Pros tutorials Flashcards
What is an occlusion?
A static relationship between the index teeth of a person dentition
What is the intercuspal position?
Maximum intercuspation of teeth independent of condylar position
What is retruded contact position?
Guided reproducible position where the condyle is in the most retruded position in the condylar fossa
What are index teeth?
Occluding surfaces of teeth in ICP
Why is RCP better for designing dentures when changing the occlusion?
- It is the most reproducible position
Why is ICP better for designing dentures when conforming to the current occlusion?
Using index teeth ensures denture construction will not change the occlusion
What are the ways obtain an inter-occlusal record?
- Wax records block - in free end saddles
- Bite registration
- Wax (modelling wax)
- Modified wax wafer (alminax)
When designing an RPD when will you require a record block stage?
- When replacing an index tooth (pre-molars and molars)
In what ways can you ask the lab to modify a wax record block?
- Finger rests
- Shellac base
- Metal wire strengthener
- Cocr base
How can you modify and improve survey lines?
- Etch and bond composite to increase undercut
What are precision attachments and what are they useful for?
Modifications made to intra-oral restorations or teeth which utilise certain components to increase denture retention
Give examples of precision attachments (2)
- Tubelock to teeth ( lock added in denture)
- Ball on post and diaphragm ( socket added in the denture for ball)
What are the challenges in precision attachements?
- Difficult to repair and replace
- Technically demanding
In some pateints localised periodontitis can cause significant tissue loss. Give 2 ways in which you will manage this?
- Alter path of insertion
- Use a two part denture
What are the indication for two part denture?
- When there is different paths of insertion
- When there is gross tissue loss
What are the components of a two part denture?
- Split pins on CoCr denture
- Acrylic slots on different path of insertion
When is a swing-lock denture indicated?
In Kennedy class 1 and 2 by using tissue and bone undercut under anterior labial sextant
What are the components of a swing lock denture?
- Hinge and lock
What are the challenges in a swing lock denture?
- Technically demanding
- Require excellent oral hygiene
Your patient has returned for a denture review appointment , complaining that their new complete denture fractured down the middle . They mention they have a headache and upon extra-oral examination, you notice **mild pain and hypertrophy upon palpating the masseter **
What major connector would you use for their new denture?
Buccal bar = buccally approaching major connector for posterior lingually tilted teeth
Your patient has returned for a denture review appointment , complaining that their new complete denture fractured down the middle . They mention they have a headache and upon extra-oral examination, you notice **mild pain and hypertrophy upon palpating the masseter **
What patient related factor has resulted in fracture of the denture?
Parafunctional habits = bruxism
Your patient has returned for a denture review appointment , complaining that their new complete denture fractured down the middle . They mention they have a headache and upon extra-oral examination, you notice **mild pain and hypertrophy upon palpating the masseter **
Give 3 features which you could incorporate into the new denture to reduce risk of future fracture?
- CoCr major connector with acrylic post dam - better reteion
- CoCr backing - reduce risk of fracture
- Crosslinked acrylic teeth - reduce wear resistance
Your patient has returned for a denture review appointment , complaining that their new complete denture fractured down the middle . They mention they have a headache and upon extra-oral examination, you notice **mild pain and hypertrophy upon palpating the masseter **
What is important to do before making a new denture for this patient?
** Manage parafunctional habit through: **
* Counselling (Education, home remediation, treat anxiety, psychologist referral),
* Medication - NSAIDs , TCA
* refer to oral medicine
What is retching?
Physiological mechanism involving involuntary contraction of muscles of soft palate and pharynx
What are the two types of retching and what can worsen it?
- Psychogenic
- Somatic
- worsened by anxiety
What are the triggers for psychogenic retching in dentistry? (4)
- Sight
- Smell
- Sound of dental instruments
- Thinking of impressions
What are the triggers of somatic retching in dentistry?
- Touching the trigger zones
What are the trigger zones that may cause retching? (5)
- Base of tongue
- Uvula
- Posterior pharyngeal wall
- Palate
- Pharyngeal folds
Give three management strategies for a retching patient
- Relaxation
- Distraction
- Desensitisation
Explain the relaxation technique to manage retching
- Passive - dim lighting , music and avoid sight of dental instruments
- Active - controlled rhythmic or relaxed abdominal breathing
- Combine this together to relax the patient
Explain how you would achieve the distraction technique to manage retching during jaw registration or impression taking (6)
- Talk to the patient
- Put salt on tongue
- Get patient to press or tap their temple
- Let patient close their eyes
- Rinse mouth with very cold water just before treatment
- concentrate on wiggling toes
Explain how you would preform desensitisation on a patient for impression taking to manage retching? (3)
- Repeated brushing or stroking of anterior palate or tongue with finger or toothbrush
- Homework for patient to brush or stroke anterior palate or tongue
- Swallowing with mouth open
What difficulties in prosthodontics may be associated with retching? (4)
- Impression taking
- Jaw registration
- Toleration of dentures
- Denture retention (as palate may be reduced)
What 3 changes can you make to the impression taking stage specifically to manage retching? (4)
- Modify stock trays
- Use lower trays in upper arch
- Modify special trays (palatal reduction)
- Mix alginate in warmer water - fast setting leading to less exposure time
What 5 denture design changes can you make to manage the retching patient?
- Buccal bar instead of lingual bar
- Gradually cutting back multiple post dams
- Thinner palatal coverage
- Rounded cusps on posterior lowers
- consider no second molars
Which retainer would you use for short term management retching?
Essix
What would you provide for a shortened dental arch that does not have sufficient units (3-3) or (4-4)?
- Implants
- Bridges
What is the most common reason of patient dissatisfaction in dentures?
- Poor retention and stability of lower denture
Which type of dentures are patients more dissatisfied with?
Partial
What factors make up effective communication in managing patient expectations before designing a denture? (6)
- Listen to patient
- Be empathetic
- Avoid jargon
- Answer questions
- Set realistic expectations
- Respect confidentiality
How can undertaking a thorough intra-oral examination help with managing patient expectations before designing a denture?
- Helps identify factors that can complicate denture design
- telling the patient about them to manage expectations
Give 5 intra-oral examination signs to look out for that may complicate denture design?
- Severely resorbed ridge
- Flabby ridge
- Tori
- Prominent mentalis, mylohyoid , Genial tubercles
- Pain on ridge
- High muscle attachments
What questions might you ask the patient to assess the risk of managing high expectations? (4)
- how long ago did you lose your teeth ?
- how many sets of dentures did you were ?
- how old is the last denture you had made ?
- are you wearing the last denture you had made?
Give some factors contributing to patient dissatisfaction with their dentures other than retention and stability of their lower denture? (4)
- Decreased chewing efficiency
- Aesthetic expectations unmet
- Facial aesthetics changed due to denture wearing
- Reduced self -esteem due to wearing a denture
Why can’t implants create the same proprioception as real teeth?
Because there is no PDL in implanted teeth leading to no physiological response to pressure
What 4 implant components that can be used to retain a denture? (4)
- Ball abutments
- Locator abutments
- Gold and titanium bar
- Screws
What are 4 post-implant treatment complications? (4)
- Peri-implant mucositis
- Peri-implantitis
- Infection
- Fenestration
According to SDCEP guidelines what is the role of a GDP in managing implant patients?
** Regular monitoring of implants **
* Baseline PA 1Y post-placement
* Baseline Periodontal pocket depth
* Tailored preventative advice to maintain good perio status
* Regular exams of peri-implant tissues
* PMPR
* Risk based recall
What is peri-implant mucositis?
Reversible inflammation of peri-implant soft tissues associated with an osseointegrated implant in the absence of cortical bone loss
What are the signs of peri-implant mucositis? (6)
- Increased pocketing
- inflamed mucosa
- Pain
- Tenderness
- Bleeding on probing
- Absence of bone loss
What is the management of peri-implant mucositis in GDP?
- Step 1 periodontal therapy
- CHX 0.2% for 7 days
A patient have a natural lower dentition with a complete upper denture
What are the consequences of this?
- Trauma to soft tissues
- Flabby ridge formation
A patient has a complete upper denture opposed by natural lower anterior teeth with no posterior, leading to an ** increased overbite ** reducing the denture stability
Give 2 management options for this?
- Reduce incisal edges of lower teeth
- Reposition the upper denture teeth higher up
A patient has a complete upper denture opposed by natural lower and posterior teeth. The lower teeth have have an **irregular occlusal plane where the teeth do not have even contacts in ICP **
What issues does this cause for the stability of the upper denture?
Displacement of denture upon eccentric movements
A patient have a natural upper dentition with a complete lower denture. There is an irregular occlusal plane
How can this be managed? (2)
- Soft liners ( Palliative as may need constant reliners)
- Impant retained lower complete dentures
How to avoid single teeth saddles?
Anterior bridges combined with denture
What is frality
- Vulnerability after a stressor event due to poor resolution of haemostasis
