Pros tutorials Flashcards
What is occlusion?
Static relationship of incisal and masticatory surfaces of maxillary and mandibular teeth
What is ICP?
Intercuspal pos
Complete intercuspation of maxillary and mandibular teth regarldess of condylar pos
What is RCP?
Retruded contact pos
Occlusal relationship of maxillary and mandibular teeth when condyle is in most retruded pos in joint cavities
When do you use ICP and RCP?
ICP when conforming to pts occlusion (most likely to have stable occlusion with sufficient index teeth)
RCP when changing pts occlusion (most likely to have unstable occlusion with insufficient index teeth)
What are index teeth?
Contacting facets of opposing teeth in ICP
Ways to obtain an Interocclusal record?
wax wafer
Bite reg paste (PVS)
Mod wax wafer (alminax)
When would you not need a record block?
If sufficient occlusion and suff index teeth
How can the lab modify record blocks?
Shellac base
CoCr wire strengthener
CoCr base
Over/under extension
How to modify unfavourable survey lines?
Add composite
Tooth reduction
Alter POI (guide planes)
Give some prescision attachment examples and how they work?
Ball on post
Tubelock
attach to abutment teeth/ implant to help retain the denture
Pt has localised perio with tissue loss. How can you manage this?
intense OHI and denture hygiene - removal whilst stablised
Two part denture
What are the components of a swinglock denture and what is it utilised for?
Hinge and Lock
Engages bone and ST undercuts for retention
Need Good OHI !
What can you do for lingually inclined teeth?
Buccal bar as major connector
What can you do for pt who is a bruxist?
CoCr back teeth
CoCr backed occlusal surfaces
Cross linked teeth for better wear resistance
CoCr back palate with acrylic to post dam in increase adhesion
What is retching?
Involuntary contraction of muscles of soft palate or pharynx
Physiological mechanism
Give the two types of retching and explain them?
Psychogenic
- Retching occur by sight, smell or sound of dental surgery or thought of something like impression
Somatic
- Touching trigger zones
- Commonly palatoglossal and palatopharyngeal folds, base of tongue, palate, uvula , posterior pharyngeal wall
worsened by anxiety
What changes can you make to impression taking stage to manage retching pt?
- modify stock trays
- use lower trays in upper arch
- palatal reduc in special trays
- Rapid setting impression material which reduces exposure time (dental composition or alginate with higher temp water)
What denture design changes can you make to manage the retching pt?
- Use of multiple postdams (so can cut back)
- Denture well adapted to tissues
- Palate not too thick
- Cusps of post teeth may need rounded so don’t stimulate dorsum of tongue
- No 2nd molars on prostheses
Management of retching pts
- identify problem
- Identify trigger zones
- Anxiety reduction (Relaxation , distraction, desensitisation)
- Patience and empathy
What is the most common cause of pt dissatisfaction in dentures ?
Usually related to retention and stability of lower denture
More dissatified with partials than completes
Disconnect between pt and clinician expectations - always inform these things - not miracle worker
What factors make up effective communication in managing pt expectations before designing a denture?
Listen to pt
Know your subject (limitations)
Avoid healthcare speak
Be attentive
Answer qs
Respect confidentiatlity
Be empathetic
Give intra oral signs that denture may not fit as well as the pt is expecting
- Severely resorbed ridges
- Flabby ridges
- Tori
- Prominent mentalis muscle, mylohyoid ridges, genial tubercles
- High muscle attachment
- Pain on ridge palpation
Why can’t implants recreate same proprioception as real teeth?
Osseointegrated
No PDL
4 Implant components used to retain a denture
- Ball abutment
- Locator abutments
- CAD-CAM titanium bar
- Gold bar
Post implant txt complications
Peri implant mucositis
Peri-implantits
Loose or fractured components
Late implant failure
What is the role of GDP in managing pt implants?
OH advice inc effective plaque removal around implants
Examine peri-implant tissue for signs of inflammation or BoP or suppuration
Remove residual cement or supra or sub plaque or calculus
PA when clinically indicated
Diagnose issues and refer back to implant clinician
What is Peri-Implant mucositis?
Inflammation of peri-implant mucosa with no evi crestal bone loss
Red swollen and bleed on gentle probing
PA
OHI and Plaque /calculus removal
Reassess and if not refer
What is Peri-implantitis?
Infection with suppuration and inflammation of ST surrounding implant
clinically sig loss of peri-implant crestal bone after adaptive phase
Red and swollen, Bleed on gentle probing and suppuration
PA to assess bone levels
Refer back to clinician who implanted
If not poss txt as per peri-implant mucositis and follow 1-2m (seek advice 2care if no improvement)
If improvement review 6-12m
Pt has a natural lower dentition with complete upper denture.
How can this cause issues in upper maxillary edentulous ridge?
What are the consequences of this?
Issues ass with flabby ridge?
3 ways to reduce rate of flabby ridge formation
Cause
- ST trauma (ulceration and discomfort)
- Alveolar ridge resorption and fibrous tissue replacement
Instability of denture
Consequences
- Fibrous flabby ridge
- Combination syndrome
Issues ass with flabby ridge
- Bone loss anterior part maxillary ridge
- Hypertrophy tuberosities
- Papillary hyperplasia hard palate
- Extrusion of mandib anterior teeth
- Bone loss under denture base
Reduce rate of flabby ridge
- Max coverage of denture bearing area with effective post dam seal
- Ensure prosthesis covers primary load bearing sites
- Overdenture abutments distal to flabby ridge
- Bilateral free end saddle in mandible
Pt has complete upper and dentate lower
pt has increased overbite reducing denture stability. Management options for this?
Change the sitting of denture teeth
Reduction of incisal edges of natural teeth
Common fractures of dentures
Midline
Tooth detaches denture base
loss of Flange
Acrylic saddle detaches form CoCr baseplate
Clasp fracture/bent
Common reasons for denture fracture
Impact
Acrylic in thin section
Work hardening of metal
Parafunctional habits
Bonding between tooth and base acrylic
How to fix midline fracture?
If fractured pieces can be located together
Disinfect and send to lab
Cast poured and fractured area removed
New acrylic processed
Acrylic flange lost , how to fix?
Impresion taken with fracture denture in mouth
Disinfected
Cast poured and new acrylic processed into defect
Temporary repairs material
Self cure acrylic
Cyanoacrylate glue
chairside
What strengtheners can be utilised in denture repairs?
Wire mesh
Glass fibre mesh
SS wire
What are the 3 types of additions done to a denture? Describe them
Immediate addition
- When tooth lost after denture construction and tooth added on day of extraction
Post-immediate addition
- Tooth lost after denture construction and at later date tooth added
retention
- Clasp added to improve retention when retention is suboptimal
Advantages of acrylic
Cheap
Easy to add to or reline or repair
technically easier to make
Aesthetic
Disadvanatges of Acrylic
Low impact resistance
Poor resistance to fracture fatigue (needs to be thick)
Poor impact strength
Water absorption and candidal infection
How does Acrylic set?
Free radical addition polymerization
Exothermic reaction
Benzoyl peroxide intitiator
Hydroquinone inhibitor
need cycle 65degress to decompose the benzoyl peroxide
What is a reline and a rebase?
Reline
- Adding new base material to tissue surface of existing denture to fill space that exists between original denture contour and altered tissue contour
rebase
- Replacing entire denture base of existing denture
Give the types of relines and examples of when you would use them
Temporary
- Tissue conditioner when grossly ill fititng denture or post immediate denture
Soft
- useful for parafunctional habits , atrophic ridges por obturators in cancer/cleft pts
- harbours microorgs and detriorate in time
Permanent
- Hard acrylic
- Peripheral seal problems or immediate/post immediate dentures
- Porlong lifespan of older dentures
Rebase technique
- Undercuts removed from denture
- Use PVS impression with wash body technique of fitting surface
- Impression poured in stone
- Overcast in plaster created
- Post dam carved at vibrating’s line on cast
- fitting surface and palate of denture removed to allow space new acrylic
- Cut back denture placed on overcast
- Palate added in wax
- Flask using Dundee injection method
- Wax removed and separator applied and acrylic injected into mould
- Sent to clinic, disinfect and all the usual insertion checks
Give some pathologicla changes that can affect dentures?
Ulcers
Denture stomatitis
Angular cheilits
Denture induced hyperplasa
Flabby ridges
MRONJ/ORN
Allergic reaction
Pt presents at denture review with ulcer in upper right maxillary tuberosity? how do you manage
identify with pressure indicating paste
Occlusal adjustment
trim and polish base
review 1-2 weeks
Non helaing >3week - urgent referral pathway to maxfac
A new patient presents to you with denture stomatitis. What are 2 different management strategies for this?
Take denture out at night
Clena denture with soft brush
Steep denture 15min max sterident
Poss use of CHX mouthwash
Antifungal such as miconazole
Consider undelrying issue like diabetes, folate, B12 , ferritin
What is the aetiology of angular chelitis?
Coexists with denture stomatitis
Overclosure i.e. loss OVD/ex FWS
Old worn dentures
Use Miconazole
Consider undelrying causes diabetes , folate, ferritn., B12
How does denture hyperplasia happen? How do you manage this?
Often due to very old il fitting denture leading to chronic trauma and hyperplastic response
Major ease of denture
Tissue conditioner
Review and repeat if required
New denture
How can allergic reactions occur and what do they look similar to?
Nickel conating Cocr or PMMA esp self cure relines as higher monomer
Redness under denture bearing area = denture stomattiis
Occur on lips / cheeks also
What dentures are more periodontally destructive?
Acrylic but easy to add to
What is a key aspect of RPD major connector design to maximise periodontal health in a periodontitis patient? Give an example of this.
Want to cross less gingival margins
Reduce tissue coverage where poss
Use lingual bar not plate
What are 3 key teeth to keep for retention and support in dentures for periodontitis patients?
canines
premolars
lone standing molars (may want to crown)
A periodontitis patient with lower bilateral free end saddles presents to you. You judge that the remaining teeth are of very poor prognosis and the patient will likely need a complete lower denture within 6 months. What can you offer the patient in the meantime. Give three reasons for this.
Bilateral free end saddle lower dentures
1. aid transition into edentulism
2. Give them denture wearing expieirnce
3. Less occlusal forces on the poor prognosis teeth
What are 2 advantages to providing no prosthesis in periodontitis patients?
Less damaging periodontally
Don’t want to premature remove teteh when doing impressions
1) Xerostomia
a. Aetiology
b. Consequences
Abti depressants
Polypharmacy of drugs
Sjogrens
Caries
retention difficulties
pain and discomfort
Ass oral mucosal problems
2) Anaemia
a. Aetiology
b. Consequences
B12, folate, iron def
ass oral mucosal problems (geogrpahic tongue, oral ulceration etc)
Pain and discomfort
3) Tremors
a. Aetiology
b. Consequences
Parkinsons
CVA
Huntington’s chorea
Stages of denture construction difficult
Jaw registration
Simple treatment plans
4) Anti-resorptive medications
a. Types
b. Risks associated
c. Risk mitigation
Bisphosphonates – eg Alendronic Acid
RANKL inhibitors – eg Denusomab
Anti-angiogenic – eg Bevacizumab
MRONJ
Keeping teeth/roots would normally XLA
SDCEP MRONJ guidelines
5) Frailty
a. Characteristics of frailty
b. Consequences
A state of increased vulnerability to poor resolution of
homoeostasis after a stressor event – NICE
Low energy, slow walking speed, reduced strength
Associated with multiple Long Term Conditions
Falls, delirium
Increased hospital admission
Care home admission
6) Dementia & capacity issues
a. What is the name of the act?
b. What is AMCUR?
c. What are the principles of the act?
d. According to the act, who can consent for dental treatment on behalf of a patient who lacks capacity to consent?
e. What are some basic questions which you could ask to assess patient capacity?
Adults with Incapacity Act 2000
Acting on decisions
Making informed decision
Communicate that decision
Understand the txt
Retaining memory of decision
Principles
- benefit
- Least restrictive option
- Past and present views
- Views of specific persons like guardian
- Encourage residual capacity
Who can consent?
- Dentists can sign section 47 certificate with appropriate training
Basic questions
- how old you
- Date of birth
- what is this place?
- What year is it?
7) Vulnerable adults
a. According to the 3 point test in the ASP act, an adult at risk of harm is one that…?
are unable to safeguard their own wellbeing, property, rights or other interests
and are at risk of harm
and because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected
