Partial denture 1 Flashcards
What are the options for a patient with a missing tooth? (3)
Resin retained bridges
Implants
Dentures
What are resin retained bridges
- Replaces one tooth per bridge and adjacent tooth needs to be healthy and strong
- comfortable and blends with patients own natural teeth
What are implants
The implant may be a gold standard for missing tooth
- The only replacement for root and relies on excellent lab word and clinical work for the restoration
- May have insufficient bone for the implant
- Surgery may provide more bone for certain circumstances
What are dentures benefits
- excellent way of missing teeth
- low cost
- skill set require is not so high
- easy to adjust
-negative attitude towards dentures - seamlessly blending with other teeth
What are the effects of partial dentures
- Known problems with denture
- adverse effect on plaque control for patients
-Plaque is more prevalent with dentures in therefore risks of caries and periodontal disease are greater
What percentage of adults where partial dentures, complete dentures or no dentures.
approximately 11% of adults wear a denture
- over 6 million people
- patients form poorer backgrounds are more likely to need dentures
What re two classification of dentures
- Partial- patient is missing some of their own teeth
- Complete- patient has none of their own teeth
What is the classification of dentures by material
Classify by the denture material
All acrylic - acrylic denture
Metla framework bt teeth and gum cyclic - cobalt chrome
Cobalt chrome used to make the metal for the frame
Acrylic is weaker than a metal so has to be more bulky to stop it from fracturing for function
So will cover more soft tissue
Which can affect taste perception
Denture itself willacyt as a plaque retentive factor
Meticulous oral hygiene
Cobalt chrome
Stronger
Cut away from gingival margin
Patient gets their taste sensations back
More retentive and stays in better than acrylic denture might do
Only for patients who have a stable mouth which may lead to further loss of tooth
More expensive than acrylic
What classification is used by saddle position
Kennedy
what is Kennedy Class I
Class 1 - bilateral means on both sides of the mouth
What is a Saddle
Area where natural teeth are going to be replaced by denture teeth
What is a free end saddle
Free end - no tooth at one of the ends of the saddle
No tooth at the back of the saddle
What is Class II
Just happening on one side of the mouth
what type of denture is this
Class II
What is Class III
Bound saddle - area where teeth are missing that’s going to be replaced by a denture but at either end of those missing teeth there is a natural tooth
5,6,7 missing
8 at back and 4 at front
what Type of denture is this
Class III
What is Class IV
Calls IV
Gap is at the front of the mouth
Specific problems as terms of aesthetic and stability of the denture
Debate whether class 4 should cross the midline
What type is this denture
Class IV
What are modifications
Denture where there is more than one saddle
If a patients got more saddles , more missing teeth is different areas
Then we give modification number denture
In tis case - 3 saddles
To give classification can be quite confusing as there is a posterior bound saddle and anterior bound saddle
If this patient was just missing UR 4 and 5- class 3
If they were missing anterior 2 or 1 , no posterior missing - class 4
Lower number
Class 3
3 saddles in total - class 3 defines one of the saddles and to record furter 2 saddles
Mod 2 is 2 other saddles
Cobalt chrome - class 2 as free end saddle or class 3 as bounded saddle at lHS - we always go for the lower number
Other saddles as modification number
What is Class II Mod 2 Denture
Denture has 3 saddles
Free end saddle at RHS
Anterior bounded saddles
And posterior saddle at posterior
Could be class 2,3,4
Since its got all 3 - lowest number
Class 2 , mod 2
What is Class II Mod 3
Class 2
Free end saddle at LHS
3 other saddles replacing UL4 ,UR1
And saddles replacing upper L 3,4,5,6
What are the components of denture
what is a saddle
Area of denture that replaces missing teeth
In this case:
Free end saddle on UR
Bound saddles on UL
What is a Flange
DENTURE REPLACE SOFT TISSUE AS WELL AS MISSING TEETH
Flange- area of acrylic that goes into sulcus
Usually gum coloured
What is support from a denture
Next term = support
Support = resistance from dentures being pushed into the resistance in terms of function
Centre of palatal bony and soft tissues thin - provide support
Occlusal rests on metal
What are the 2 classification by support
What is Mucosa borne denture
The spoon denture improves the situation by allowing access to the gingival margins by saliva.
The design follows a 3 mm rule i.e as much of the denture as possible is kept at least 3 mm from the gingival margins.
Retention of such a denture might be a problem, and so….
All support is placed on soft tissues and no support on teeth themselves
Denture just sitting on tissues of the palate
Pressure of that bite goes into that soft tissue beneath the teeth.
What are the adverse effects of the mucosa borne Denture
Adverse effects
Whenever bite down
Teeth will sink into the tissues and put pressure on underlying bone and lead to resorption of the bone and teeth sinking in permanently
Tend to see mucosa born dentures
Positioned around gums - downwards movement on denture can affect the health of the gums
Gum stripper
It’s not tho but exacerbates inflammation due to poor oral hygiene
What is the tooth borne denture
Metal component of denture that sit on top of the tooth
Metal framework underneath that connecting everything together
What are occlusal rests
Whenever a patient sitting on denture teeth has tooth support
Force of that bite is transmitted down tis teeth rather than in the mucosa
Occlusal rests
describe this diagram
Diagram
Occlusal rests
When patient bites down on denture teeth
Force transmitted to teeth on either side
As long as those teeth are nice and healthy
Need good periodontal health and bone support
What is a tooth and mucosa supported denture and limitations
Some dentures can have a mixture
Occlusal rests and free end saddle
Free end saddles - no teeth at back of saddle to support denture so needs to be supported by mucosa at the back
Mixture of tooth and mucosa supported
Limitations:
Can be problematic
When patient bites on denture teeth
Part supported by tooth and apart on mucosa
Mucosa more compressible than a tooth is
Finger on a patient’s natural tooth
Won’t be able to push the tooth a bit
Bites on a denture like this , tend to tip at back and give unwanted forces particularly at back end of saddle
Describe retention of dentures
Next component
Those that provide retention
Amalgam - cavity undercuts sod amalgam can’t come out
Denture has retention too
Component t to prevent for happening
Usually clasps
What type of clasps are there
Two of the main types of clasps used for denture retention
Occlusal surface from tooth and come down
Come in form musical side onto the undercut area of tooth
Gingivally approaching - anterior teeth
Encircles tooth almost completely and called the ring clasp
Main common usage for Cobalt chrome
I bar
Resembles I letter
What are the connectors components of dentures
Final component
Connectors
Things that joining all various saddle together
There are major and minor connectors
What are the properties of major connector
Have major connectors and minor connectors
Major connectors
join all of the saddles and can be a variety
Lingual bar
Right hand side - lingual plate
Two different designs on upper arch
Plate connectors
Cobalt chrome on right - ring connector
What are the minor connectors
What is the development of a Cobalt Chrome Denture
Design
How to design dentures
Wax pattern converted to metal by lost wax technique
Technicians using CAD CAM systems and sintering for metal framework
What is the collected Denture
Most common denture - cover whole palate
Fully collected denture
Popular with dentist and patients
Very well tolerated by patients
Very retentive and stable
What are the limitations of collated dentures
Saliva can’t get underneath denture that well
Different candida species of fungi can colonise features of denture
Candida albicans which lives on inside of denture
When mucosa is covered, the saliva can’t get underneath and it contains antifungal agents but because saliva can’t get underneath the candida thrives
why does collecting need to be done correctly
Another problem
Collets go
Go all around gum margin
Denture benign mucosa supported
Acrylic is going to be pushing plaque into the pockets all around those teeth all of the time
Can lead to inflammation , periodontitis
To solve that problem
The technician can change the design of the denture so the acrylic goes higher up the tooth the gingival margin
Biting force places on tooth than soft tissue
What is a spoon denture
Denture clear nearly form all gingival margins
Easy and quick denture to make
Ideal if front tooth knocked out
Single impression of patient
24 hours
Embarrassment of losing tooth wouldn’t be too long
Good in terms of health of tissues
What are the disadvantages of spoon dentures
Not very supportive
Covering elss fo SA
Load of the bite to spread widely
Cause localised gingival trauma of teeth
Anterior teeth can fracture off load
If anterior teeth can break off
Could inhale denture
Suitable as temporary measure particularly with younger patients
What is a modified spoon denture
Some areas of collided
But majority of silver margin free
Clasps are known as adam’s clasps
Can be used in orthodontics for retainers
Good compromise
what are the advantages of modified spoon denture
What are the advantages of modified spoon denture
More complicated for technician to make
Adam clasp cna fracture but easily replace
What is a important feature for dentures
Keep the away for the gums where possible
Every denture
Named after person
Acrylic denture
Does Not cover gingival
What are the effects of poorly designed dentures
What are the 4 principles of good denture design
Provided where possible
Spread around several teeth
Teeth could feel less fo the laid than if it was all confined to one tooth
Denture needs to be rigid
What are the clinical stages for acrylic dentures
Normal clinical stages
Primary impression
Alginate impression
Tired to record all of patients missing teeth
Sulcus around the mouth where the dneute may go too
Impression tray that fits the patient well
Acrylic denture - secondary impression to make wax rims
Wax rims used to record the occlusion so models mounted onto articulator
For that paint to be able top function
Send them back to the dentist to try in for the patient
Function nicely for the patient
Color and shape of teeth, the patients happy
Normal route for denture
Is possible for primary to fit
What are the clinical stages for cobalt chrome dentures
More stages
Cannot skip
Primary impression for special trays
Surveying on the model
Identifies where undercuts are
Tooth modifications for denture
Create undercut where tis not there
Take secondary impression
