Patient assessment and treatment planning Flashcards
Limitations of complete dentures
Functional
Aesthetic
Feedback
What should you find out in denture history?
How long they have been edentulous, how many sets of dentures they’ve had, have they had any sets that have been very successful
What is one of the hardest components of complete denture cases?
Patient expectations - they expect the dentures to be as good as teeth
What should you include in the description of edentulous ridges (complete denture assessment form)
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
Describe Cawood and Howell classification of ridge form
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
In order to assess retention and stability should you ask patient to
a) open wide
b) open by a few mm
Only a few mm
When first assessing retention and stability, what are you looking for?
Do dentures stay in place?
Are maxillary dentures displaced vertically
Is there any displacement of mandibualr denture?
What is retention?
Capacity of denture to resist displacement away from tissues
How do you assess retention?
Attempt to remove the dentures along their long axis - is their a border seal?
What is stability?
Capacity of dentures to resist movement whilst in contact with tissues (horizontal and rotational forces)
How is stability asessed?
Apply lateral finger pressure to dentures and look for any rocking/rotational
What influences stability?
Maxillary and mandibular ridges, adaptation of the denture base, occlusion
What influences retention?
Adhesion, cohesion, gravity, tissue contact, peripheral seal
Stability
What is support?
Resistance of vertical movement towards the ridge
How should support be assessed?
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
What are base extensions relative to?
Sulcus and limiting anatomy
How can base extensions be assessed?
Is there a gap between denture and sulcus
Does it displaced in function
Can denture be moved by border moulding?
Impinging on frenal attachments?
What is the aim in terms of occlusion when creating complete dentures?
Balanced occlusion such that teeth remain in contact during static and dynamic occlusion
Why should complete dentures have balanced occlusion in static and dyamic occlusion?
Prevents displacement or dislodgement due to premature or deflective contacts affecting the retention/stability
Why do we use retruded arc of closure when recording jaw relationships in edentulous patients?
The only stable, reproducible position
What is RCP?
First point of contact between maxillary and mandibular teeth on retruded arc of closure
When producing complete dentures what should the RCP be?
Co-incident with ICP (teeth fully meet together)
What will occur if RCP doesn’t = ICP?
Instability, not retentive, impair ability to function
What should you look for in lateral excursive movements?
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
What is a slide?
Denture teeth meet together in one position initally there is then a slide visible into final occlusion
Affect of slides?
Displace lower denture
How to work out freeway space?
Resting face height - occlusal vertical dimension
Measuring freeway space is not always accurate, what is a good gauge?
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)
What is the incisal plane measured against?
Inter-pupillary line
What is the occlusal plane measured against?
Alar-tragal line
What should you asses for incisal level?
How much tooth is visible at rest and when smiling
What should be considered when looking at the position of the posterior teeth?
Occlusal plane relative to resting position of tongue
Buccal corridor
What should you look at when assessing anterior tooth psoiton?
Lip support
Position relative to ridge anatomy
What should you assess additionally in implant supported over-dentures?
Assess implants
Periodontal health around implants
Components within denture base
What should you think about when coming to a diagnosis for complete denture assessment?
What have you identified that needs improvement
Presenting complaint
What is the prognosis?
Prediction of success of replacement dentures
What should you consider when writing your prognosis?
Patient satisfaction - previous denture wearer, bothered about aesthetics, expectations, ridge anatomy
What may eb involved in treatment plan?
Planned modifications to existing dentures Replacement Copy Referral No treatment
