Polishing, Insertion & Adjustment + Remounts Flashcards
insertion is really a how many step visit?
wo step
- adjust the intaglio surface of denture
- adjust occlusion through clinical remount
then re-adjust the intaglio surface of denture if needed further
How to adjust intaglio?
PIP - white and creamy
for the intaglio and is MUCOSTATIC
adjusting borders? Describe what material and how it is applies
MUCODYNAMIC soren’s paste and is applied to the borders like we are border molding – THICKLY applied with a tongue blade – done so intra-orally
show throughs with soren’s paste indicate what?
these are due to OVEREXTENSION and this could lead to a potential sore spot
showthorughs on psot dam?
do not grind them – we did this on purpose.
unless we did score paste the post dam
before you adjust with handpiece?
do it again to make sure
PIP placement
THIN WITH A BRUSH and want to be able to see strokes and the base so we can see the displacement
brush strokes not touched by tissue?
not fully seated so check for show throughs and over compressed areas to adjust
show through on rugae?
common if they are flabby
show through means
pushing too hard in that area and need to adjust – want uniform seating
why do we get discrepencies with seating at insertion?
processing errors during lab processing
importance of our CR record during insertion?
to make sure the occlusion is NOT the reason for the ill seating/ fitting of the denture
when is the most accurate CR record taken?
during the insertion appointment
study regarding the adjustment of occlusion in the mouth and on the articulator (using a clinical remount)
NO CLINICAL REMOUNT – ALL PATIENTS HAD SORE SPOTS
pt. calls and complaints of a sore spot on lower left side…. what should you consider before adjusting occlusion?
MAY NOT BE THAT SPOT – could be from over seating denture on the opposite side and the side that has the sore spot is not actually fully seated so when they bite – it is moving and pushing on the other side – do NOT IMMEDIATELY begin to grind the intaglio/adjust the intaglio of the spot where pt. is describing
occlusion affects what?
retention, stability, fit of denture, as well as health of underlying tissue
When should remount casts be made?
BEFORE clinical appointment
so should try denture in – adjust intaglio and do clinical remount to EQUILIBRATE THE OCCLUSION — then go back and check the intaglio again to make sure it is perfect for the patient
how is the maxillary cast re-mounted? when?
using the facebow PRESERVATION index and is done BEFORE the clinical appointment
what is major thing you have to do with patient when they come in for insertion?
CR record – your clinical remount should already be done
what has to be the same before you adjust occlusoin on articulator during insertion? (part of clinical remount)
MAKE SURE ARTICULATOR = THE PATIENT with the CR record you made
T/F you have different show throughs when you have occlusion or not?
implications
YES – so this is why you adjust intaglio first then do occlusion so each base is fitting perfectly before go into motion
what do you adjust after using articulator paper?
adjust the bullseyes NOT THE SMUDGES
In anatomical teeth what do you adjust?
adjusting the inclines when can to achieve the cusp- fossa relationship
adjusting occlusion on monoplane?
flat plane and FLAT adjustments – do not create inclines
check the mandibular occlusal plane first (2/3 of the RMP) and if that is where it should be — correct the maxilary teeth accordingly - so make sure C is okay then adjust D if need to
when do you do clinical remount in conventional denture? for immediate/interim denture?
conventional = at insertion
immediate/interim = NOT at insertion – but at subsequent visit when tissue is no longer swollen
for both @ subsequent visit when occlusion caused sore spot and occlusion is cause of patient Chief Complaint
post insertion adjustments for conventional and immediate/interim?
Conventional = 48 hours – will happen by this time if sore spot is going to develop
1 week
then whenver they need
Immediate = 24 hours, 72, 1 week, 1 month – monthly for 6 months until ready for difinitive tx
how to do post insertion adjustments - general
LISTEN TO THEM
ask questions and observe and inspect denture for more clues
pt yawns and denture falls out what is likely the problem
distobuccal flange is too thick – put PIP on these aspects
coronoid process hitting
indeb. pencil use?
place on spot pt. is complaining about and transfer to the denture to identify spot
what are the main things done BEFORE insertion
- Lab remount (done by lab before de-casting)
- Polish
- Prepare remount casts
- mount the upper using FB preservation
single sore spot on ridge is usually due to what?
OCCLUSION problem
burning sensation on anterior palate or ridge?
anterior palatine foramen
burning sensation on bicuspid to molar
posterior palatine foramen
burning sensation on lower anterior ridge
mental foramen – not much we can do about these patients except send to oral surgery and get bone graft
generalized burning sensation - not defined
maybe has burning mouth syndrome?
overall tissue redness??
acrylic allergy - extremely rare – so you see redness on all tissues NOT JUST denture bearing tissues
TMJ problems?
pain – excessive vdo
clicking – multifactorial
limitation of movement – arthritis or trauma
instability - when not occluding
border is either over or under extended
loss of posterior palatal seal
tissue dehydration
instability when incising?
loss of posterior palatal seal
anteriors are too labial
poor denture fit
instability when occlusing in centric
malocclusion
difficulty swallowing
MAX OR MAND. POSTERIOR TOO LONG OR THICK
Posteriors are too lingual
excessive VDO
Palatal portion too thick (space of donders)
gagging cause
too long or thick or moving
clicking cause
excessive vdo
unstable denture
muscle fatigue cause
excessive vdo
if patient has general uneasy feeling about denture?
probably a malocclusion problem or an incorrect VDO
almost all complaints have what component?
occlusal component
