Pros tutorials Flashcards
How do we decide wether to set the denture up in ICP or RCP?
ICP- if the patient has a stable occlusion- unless the pt is a severe wear case then we will be changing their occlusion
RCP- In complete dentures (insufficent teeth) or instances when there is an occlusal imbalance.
Compare ICP to RCP
ICP- The complete intercupsation of opposing teeth independent of condylar position. This tooth position can change dependent on wear/ restoration/ toothloss. We need sufficient index teeth (So pt has a stable position- achieving same bite every time)
RCP- A guided occlusal relationship occuring at the most retruded positions of the condyle in the joint cavities. This is fixed in life unless the patient’s condyle is damaged.
The patient’s denture does not fit properly. What can we do to adjust it?
- Lingual frenulum- check the denture is not impinging (if so cut some relief)
- Fit surface (if overextended- reduce fit surface. If underextended - add greenstick compound & reproduce the denture.
- Check the occlusion with articulating paper & selectively grind (adjust contacting surfaces rather than cusp tips)
- If there are still problems use pressure indicating paste (coat denture base & flange edge onto the buccal surface)
How do we polish the denture?
- using a bur with more torque to smooth it off.
- mix pumice and water together & coat the denture before using the first polisher.
- use a softer polisher with a brown material.
Why would we reline a denture
For patients with excessively resorbed alveolar crests. This means there is also reduced mucosal thickness- diminishing the resorptive effect & causing pain especially during occlusion.
What do we use to reline a denture?
A soft lining material on the inner surface of the denture to replace the missing mucosa.
These can be short term or long term.
What are short term lining materials and when would we use them?
Tissue conditioners. e.g. Coe comfort/ Viscogel
To:
Relieve pain during occlusion (Absorbs energy by deformation whcih decreases the energy absorbed by the tissues)
-Help heal the wounded denture bearing mucosa (regain normal volume and contour)
-Prevent pressure on the oral tissues for patients with denture stomatitis.
What is the disadvantage of a short term material?
They should not stay in the oral cavity for more than a week
What is our long term material of choice?
Silicone based soft lining material
How do we add a lining?
We take a functional impression after the denture is produced and send it to the lab. The lab produces a soft lining and adds it to the inside of the denture .
What is an immediate denture?
A denture given on the same day as the tooth is extracted.
How do you produce an immediate denture?
You take an impression prior to extraction, indicate which teeth are for immediate replacement by marking the teeth on the working cast with a cross.
What material is an immediate denture made of and why?
Acrylic- as patients have to wait 6 months after extraction for a cobalt chrome denture (bone will still change)
The patient attends with a broken denture, what is the first thing we check?
Can the fractured pieces join back together?
If the fractured pieces of the denture join together how do we deal with this?
We disinfect the denture and send it to the lab
If the denture has fractured but a piece of the denture is missing what do you do?
We place any parts of the denture we can into the patient’s mouth and take an impression of it.
We send the denture and impression to the lab to be fixed.
The patient has attended with an acrylic tooth that has fallen off. How do we help the patient?
If there is no urgency for the patient- send it back to the lab.
If urgent &
If the patient has the tooth- stick it back on with self cure acrylic
If the patien doesn’t have the tooth- Use a preformed tooth as a temporary fix.
If the denture is repeatedly failing- you may need to redesign it.
The patient has attended with a cobalt chrome denture but the acrylic has fallen off. How do we treat this?
Send the denture to the lab to get tags on the cobalt chrome.
This gives more gri for the cobalt chrome denture to attach to the acrylic.
What is an immediate denture addition?
When the Patient already has a denture but is getting a tooth extracted- so we add to their old denture prior to extraction. This allows the denture to be fitted on the same day as extraction
What is a post-immediate addition?
When the patient already has a denture.
But the patient has to wait until the socket has healed (a few weeks after the extraction to get the new tooth added to the denture)
What impression do we take for a denture addition?
An impression of the arch while the patient is wearing the denture.
Adding to a cobalt chrome denture is difficult- why is this and how can we help ourselves if we forsee an addition being neccessary?
Because you would need to solder on a large bit of cobalt chrome which isn’t feasable.
If you are concerned about a patient losing a tooth in the future- get the baseplate extended in that area so we can add the tooth on if neccessary.
Name ways we can secure a denture using implants?
Locator abutments-A button is present on the implant and locator inserts are present on the denture. It clicks into place.
Ball abutments - Acts as a ball in socket to secure the denture into place.
Bar (Gold or Stainless steel)- Implants are joined together and soldered using a bar & the denture has clips. These are anti-rotation.
Discuss the impact of a complete upper denture against natural lower teeth?
Trauma-
Short term mucous membrane damage presenting as ulceration and discomfort.
Long term- Alveolar resorption and fibrous tissue replacement causing a flabby ridge
Loss of stability- the additional forces and unevenness of teeth prevent a balanced occlusion.