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.
What do we see in patients with combination syndrome?
Bone loss from anterior part of the maxillary ridge.
Hypertrophy ofmaxillary tuberosities.
Papillary Hyperplasia of the hard palate.
Extrusion of mandibular anterior teeth
Bone loss under the denture base.
How do we improve dentures in patients with opposing mandibular teeth?
Maximal coverage of the denture bearing area & primary load bearing areas (palatal coverage of the hard palate)
Optimising loading of the denture bearing area using overdenture abumtents- giving an element of tooth borne support which reduces absorption.
Improving the stability through an optimum border seal ,effective post dam, managing any overbites and dealing with any absent posterior mandibular teeth.
What issues present when a patient has absent posterior mandibular teeth?
All the force goes from the present anterior teeth which bites aginst the front of the denture
This causes the back of the denture to drop down (it is even worse when eating)
This force also causes the real anterior teeth to tip forward.
How do we treat a patient with absent posterior mandibular teeth?
A lower partial denture to give a more even occlusal plane, provide denture stability and stop the tilting.
How does an incisor overbite affect a patient’s denture?
When the maxilla moves forward the lower anterior teeth can dislodge the upper denture.
How does the incisor overbite of a patient affect our denture treatment?
Treatment will affect aesthetic as it affects the length of the teeth visible.
Reduce the height of the lower anterior teeth
Sit the denture further up in the patients mouth.
How does an irregular occlusal plane affect our treatment of the denture?
What are the treatment options
We need to make an irregular denture to fit with the irregular denition.
But this denture is not stable in mandibular movements movements- there are points of contact that will cause the denture to destabilize and tilt in the eccentric movements.
Accept-
Deal with the contact points (Minimal localised occlusal grinding/Radical occlusal adjustment)
Extraction- e.g. a tilted tooth making a stable occlusion unachieveable.
Overlay appliance- overlaying the natural teeth to even out the occlusal plane.
Discuss a complete mandibular denture with natural maxillary teeth?
This is more problematic & will cause more damage to the missing mandibular teeth.
If it is causing the patient pain we can offer a soft lining (But this gets hard so has to be changed every 18 months)
Discuss the material choices when we are considering giving a denture to a patient with periodontal disease?
Acrylic
Adv- can add teeth on
Disadv- covers gingivae so can exacerbate problem.
Cobalt chrome
Adv- less peridontally destructive (load directed on a few periodontally affected teeth)
Disadv- Difficult to add teeth on. Design the cobalt chrome with the baseplare going towards the dodgy tooth to facilitate addition (if the patient loses his tooth due to perio) Don’t want to clasp a tooth that is likely to be lost.
What are the key teeth and why ?
Canines- longest roots
Molars- Largest roots so can take the most occlusal load.
Discuss the option of providing no prothesis for the patient?
Adv- less periodontal damage
Disadv- Lack of posterior support increases the tooth mobility of the remaining teeth.
What do we do with periodontally compromised teeth prior to taking an impression?
Cover the teeth in vaseline.
How does xerostomia affect denture treatment
The lack of saliva affects the adhesion & cohesion of the denture.
The lack of lubrication can cause trauma from the plastic rubbing against the dry tissue.
Increased risk of caries.
How does anaemia affect denture treatment
Patient is more prone to ulcers.
We want to check if the ulcer is caused by the denture.
List some conditions in which you would get a tremor and how do tremors affect denture production?
Parkinson’s disease.
Huntington’s
It makes the jaw registration stage very difficult.
Remember, the patient’s condition will only get worse.
How does dementia affect denture treatment.
Does the patient have capacity to consent?
Power of attorney- Patient may have not yet lost capacity.
Dentists with training can sign Section 47 AWI.
At what age are parents no longer allowed to consent for the patient and how do they get this consent back?
Parents need to apply to be a welfare guardian after age 16.
