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BDS4 CDS Restorative, Pros & Endo > Pros: All Tutorials > Flashcards

Pros: All Tutorials Flashcards

1
Q

RELINES AND REBASES

Describe a reline.

A

Adding new base material to tissue surface of existing denture in a qualtity sufficient to fill space that exists between original denture contour and altered tissue contour.
Mostly done chairside.

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2
Q

RELINES AND REBASES

Describe a rebase.

A

Replacing the entire denture base material of an existing denture.
Mostly done by the lab.

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3
Q

RELINES AND REBASES

What are the three types of relines ?

A

Temporary, soft, permanent.

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4
Q

RELINES AND REBASES

When would a temporary reline be appropriate ?

A

When grossly ill fitting denture - tissue conditioning prior to new defintive denture construction.
Post immediate dentures.
After implant surgery.

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5
Q

RELINES AND REBASES

Name a brand of temporary reline material.

A

Coe-Comfort.

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6
Q

RELINES AND REBASES

When are soft relines used ?

A

Parafunctional habits.
Very atrophic ridges.
Cancer/cleft patients for obturator construction.
Denture-related hyperplasia - settle condition until provision of new denture.

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7
Q

RELINES AND REBASES

What is the main problems with soft relines ?

A

Plasticizer leaches.
Deteriorates with time.
Harbours microorganisms.

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8
Q

RELINES AND REBASES

What are four types of soft lining materials ?

A

Heat cured acrylic.
Self cured acrylic.
Heat cured silicones.
Self cured silicones.

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9
Q

RELINES AND REBASES

What material is used for permanent relines ?

A

Hard acrylic.

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10
Q

RELINES AND REBASES

When might a permanent reline be suitable ?

A

Peripheral seal problems.
Correction of errors following inadequate master impressions.
Immediate/post-immediate dentures.
Prolonging life span of older dentures.

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11
Q

RELINES AND REBASES

Describe the clinical procedure for rebasing dentures prior to sending to the lab.

A
  1. Remove undercuts from denture.
  2. Wash impression taken using closed mouth technique.
  3. Denture taken to the lab.
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12
Q

COMPLETE DENTURES OPPOSED BY NATURAL TEETH

COMPLETE UPPER DENTURE WITH LOWER NATURAL TEETH
What are the consequences of this ?

A

High forces developed against upper maxillary edentulous ridge.

Leads to trauma (ulceration, discomfort), instability of denture, alveolar resorption and fibrous tissue replacement (flabby ridge).

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13
Q

COMPLETE DENTURES OPPOSED BY NATURAL TEETH

Describe a fibrous ridge. And what are the problems associated with it in denture design ?

A

Alveolar ridge resorption and fibrous tissue replacement, where lower anteriors have been the last teeth to be lost.

Fibrous tissue can be displaced, can compromise retention/support of the denture - causing tipping of prosthesis.

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14
Q

COMPLETE DENTURES OPPOSED BY NATURAL TEETH

Describe ‘combination syndrome’ features (Kelly 1972).

A

Accelerated maxillary anterior alveolar bone loss.
Fibrous tissue replacement i.e. papillary hyperplasia.
Appearance of hypertrophy of tuberosities.
Possible extrusion of mandibular anterior teeth.

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15
Q

COMPLETE DENTURES OPPOSED BY NATURAL TEETH

Describe some ways of reducing trauma to maxillary denture bearing area (avoid development of fibrous ridge where possible).

A

Maximise coverage of denture bearing area.
Ensure prosthesis covers the primary load bearing sites.
Use overdenture abutment roots to maintain alveolar bone level.

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16
Q

COMPLETE DENTURES OPPOSED BY NATURAL TEETH

In what 4 ways can you improve the stability of a maxillary denture if opposing natural teeth ?

A

Optimal border seal

Effective post dam

encourage patient to wear lower RPD and correct irregular occlusal plane

Manage incisal overbite.

Articulation in eccentric movements of mandible - even contacts on both sides of the arch.

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17
Q
A
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18
Q

COMPLETE DENTURES OPPOSED BY NATURAL TEETH

At what clinical stage of denture design, can you achieve the best border seal possible ?

A

Master impression stage with border moulding.

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19
Q

COMPLETE DENTURES OPPOSED BY NATURAL TEETH

What is the benefit of encouraging a patient to wear a lower RPD with their complete maxillary denture ?

A

Prevent breaking posterior border seal, better occlusal plane and better stability. Prevents denture from falling down at the back.

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20
Q

COMPLETE DENTURES OPPOSED BY NATURAL TEETH

Why always ask for two post dams to be placed on upper complete dentures ?

A

Put two - on vibrating line between hard and soft palate and one further forward, if patient cannot tolderate without retching, can be cut back.

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21
Q

COMPLETE DENTURES OPPOSED BY NATURAL TEETH

Where does posterior post dam sit ?

A

On vibrating line - junction between soft and hard palate - compressible tissue.
Helps with retention.

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22
Q

COMPLETE DENTURES OPPOSED BY NATURAL TEETH

How can an irregular occlusal plane on natural teeth be managed ?

A

No adjustments - accept problems.
Minimal localised occlusal grinding.
Radical occlusal adjustment.
Extraction of teeth.
Overlay appliances.

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23
Q

COMPLETE DENTURES OPPOSED BY NATURAL TEETH

Complete lowers with upper naturals OR complete upper with lower naturals - what is more complex ?

A

Complete lowers with upper natural teeth - more significant trauma to lower ridge is seen.

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24
Q

COMPLETE DENTURES OPPOSED BY NATURAL TEETH

For complete lowers opposed by natural uppers, what can be done to prevent trauma and resoprtion of lower ridge ?

A

Soft linings.
Implant retained dentures.

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25
Q

REPAIRS AND ADDITIONS OF DENTURES

What are some reasons for denture fracture ?

A

Impact.
Acrylic thin in section.
Work hardening of metal.
Parafunctional habits.
Deep overbite.
Soft linings.
Porosity in denture processing.
Bonding between tooth and acrylic.

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26
Q

REPAIRS AND ADDITIONS OF DENTURES

SIMPLE REPAIR - your patient comes into the practice with denture midline fracture and the two pieces can be relocated together - how would you manage this situation ?

A

Send both parts to lab.
No impression required.
Cast poured.
Fractured area removed.
New acrylic processed.

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27
Q

REPAIRS AND ADDITIONS OF DENTURES

PIECE OF DENTURE MISSING - patient comes into the practice with part of acrylic flange lost - how would you manage this situation ?

A

Take impression with fracture denture in mouth.
Disinfect.
Cast poured.
New acrylic processed into defect.

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28
Q

REPAIRS AND ADDITIONS OF DENTURES

Your patient comes into your practice with loss of an acrylic tooth from their denture - how would you manage this situation ?

A

If patient has tooth - it can be rebonded with self cure acrylic.

If patient does not - might need to match shape and mould and cut denture down for tooth to fit.

Is there repeat failures ? Ask why ? Is occlusion wrong or failure in tooth to acrylic bond - might have to redesign denture.

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29
Q

REPAIRS AND ADDITIONS OF DENTURES

What two materials can be used for temporary repairs ?

A

Self cure acrylic.
Cyanoacrylate glue.

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30
Q

REPAIRS AND ADDITIONS OF DENTURES

What are some strengtheners which can be used in denture repair ?

A

Wire mesh.
Glass fibre mesh.
SS wire.

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31
Q

PATHOLOGY RELATED TO DENTURES

What are the three causes of pathology related to dentures ?

A

Acute or chronic reactions to microbial denture plaque due to poor denture hygiene.
A reaction to consisituents of denture base material - due to allergy.
Mechanical denture injury due to ill-fitting dentures.

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32
Q

PATHOLOGY RELATED TO DENTURES

Give some examples of pathological changes associated with dentures.

A

Ulcers.
Denture stomatitis.
Angular chelitis.
Denture irritation hyperplasia.
Flabby ridges.
MRONJ/ORN.
Allergic reactions.

33
Q

PATHOLOGY RELATED TO DENTURES

What are the signs/symptoms of denture stomatitis ?

A

Erythema and oedema of denture bearing area.

34
Q

PATHOLOGY RELATED TO DENTURES

What microbe is the cause of denture stomatitis ?

A

Candida albicans.

35
Q

PATHOLOGY RELATED TO DENTURES

How should denture stomatitis be managed ?

A

Take denture out at night.
Clean with soft brush.
Steep denture 1-2 weekly.
Use nystatin or antifungal on denture base.
Can use chlorhexidine.
Might be appropriate to give new denture.

36
Q

PATHOLOGY RELATED TO DENTURES

What are the possible causes of denture stomatitis ?

A

Poor denture hygiene.
Underlying issues - diabetes, folate, B12, ferritin.

37
Q

PATHOLOGY RELATED TO DENTURES

What is the cause of angular chelitis in denture patients ?

A

Loss of OVD or excessive freeway space.
Related to old worn dentures.
Consider underlying problems - diabetes, folate, ferritin, B12, xerostomia, polypharmacy.

38
Q

PATHOLOGY RELATED TO DENTURES

How should denture related angular chelitis be managed ?

A

Replace denture with correct OVD.
Use topical miconazole.

39
Q

PATHOLOGY RELATED TO DENTURES

What microbes are related to angular chelitis ?

A

Candida albicans.
S. Aureus.
Beta-haemolytic streps.

40
Q

PATHOLOGY RELATED TO DENTURES

What is the cause of denture irritation hyperplasia ?

A

Very old ill-fitting dentures causing chronic trauma.
Causing hyperplastic response.

41
Q

PATHOLOGY RELATED TO DENTURES

How should denture hyperplasia be managed ?

A

Ease of denture.
Tissue conditioner (Coe Comfort).
Review and repeat if requires.
Make new denture.

OR removal of hyperplastic tissue if excessive by OS and make new denture.

42
Q

PATHOLOGY RELATED TO DENTURES

What is the cause of flabby/fibrous ridges ?

A

Trauma of denture of anterior ridge opposed by lower anteriors with no posterior support and no lower denture.

43
Q

PATHOLOGY RELATED TO DENTURES

What is the solution to managing a flabby/fibrous ridge ?

A

Produce new denture covering whole denture bearing area with good peripheral seal - double post-dam.
AND
Opposing arch denture with posterior support.

Perforated tray or tray with anterior window - reduces displacement of tissues - to get more accurate impression.

44
Q

PATHOLOGY RELATED TO DENTURES

What is the causes of denture-related MRONJ/ORN ?

A

Continual irritation of ill fitting denture on mucosa in patient with history or currently taking anti-resorptive drugs or having previous radiotherapy.

45
Q

PATHOLOGY RELATED TO DENTURES

How should potential MRONJ/ORN patients be managed who wear dentures ?

A

Regular oral health checks.
Prevention by creating well fitting dentures.
Immediate referral to Max-Fax if MRONJ or ORN is suspected (SDCEP guidelines).

46
Q

PATHOLOGY RELATED TO DENTURES

What denture constituents are most likely to cause allergic reactions ?

A

Nickel.
PMMA.

47
Q

PATHOLOGY RELATED TO DENTURES

Patient presents with erythema and oedema of denture bearing area (following outline of denture) - what is the possible differential diagnoses ?

A

Allergic reaction.
Denture stomatitis.

48
Q

PATHOLOGY RELATED TO DENTURES

What sites of the mouth are most commonly affected by denture-related traumatic ulceration ?

A

Lingual frenum.
Mylohyoid ridge.
Undercuts.

49
Q

PATHOLOGY RELATED TO DENTURES

What are the possible causes of denture-related traumatic ulceration ?

A
  • Overextension.
  • Sharp edges.
  • Occlusal trauma.
50
Q

COMBINING DENTURES AND CROWNS AND BRIDGEWORK

How can crowns/bridgework be modified to aid denture design ?

A

Precision attachments.
Survery lines.
Rest seats.
Anterior bridges to avoid single tooth saddle.

51
Q

COMBINING DENTURES AND CROWNS AND BRIDGEWORK

What are the main benefits/disadvantages of precision attachments ?

A

Better retention and stability.

OH harder to maintain.
Technical difficulties.
Difficult to repair/replace.

52
Q

MEDICAL PROBLEMS RELATED TO DENTURES

What is the consequences of xerostomia ?

A

Caries.
Retention difficulty.
Pain.
Discomfort.
Associated mucosal disease.

53
Q

MEDICAL PROBLEMS RELATED TO DENTURES

What are the potential causes of xerostomia ?

A

Polypharmacy.
Anti-depressants.
Sjorgens syndrome.

54
Q

MEDICAL PROBLEMS RELATED TO DENTURES

What is the consequences of anaemia related to dentures ?

A

Increased risk of candida and angular chelitis.
Pain and discomfort.

55
Q

MEDICAL PROBLEMS RELATED TO DENTURES

What are some causes of tremors ?

A

Parkinsons.
CVA.
Huntington’s disease.

56
Q

MEDICAL PROBLEMS RELATED TO DENTURES

What are the denture-related consequences of treating a patient with a tremor ?

A

Stages of denture construction can be difficult.
Jaw registration.
Aim for simple treatment plan.
Insertion and removal.

57
Q

MEDICAL PROBLEMS RELATED TO DENTURES

Name some anti-resorptive agents.

A

Bisphosphonates - alendronic acid.
RANKL inhibitors - denusomab.
Anti-angiogenic - bevacizumab.

58
Q

MEDICAL PROBLEMS RELATED TO DENTURES

Define frailty.

A

State of increased vulnerability to poor resoltuion of homoeostasis after stressor event (NICE).
Examples - low energy, slow walking speed, reduced strength.

59
Q

MEDICAL PROBLEMS RELATED TO DENTURES

What are the denture-related concerns about treating a frail person ?

A
  • Falls.
  • Hospital/care home admission.
  • Attending appointments.
  • Maintaining good denture hygiene.
  • Lost dentures.
  • Losing weight resulting in poor denture retention.
  • Reduced neuromuscular control.
60
Q

DENTURES AND PERIODONTITIS PATIENTS

What are the benefits of treating a periodontitis patient with a denture ?

A

Good transition to edentulism - easy to add to.

61
Q

MANAGEMENT OF RETCHING PATIENT

What is retching ?

A
  • Physiological mechanism.
  • Involuntary contraction of muscles of soft palate or pharynx.
  • Involuntary reaction to foreign objects in going into airway.
62
Q

MANAGEMENT OF RETCHING PATIENT

What part of the brain controls retching ?

A

Medulla oblongata.

63
Q

MANAGEMENT OF RETCHING PATIENT

What are the two types of retching ?

A

Psychogenic.
Somatic.

64
Q

MANAGEMENT OF RETCHING PATIENT

Describe psychogenic retching.

A

Sight, smell or sound of dental surgery or thought of impression.

65
Q

MANAGEMENT OF RETCHING PATIENT

Describe somatic retching.

A

Touching trigger zones.

Common trigger zones - palatoglossal and palatolpharyngeal folds, base of tongue, palate, uvula, posterior pharyngeal wall.

66
Q

MANAGEMENT OF RETCHING PATIENT

What aspects of denture construction does retching interfere with ?

A

Impression taking.
Jaw registration.
Tolerating dentures.
Retention.

67
Q

MANAGEMENT OF RETCHING PATIENT

How can a retching patient be managed in the dental surgery ?

A

Identify problem.
Identify trigger zones.
Anxiety reduction - relaxation.
Patience and empathy.

68
Q

MANAGEMENT OF RETCHING PATIENT

What distraction methods can be used in management of retching patient ?

A

Wiggle their toes.
Talk to patient.
Raise their leg.
Press on temple.
Close eyes.
Rinse mouth with water before impression.

69
Q

MANAGEMENT OF RETCHING PATIENT

What densensitiation techniques can be used in management of retching patient ?

A

Homework of touching trigger points in their mouth.
Swallowing with mouth open.

70
Q

MANAGEMENT OF RETCHING PATIENT

Impression taking stage - how can this be modifyed for the retching patient ?

A

Modify stock trays.
Lower trays in upper arch.
Rapid setting impression materials for reduced exposure time.

71
Q

MANAGEMENT OF RETCHING PATIENT

Denture design - what considerations should you give to this stage where managing a retching patient ?

A

Do they really require a denture - do they have a SDA ? Can bridges/implants be used ?
Horse shoe palate design.
Shortening palatal extension.
Use of double post dam.
Consider no second molars on prosthesis.

72
Q

MANAGEMENT OF PATIENT EXPECTATIONS

Effective communication - what % of communication is body language, tone of voice and words ?

A

Body language 55%.
Tone of voice 38%.
Words 7%.

73
Q

OCCLUSION FOR PARTIAL DENTURES

Describe ICP.

A

Tooth position.
Complete intercuspation of opposing teeth independent of condylar position.

74
Q

OCCLUSION FOR PARTIAL DENTURES

Describe RCP.

A

Guided occlusal relationship occuring at most retruded position of condyles in mandibular fossa.
Most reproducible mandibular position.

75
Q

OCCLUSION FOR PARTIAL DENTURES

Define index teeth.

A

Contacting facets of teeth in ICP.

76
Q

OCCLUSION FOR PARTIAL DENTURES

When do you record in ICP ?

A

Need sufficient index teeth.
Stable occlusion.
Conforming occlusion.

Can vary through life.
Depends on tooth relationships.
Sometimes more anterior than RCP (1-2mm).

77
Q

OCCLUSION FOR PARTIAL DENTURES

When do you record in RCP ?

A

Insufficient index teeth.
Unstable occlusion.
Changing occlusion.

Most reproducible position.
Sometimes more posterior than ICP (1-2mm).

78
Q

OCCLUSION FOR PARTIAL DENTURES

What three materials can be used for recording intercuspal record ?

A

Bite registration paste.
Wax wafer with modelling wax.
Modified wax wafer with Alminax.

79
Q

OCCLUSION FOR PARTIAL DENTURES

When are record blocks required ?

A

When insufficient idex teeth, unstable occlusion.

BDS4 CDS Restorative, Pros & Endo (13 decks)

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