Patient assessment and treatment planning

Question 1

Limitations of complete dentures

Answer 1

Functional
Aesthetic
Feedback

Question 2

What should you find out in denture history?

Answer 2

How long they have been edentulous, how many sets of dentures they’ve had, have they had any sets that have been very successful

Question 3

What is one of the hardest components of complete denture cases?

Answer 3

Patient expectations - they expect the dentures to be as good as teeth

Question 4

What should you include in the description of edentulous ridges (complete denture assessment form)

Answer 4

Hight
Firmness
Irregularity
Mobility
Sulci
Any bony exostoses and tori? - may need to be removed 
Muscle attachments (high/low)
Is there a line of erythema outline current denture (stomatitis)
Sulcus depth

Question 5

Describe Cawood and Howell classification of ridge form

Answer 5

Class I - dentate
Class II - immediately post extraction
Class III - well rounded ridge form with adequate height and width
Class IV - knife-edge adequate height, inadequate width
Class V - flat ridge form, inadequate height and width
Class VI - depressed ridge form, basalar loss

Question 6

In order to assess retention and stability should you ask patient to

a) open wide
b) open by a few mm

Answer 6

Only a few mm

Question 7

When first assessing retention and stability, what are you looking for?

Answer 7

Do dentures stay in place?
Are maxillary dentures displaced vertically
Is there any displacement of mandibualr denture?

Question 8

What is retention?

Answer 8

Capacity of denture to resist displacement away from tissues

Question 9

How do you assess retention?

Answer 9

Attempt to remove the dentures along their long axis - is their a border seal?

Question 10

What is stability?

Answer 10

Capacity of dentures to resist movement whilst in contact with tissues (horizontal and rotational forces)

Question 11

How is stability asessed?

Answer 11

Apply lateral finger pressure to dentures and look for any rocking/rotational

Question 12

What influences stability?

Answer 12

Maxillary and mandibular ridges, adaptation of the denture base, occlusion

Question 13

What influences retention?

Answer 13

Adhesion, cohesion, gravity, tissue contact, peripheral seal

Stability

Question 14

What is support?

Answer 14

Resistance of vertical movement towards the ridge

Question 15

How should support be assessed?

Answer 15

Coverage of the denture bearing anatomy without impinging on tissues that will displace it

Do the dentures move when patient speaks

Attempt to displace along vertical axis and attempt to tip anteriorly

Question 16

What are base extensions relative to?

Answer 16

Sulcus and limiting anatomy

Question 17

How can base extensions be assessed?

Answer 17

Is there a gap between denture and sulcus

Does it displaced in function

Can denture be moved by border moulding?

Impinging on frenal attachments?

Question 18

What is the aim in terms of occlusion when creating complete dentures?

Answer 18

Balanced occlusion such that teeth remain in contact during static and dynamic occlusion

Question 19

Why should complete dentures have balanced occlusion in static and dyamic occlusion?

Answer 19

Prevents displacement or dislodgement due to premature or deflective contacts affecting the retention/stability

Question 20

Why do we use retruded arc of closure when recording jaw relationships in edentulous patients?

Answer 20

The only stable, reproducible position

Question 21

What is RCP?

Answer 21

First point of contact between maxillary and mandibular teeth on retruded arc of closure

Question 22

When producing complete dentures what should the RCP be?

Answer 22

Co-incident with ICP (teeth fully meet together)

Question 23

What will occur if RCP doesn’t = ICP?

Answer 23

Instability, not retentive, impair ability to function

Question 24

What should you look for in lateral excursive movements?

Answer 24

Does denture move
Are there any slides? - denture teeth may meet together in one position initially then there is a slide visible into final occlusion

Question 25

What is a slide?

Answer 25

Denture teeth meet together in one position initally there is then a slide visible into final occlusion

Question 26

Affect of slides?

Answer 26

Displace lower denture

Question 27

How to work out freeway space?

Answer 27

Resting face height - occlusal vertical dimension

Question 28

Measuring freeway space is not always accurate, what is a good gauge?

Answer 28

Looking at your patient

Look at the face height - does it appear as though the patient is making an effort to keep lips together (muscles strained)

Question 29

What is the incisal plane measured against?

Answer 29

Inter-pupillary line

Question 30

What is the occlusal plane measured against?

Answer 30

Alar-tragal line

Question 31

What should you asses for incisal level?

Answer 31

How much tooth is visible at rest and when smiling

Question 32

What should be considered when looking at the position of the posterior teeth?

Answer 32

Occlusal plane relative to resting position of tongue

Buccal corridor

Question 33

What should you look at when assessing anterior tooth psoiton?

Answer 33

Lip support

Position relative to ridge anatomy

Question 34

What should you assess additionally in implant supported over-dentures?

Answer 34

Assess implants
Periodontal health around implants
Components within denture base

Question 35

What should you think about when coming to a diagnosis for complete denture assessment?

Answer 35

What have you identified that needs improvement

Presenting complaint

Question 36

What is the prognosis?

Answer 36

Prediction of success of replacement dentures

Question 37

What should you consider when writing your prognosis?

Answer 37

Patient satisfaction - previous denture wearer, bothered about aesthetics, expectations, ridge anatomy

Question 38

What may eb involved in treatment plan?

Answer 38

Planned modifications to existing dentures
Replacement 
Copy 
Referral
No treatment