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BDS3 OSCE > Pros: Factors in Designing a Complete Denture > Flashcards

Pros: Factors in Designing a Complete Denture Flashcards

1
Q

What is the definition of support?

A

Resistance in vertical movement towards the tissues

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2
Q

What areas of the mandible provide support

A
  • buccal shelf
  • residual ridge
  • retromolar pad
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3
Q

What areas of themaxilla provide support?

A
  • hard palate
  • maxillary tuberosity
  • rugae area
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4
Q

What is the definition of retention?

A

Resistance to displacement in a vertical direction away from the tissues

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5
Q

What features of a denture provide good retention?

A
  • Accurate fit (space between denture base + mucosa small)
  • Border seal (extension of flanges into depth of functional sulcus + post-dam)
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6
Q

What design features would reduce the retention of a denture?

A
  • Denture over-extended + interfering with muscles / frenal attachments (happens during function - e.g. talking / eating)
  • Peripheries under-extended (happens during rest due to lack of border seal)
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7
Q

How would you test the retention of a complete denture?

A

Pull vertically on the anterior teeth

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8
Q

What is the definition of stability?

A

resistance to horizontal movement

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9
Q

How would the design of a denture reduce the stability?

A
  • Denture under-extended
  • Occlusion not balanced (no even contact when patient articulates)
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10
Q

How to test the stability of a denture?

A

Place fingers on occlusal surfaces and try rocking the denture side-to-side

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11
Q

What happens to bone when natural teeth are lost

A

will resorb

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12
Q

When does the maximum rate of resorption occur

A

first 3 months

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13
Q

How does the upper ridge resorb

A

resorbs posteriorly / reduces in width

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14
Q

How does the lower ridge resorb

A

resorbs vertically / increases in width

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15
Q

What are extra oral changes you see after loss of teeth

A
  • Changes in upper lip
  • Changes in lower lip
  • Reduced face height (causes significant change in profile)
  • Reduced support for muscles + soft tissues
  • More pronounced naso-labial angle + prominence of chin
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16
Q

What are physiological factors

A
  • Loss of proprioception
  • Decreased masticatory / incising / swallowing efficiency
  • Problems with speech
  • Embarrassment / denial / depression / lost limb syndrome
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17
Q

What is cawood and howell classification

A

describes the ridges

6 categories

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18
Q

What are the 6 categories for the cawood and howell classification

A
  1. dentate
  2. post extraction
  3. broad alveolar process
  4. knife edge
  5. flat ridge
  6. submerged ridge
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19
Q

You have taken primary impressions and done a patient assessment.

What will you do next and wha will you write on the labcard

A
  • master impressions is the next stage
  • ‘please cast upper and lower alginate/impression compound impressions and please provide special trays in light cured acrylic, extra oral handle and 3mm spacer
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20
Q

You have taken master impressions

What is the next stage and what will you write on the lab cards

A

Stage: Record blocks

Please cast upper and lower alginate impressions and please provide wax record blocks

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21
Q

You have done the jaw registration

What is the next stage and what will you write on the lab cards

A

wax try in

please articulate the casts to the registration provided and please provide wax try-in with shade, mould and any special instructions

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22
Q

You have done the trial, what is the next stage and what will you write on the lab card

A

delivery

please take denture to finish and prepare a post-dam on the casts as indicated by the markings. Please process in heat cured acrylic and provide upper and lower complete dentures

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23
Q

What are limiting structures

A
  • sites that will guide us in having optimum extension of the denture to allow for maximum surface area to be engaged without encroaching upon muscles actions
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24
Q

What happens if you encroach on limiting structures

A

lead to dislodgement of the denture/soreness of the area

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25
Q

What happens if you dont cover areas up to the limiting structure

A

will imply decreased retention stability and support

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26
Q

What is the labial frenum (maxilla)

A
  • Fibrous band covered by mucous membrane
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27
Q

What does the labial frenum extend from (maxilla)

A
  • labial aspect of the residual ridge to the lip
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28
Q

Does the labial frenum have muscles fibres (maxilla)

A

no

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29
Q

What should be done to a denture in regards to the labial frenum (maxilla)

A
  • A V-shaped notch (labial notch) should be provided very carefully on the denture
  • should be narrow but deep enough to avoid interference and should also seat adequately around frenum, if peripheral seal is to be achieved
30
Q

What are the limiting structures (maxilla)

A

labial sulcus

labial frenum

buccal frenum

buccal sulcus

vibrating line

hamular notch

31
Q

What is the labial sulcus (maxilla)

A
  • Bounded on one side by teeth, gingiva and residual alveolar ridge and on the other side, by lips
  • It runs from one side of the buccal frenum of one side to the other side; dividing in two compartments-left and right by the labial frenum
32
Q

What is the buccal frenum (maxilla)

A
  • Fibrous band covered by mucous membrane.
33
Q

what muscles attach to the buccal frenum (maxilla)

A
  • Has the attachment of the following muscles; levator anguli oris, orbicularis oris and bucciniator.
34
Q

What modifications should be made to a denture in regards to the buccal frenum (maxilla)

A

Requires greater clearance on buccal flange of the denture (shallower and wider) that the labial frenum.

35
Q

What is the buccal sulcus (maxilla)

A
  • Extends from buccal frenum anteriorly to the hamular notch posteriorly.
36
Q

What is the size of the buccal sulcus / vestibule dependent on (maxilla)

A

Contraction of buccinator muscle. 2. Position of the mandible. 3. Amount of bone loss in maxilla.

37
Q

What is the hamular notch (maxilla)

A

A depression situated between the maxillary tuberosity and the hamulus of the medial pterygoid plate. It is a soft area of loose connective tissue.

38
Q

What is the significance of the hamular notch (maxilla)

A
  • It houses the disto-lateral termination of the denture (is where we extend the distal border of the denture to to help with posterior retention)
  • Aids in achieving posterior palatal seal.
39
Q

What is the vibrating line (maxilla)

A
  • An imaginary line drawn across the posterior part of the palate that marks the division between the movable and immovable tissue of the soft palate,
40
Q

How do you identify the vibrating line (maxilla)

A

which can be identified by asking the patient to say ‘ah’.

41
Q

Where does the vibrating line lie (maxilla)

A

2mm infront of palatine fovea

42
Q

What are the limiting structures in the mandible

A
  • labial frenum
  • labial sulcus
  • buccal frenum
  • buccal sulcus
  • retromolar pad
  • alveololingual sulcus
  • genial tubercle/spine
  • lingual frenum
43
Q

What is the labial frenum (mandible)

A
  • It is fibrous band extending from the labial aspect of the residual alveolar ridge to the lip containing a band of the fibrous connective tissue, which helps in the attachment of the orbicularis oris muscle.
44
Q

What is the labial sulcus (mandible)

A
  • The labial sulcus runs from the labial frenum to the buccal frenum on each side.
  • Mentalis muscle is quite active in this region.
45
Q

What is the buccal frenum (mandible)

A
  • The fiberes of buccinator are attached to the buccal frenum.
  • Should be relieved to prevent displacement of the denture during function.
46
Q

What is the buccal sulcus (mandible)

A
  • Extends posteriorly from the buccal frenum to the outside back corner of the retromolar region.
47
Q

Why can area maximisation be safely done in the buccal sulcus of the mandible

A
  • as the fibres of the buccinator run parallel to the border, hence displacing action due to buccinator during it’s contraction is slight.
  • The impression is at widest within this region.
48
Q

What are the retromolar pads (mandible)

A
  • Pear-shaped triangular soft pad of tissue at the distal end of the lower ridge.
49
Q

Why are retromolar pads an important structure for dentures

A
  • forms the posterior seal of the mandibular denture.
50
Q

Where should a denture extend to in regards to the retromolar pad

A

up to 2/3rd of the retromolar pad triangle.

51
Q

What is the alveololingual sulcus (mandible)

A
  • Between lingual frenum to retro-mylohyoid curtain.
  • Overextension causes soreness and instability.
52
Q

What can the alveololingual suclus be divided into (mandbile)

A

anterior

middle

posterior

53
Q

Where is the anterior part of the alveololingual sulcus

A
  • From lingual frenum to mylohyoid ridge.
  • The shallowest portion (Least height) of the lingual flange.
54
Q

Where is the middle region of the alveololingual sulcus

A

From the pre-mylohyoid fossa to the distal end of the mylohyoid region.

55
Q

Where is the posterior region of the alveololingual sulcus

A
  • From the end of the mylohyoid ridge end to the retro-mylohyoid curtain
  • Provides for a valuable undercut area, so important retention.
  • Over extension causes soreness and instability.
56
Q

What is the genial tubercle

A
  • Area of muscle attachment (Genioglossus and Geniohyoid).
  • Lies away from the crest of the ridge.
  • Prominent in resorbed ridges, therefore adequate relief to be provided.
57
Q

What is important about the lingual frenum

A
  • The lingual frenum relief should be provided in the anterior region of the lingual flange.
58
Q

What are supporting structures

A

load bearing areas

59
Q

How should a denture be designed in regards to supporting structures

A

The denture should be designed such that most of the load is concentrated on these areas.

60
Q

What is the primary stress bearing (supporting) area in the maxilla

A

posterior palate

61
Q

What are the secondary stress bearing areas in the maxilla

A

rugae

maxillary tuberosity

62
Q

What is the primary stress bearing area in the mandible

A

buccal shelf

63
Q

Where is the buccal shelf

A
  • Extends from the buccal frenum to retromolar pad.
  • Between external oblique ridge and crest of alveolar ridge.
64
Q

What are the boundaries of the buccal shelf

A
  1. Medially the crest of the ridge
  2. Laterally the external oblique ridge
  3. Distally the retromolar pad
  4. Mesially the buccal frenum
65
Q

What happens to the width of the buccal shelf as resorption occurs

A

width of this area increases

66
Q

What are relief areas

A

areas where there are either resorption under constant load, having fragile structures within or covered by thin mucosa which can be easily traumatised

67
Q

How should a denture be designed in regards to relief areas

A

The denture should be designed in such a way that the masticatory load is not concentrated over these areas

68
Q

In the maxilla, what are relief areas

A
  • crest of alveolar ridge
  • palatine fovea
  • palatine raphe
69
Q

What is the palatine raphe

A
  • Extends from incisive papilla to distal end of hard palate
  • Median suture area covered by thin submucosa
  • Relief is to be provided as it is supposed to be the most sensitive part of the palate to pressure
70
Q

What is the secondary stress bearing area in the mandible

A

residual alveolar ridge

BDS3 OSCE (65 decks)

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