of root resorption
Can be expensive

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13
Q

Why would you use an RPD over a fixed prosthesis?

A

Replacing multiple missing teeth
Restoring long edentulous spans
Restoring free-end saddles
Managing alveolar resorption - RPD can provide lip support, teeth can be set ahead of the ridge to provide better support

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14
Q

What are the advantages of CoCr RPDs?

A

Stronger material
Better tolerance and taste sensation
More hygienic
Better retention potential

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15
Q

What are the disadvantages of CoCr RPDs?

A

Poorer aesthetics
Difficult to add to, repair and adjust
More expensive and involves more stages to make

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16
Q

What are the advantages of PMMA RPDs?

A

Good aesthetics
Easier to add to, repair and adjust
Has low density
Cheaper to process and requires less stages to make

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17
Q

What are the disadvantages of PMMA RPDs?

A

Brittle and susceptible to distortion
Must make them in bigger bulk to overcome brittleness
Less hygienic
Less strong
Less tolerable for some pts

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18
Q

What are the aims of surveying?

A

Establish path of insertion
Identify undercuts which may be used to retain denture
Identify undercuts to be blocked out prior to finish
Informs decision making on position, type and material of clasp

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19
Q

What instruments are used in surveving?

A

Analysing rod
Graphite marker
Undercut gauge
Wax trimmer

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20
Q

Where are rests placed in bounded saddles?

A

At equal distance on either side of the bounded ssaddle, so load is distributed evenly

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21
Q

Where should rests be placed on free-end saddles and why is this?

A

Further away from saddle ie - mesial of tooth
Reduces torque on the abutment so denture sinks into mucosa less, giving even compression of soft tissue distally

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22
Q

How large should CoCr rests seats be?

A

At least 1mm wide with 0.5mm depth

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23
Q

When is tooth support often used?

A

In bounded saddles

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24
Q

When is mucosal support considered?

A

Inadequate teeth available to support number of teeth being replaced
Teeth available in poor condition or if denture is transitional or immediate

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25
When is tooth and mucosal support considered?
Free-end saddles When inadequate teeth for tooth borne support only There is a lower free-end saddle present - prevents last tooth from potentially tipping
26
What is support?
Resistance to a vertical displacing force directed towards teeth and mucosa
27
What is retention?
Resistance to vertical displacement of the denture
28
What are the types of retention?
Direct - keeps denture in place during function and at rest Indirect - the ability of the denture to resist rotational movements
29
What gives a denture direct retention?
Neuromuscular forces Physical forces - adhesion/cohesion to denture surface - comes with experience Guide surfaces - parallel guide planes Mechanically - clasps
30
What depth of undercut is needed for each clasp material?
0.2mm - CoCr 0.5mm - SS 0.75mm - to deep
31
What provides indirect retention?
Major and minor connectors Rest seats Saddles Denture bases
32
What is an RPI system?
Stress relieving system used for free-end saddles on lower arches Includes: - mesial occlusal Rest - distal proximal Plate - gingivally-approaching I-bar clasp
33
How does each component of the RPI system work?
Rest prevents distal tipping of the premolar when occlusal forces act on the posterior saddle I-bar clasp provides retention and disengages from the tooth when occlusal forces are places on the free-end saddle The distal proximal plate provides retention. An undercut below it allows it to slide into the undercut, relieving pressure from the tooth during masticatory forces
34
What is reciprocation?
Resistance against horizontal displacing forces on abutment teeth caused by clasp removal from undercuts
35
How is reciprocation achieved?
Opposing clasp arm By the connector - plate makes continuous contact with the tooth as the retentive arm moves through its retention distance
36
What are minor connectors?
Join small components (rests, clasps) to the saddle or to the major connector May contribute to bracing and reciprocation
37
What is a major connector?
Links the saddles and minor connectors Contributes to support, retention, reciprocation and bracing
38
When are anterior plate/horseshoe connectors used and what are their drawbacks?
When several anterior teeth to be replaced If maxillary tori present Pt tolerance may be limited due to highly innervated rugae and mucosa
39
When are mid palatal plates used and what are their drawbacks?
Leaves most gingival margins uncovered and well tolerated as allows sensation to uncovered mucosa Contraindicated if maxillary torus
40
When are full palatal plates used?
To distribute forces between teeth and mucosa Can leave gingival margins uncovered but may act as food trap
41
When is a ring design used?
Good if multiple saddles around arch Well tolerated as increased sensation to uncovered mucosa Good if torus would contraindicate a mid palatal plate or full palate
42
What are the requirements for a lingual bar?
Space required - 8mm: - 3mm away from gingival margin - 4mm height for lingual bar - 1mm above raised functional depth of FoM
43
What are the pros and cons of a lingual bar?
+ well tolerated + less of a plaque trap - cannot be used when inadequate space of prominent lingual frenum/torus
44
What are the requirements of a sublingual bar?
Space required - 5mm: - 3mm away from gingival margin - 2mm height for actual bar 4mm thickness for rigidity
45
What is used if there is insufficient space for a sublingual bar?
Dental bar or lingual plate
46
List 3 non-elastic impression materials
Plaster Impression compound Zinc-oxide eugenol
47
What are the different types of elastic impression materials?
Hydrocolloids: - agar (reversible) - alginate (irreversible) Synthetic elastomers: - polysulphide - polyether - addition silicone - condensation silicone
48
When is impression compound used?
Primary imps for complete dentures (Red IC) Border moulding and tray extension (Greenstick)
49
When is zinc-oxide eugenol used?
Master imps for complete dentures
50
What are the components of alginate and what is their significance?
Trisodium phosphate - controls setting time Polysaccharide - allows for irreversible setting Calcium salts - causes the setting reaction by reacting with sodium Filler - increases viscosity to increase handling
51
What are the advantages of alginate?
Non toxic and non irritant Good surface detail Ease of use and mix Cheap and good shelf life Setting time can be controlled by water temp
52
What are the disadvantages of alginate?
Poor dimensional stability Poor tear strength Can distord if unsupported Incompatible with some dental stones Setting time very dependent on operator handling Messy Needs good mixing so no air bubbles
53
What happens if an alginate imp is left out in the open?
Syneresis - loss of moisture causing shrinkage leading to an inaccurate impression
54
What happens if an alginate imp is stored in wet conditions?
Imbibition - water absorbed causing localised expansion where it has contracted water leading to an inaccurate impression
55
What is the post dam and where is it anatomically?
The posterior extension of a maxillary acrylic denture that aims to enhance retention and maintain peripheral seal Lies on the junction of the hard and soft palate - the vibrating line Can be identifies using finger - vibrating line moves when the pt says ahhh
56
What may occur if the post dam is placed in the wrong position?
Too deep - pain Too anterior - lack of posterior seal and retention Too posterior - poor pt tolerance, triggers gag reflex
57
What are the advantages of replica dentures?
Increased success as able to reproduce successful features that pt is already accustomed to Tooth position is already given to lab Able to accurately alter undesirable features Simplified occlusal registration Reduced number of visits
58
What are the disadvantages of replica dentures?
Cannot be done for RPDs Cannot be done if major problems with old denture
59
What are the indications for replica dentures?
Pt has successful denture but: - is losing retention - has difficulty when eating - wants a spare Following successful immediate replacement denture that requires replacement To renew old, deteriorated and stained denture base material For physically or psychologically impaired pts who cannot adapt to new dentures (utilises same neuromuscular control)
60
What is an immediate denture?
A denture that is made prior to the extraction of the natural teeth and which is inserted into the mouth immediately after the extraction of those teeth
61
What are the advantages of immediate dentures?
Maintenance of soft tissue contour of face Maintaining appearance and mental well-being Duplication of existing teeth and jaw relationship Aids function Prevention of tongue spread Reduction in alveolar bone resorption Protection of extraction site
62
What are the disadvantages of immediate dentures?
Discomfort Increased cost and number of visits No trial denture stage possible - unable to assess aesthetics
63
What is relining?
The addition of material to resurface the fit surface of a denture producing an accurate adaptation to the denture bearing area Will increase the thickness of the denture
64
What is an overdenture?
A denture that lies above one or more natural teeth or implants which gives it additional support
65
What are the indications for overdentures?
Motivated pt with good OH RCT treated teeth with significant tooth wear If MH suggests avoiding extractions To mask cleft lip and palate Severe toothwear
66
What are the advantages of overdentures?
Alveolar bone maintained Improved retention, stability and support Preservation of proprioception Enhanced masticatory force Additional retention possible using precision attachments Psychologically aids transition from partial to complete dentures Ridge preservation Good pt tolerance
67
What are the disadvantages of overdentures?
RCT usually required on natural abutments Increased maintenance for patient Needs meticulous OHI Roots prone to caries Higher cost and surgical risk if opting for implant-supported
68
What denture hygiene instructions should be given?
Rinse denture after every meal Remove debris by brushing with soft toothbrush, soap and cold water Clean over basin full of water to avoid breakage if dropped Soak in appropriate denture cleaning solution for recommended time Rinse thoroughly with cold water then soak overnight in cold/room temp water Do not sleep with dentures in Do not use effervescent peroxides for long periods
69
How should CoCr dentures be cleaned?
Do not use acid cleaners as metal will corrode Soak in effervescent cleansers (alkaline peroxide) for 15 minutes Or soak in alkaline hypochlorite for 10 minutes Rinse and soak in cool water overnight
70
How should acrylic dentures be cleaned?
Use alkaline hypochlorite for 20 minutes in evening if necessary Alkaline peroxides fine to use Rinse and soak in cool water overnight
71
What is candida-associated denture stomatitis?
Secondary candidal infection of tissue modified by the continual wearing of an ill-fitting denture and poor denture hygiene
72
What are the predisposing factors to candida-associated denture stomatitis?
High carbohydrate diet Poor denture hygiene Denture appliance wearing at night Dry mouth and denture wearing Diabetes

4 - misc (10 decks)

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