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Pros tutorials Flashcards

1
Q

What is an occlusion?

A

A static relationship between the index teeth of a person dentition

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2
Q

What is the intercuspal position?

A

Maximum intercuspation of teeth independent of condylar position

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3
Q

What is retruded contact position?

A

Guided reproducible position where the condyle is in the most retruded position in the condylar fossa

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4
Q

What are index teeth?

A

Occluding surfaces of teeth in ICP

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5
Q

Why is RCP better for designing dentures when changing the occlusion?

A
  • It is the most reproducible position
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6
Q

Why is ICP better for designing dentures when conforming to the current occlusion?

A

Using index teeth ensures denture construction will not change the occlusion

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7
Q

What are the ways obtain an inter-occlusal record?

A
  • Wax records block - in free end saddles
  • Bite registration
  • Wax (modelling wax)
  • Modified wax wafer (alminax)
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8
Q

When designing an RPD when will you require a record block stage?

A
  • When replacing an index tooth (pre-molars and molars)
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9
Q

In what ways can you ask the lab to modify a wax record block?

A
  • Finger rests
  • Shellac base
  • Metal wire strengthener
  • Cocr base
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10
Q

How can you modify and improve survey lines?

A
  • Etch and bond composite to increase undercut
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11
Q

What are precision attachments and what are they useful for?

A

Modifications made to intra-oral restorations or teeth which utilise certain components to increase denture retention

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12
Q

Give examples of precision attachments (2)

A
  • Tubelock to teeth ( lock added in denture)
  • Ball on post and diaphragm ( socket added in the denture for ball)
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13
Q

What are the challenges in precision attachements?

A
  • Difficult to repair and replace
  • Technically demanding
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14
Q

In some pateints localised periodontitis can cause significant tissue loss. Give 2 ways in which you will manage this?

A
  • Alter path of insertion
  • Use a two part denture
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15
Q

What are the indication for two part denture?

A
  • When there is different paths of insertion
  • When there is gross tissue loss
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16
Q

What are the components of a two part denture?

A
  • Split pins on CoCr denture
  • Acrylic slots on different path of insertion
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17
Q

When is a swing-lock denture indicated?

A

In Kennedy class 1 and 2 by using tissue and bone undercut under anterior labial sextant

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18
Q

What are the components of a swing lock denture?

A
  • Hinge and lock
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19
Q

What are the challenges in a swing lock denture?

A
  • Technically demanding
  • Require excellent oral hygiene
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20
Q

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?

A

Buccal bar = buccally approaching major connector for posterior lingually tilted teeth

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21
Q

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?

A

Parafunctional habits = bruxism

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22
Q

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?

A
  • CoCr major connector with acrylic post dam - better reteion
  • CoCr backing - reduce risk of fracture
  • Crosslinked acrylic teeth - reduce wear resistance
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23
Q

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?

A

** Manage parafunctional habit through: **
* Counselling (Education, home remediation, treat anxiety, psychologist referral),
* Medication - NSAIDs , TCA
* refer to oral medicine

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24
Q

What is retching?

A

Physiological mechanism involving involuntary contraction of muscles of soft palate and pharynx

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25
Q

What are the two types of retching and what can worsen it?

A
  • Psychogenic
  • Somatic
  • worsened by anxiety
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26
Q

What are the triggers for psychogenic retching in dentistry? (4)

A
  • Sight
  • Smell
  • Sound of dental instruments
  • Thinking of impressions
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27
Q

What are the triggers of somatic retching in dentistry?

A
  • Touching the trigger zones
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28
Q

What are the trigger zones that may cause retching? (5)

A
  • Base of tongue
  • Uvula
  • Posterior pharyngeal wall
  • Palate
  • Pharyngeal folds
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29
Q

Give three management strategies for a retching patient

A
  • Relaxation
  • Distraction
  • Desensitisation
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30
Q

Explain the relaxation technique to manage retching

A
  • Passive - dim lighting , music and avoid sight of dental instruments
  • Active - controlled rhythmic or relaxed abdominal breathing
  • Combine this together to relax the patient
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31
Q

Explain how you would achieve the distraction technique to manage retching during jaw registration or impression taking (6)

A
  • 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
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32
Q

Explain how you would preform desensitisation on a patient for impression taking to manage retching? (3)

A
  • 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
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33
Q

What difficulties in prosthodontics may be associated with retching? (4)

A
  • Impression taking
  • Jaw registration
  • Toleration of dentures
  • Denture retention (as palate may be reduced)
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34
Q

What 3 changes can you make to the impression taking stage specifically to manage retching? (4)

A
  • 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
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35
Q

What 5 denture design changes can you make to manage the retching patient?

A
  • Buccal bar instead of lingual bar
  • Gradually cutting back multiple post dams
  • Thinner palatal coverage
  • Rounded cusps on posterior lowers
  • consider no second molars
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36
Q

Which retainer would you use for short term management retching?

A

Essix

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37
Q

What would you provide for a shortened dental arch that does not have sufficient units (3-3) or (4-4)?

A
  • Implants
  • Bridges
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38
Q

What is the most common reason of patient dissatisfaction in dentures?

A
  • Poor retention and stability of lower denture
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39
Q

Which type of dentures are patients more dissatisfied with?

A

Partial

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40
Q

What factors make up effective communication in managing patient expectations before designing a denture? (6)

A
  • Listen to patient
  • Be empathetic
  • Avoid jargon
  • Answer questions
  • Set realistic expectations
  • Respect confidentiality
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41
Q

How can undertaking a thorough intra-oral examination help with managing patient expectations before designing a denture?

A
  • Helps identify factors that can complicate denture design
  • telling the patient about them to manage expectations
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42
Q

Give 5 intra-oral examination signs to look out for that may complicate denture design?

A
  • Severely resorbed ridge
  • Flabby ridge
  • Tori
  • Prominent mentalis, mylohyoid , Genial tubercles
  • Pain on ridge
  • High muscle attachments
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43
Q

What questions might you ask the patient to assess the risk of managing high expectations? (4)

A
  • 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?
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44
Q

Give some factors contributing to patient dissatisfaction with their dentures other than retention and stability of their lower denture? (4)

A
  • Decreased chewing efficiency
  • Aesthetic expectations unmet
  • Facial aesthetics changed due to denture wearing
  • Reduced self -esteem due to wearing a denture
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45
Q

Why can’t implants create the same proprioception as real teeth?

A

Because there is no PDL in implanted teeth leading to no physiological response to pressure

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46
Q

What 4 implant components that can be used to retain a denture? (4)

A
  • Ball abutments
  • Locator abutments
  • Gold and titanium bar
  • Screws
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47
Q

What are 4 post-implant treatment complications? (4)

A
  • Peri-implant mucositis
  • Peri-implantitis
  • Infection
  • Fenestration
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48
Q

According to SDCEP guidelines what is the role of a GDP in managing implant patients?

A

** 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

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49
Q

What is peri-implant mucositis?

A

Reversible inflammation of peri-implant soft tissues associated with an osseointegrated implant in the absence of cortical bone loss

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50
Q

What are the signs of peri-implant mucositis? (6)

A
  • Increased pocketing
  • inflamed mucosa
  • Pain
  • Tenderness
  • Bleeding on probing
  • Absence of bone loss
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51
Q

What is the management of peri-implant mucositis in GDP?

A
  • Step 1 periodontal therapy
  • CHX 0.2% for 7 days
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52
Q

What is peri-implantitis?

A

Inflammation of peri-implant soft tissue and hard tissue related to an osseointegrated implant with cortical bone loss

53
Q

What are the signs of peri-implantitis? (7)

A
  • BPE probes through epithelial barrier to alveolar bone
  • Implant fracture
  • Pain
  • Tenderness
  • Bleeding on probing
  • Cortical bone loss
  • Mobility
54
Q

How to manage peri-implantitis in GDP?

A

Refer and grade based on clinical signs
Early onset - explant
Mild/moderate - Remove abutement and Step 1 (PMPR , CHX mouthwash)
Severe - remove abutement, surgical access , Step 1 perio (PMPR) , AB ± surgery

55
Q

A patient have a natural lower dentition with a complete upper denture

How can this cause issues with in the upper maxillary edentulous ridge?

A
  • High forces directed on anterior area of edentulous ridge causing rapid alveolar bone loss that is replaced with fibrous tissue due to response to trauma
56
Q

A patient have a natural lower dentition with a complete upper denture

What are the consequences of this?

A
  • Trauma to soft tissues
  • Flabby ridge formation
57
Q

What 2 issues are associated with a flabby ridge?

A
  • Tissue displaceability
  • Tipping of denture
58
Q

Give 3 ways in which you can reduce the rate of a flabby ridge?

A

** Maximise stability by **
* mandibular posterior extension support and good peripheral extensions
* Effective post dam and posterior seal (upper)
* Maximise palatal coverage
* Use Overdenture abutements (retained roots or implants)

59
Q

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?

A
  • Reduce incisal edges of lower teeth
  • Reposition the upper denture teeth higher up
60
Q

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?

A

Displacement of denture upon eccentric movements

61
Q

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 **

How would you manage this? (4)

A
  • Accept and monitor
  • Use of overlay appliance
  • Extraction of posterior teeth
  • Minimal or major localised occlusal adjustments
62
Q

A patient have a natural upper dentition with a complete lower denture. There is an irregular occlusal plane

Why is this much harder to manage compared to upper denture opposed by natural lower teeth?

A
  • Less available physiological tissue for support
  • High forces directed onto lower ridge
  • Leading to pain and significant trauma to lower ridge
63
Q

A patient have a natural upper dentition with a complete lower denture. There is an irregular occlusal plane

How can this be managed? (2)

A
  • Soft liners ( Palliative as may need constant reliners)
  • Impant retained lower complete dentures
64
Q

According to kelly (1972) how does combination syndrome occur? (5)

A

** Maxillary denture is opposed by natural anterior mandibular dentition which is said to cause **
* Bone loss from anterior part of maxillary ridge
* Hypertrophy in the tuberosities
* Papillary hyperplasia in the hard palate
* Extrusion of mandibular anterior teeth
* Bone loss under denture base

65
Q

Give 5 common types of denture fractures?

A
  • acrylic tooth detachment
  • midline fractures
  • flange fractures
  • clasp fracture or bent
  • acrylic saddle detaches from Cocr base
66
Q

Give 5 common reasons for denture fractures?

A
  • Bruxism
  • Dropping
  • Thin section of acrylic
  • Work hardening failure
  • Denture processing problem - porosity
  • Soft linings
67
Q

How would you fix a fractured flange?

A
  • Impression with denture in situ + standard impression
  • Send to lab with denture
  • Return and fit
68
Q

How would you fix a fractured denture?

A
  • If all fragments can be located
  • Disinfect and send to lab for repair
  • no impression is needed
69
Q

How would you fix a lost acrylic tooth? (2)

A
  • Reattach with self-cure acrylic or -
  • Match shade and trim new acrylic tooth and set with self-cure acrylic
70
Q

How can you repair an acrylic-cocr denture? (3)

A
  • Solder on retentive tags
  • Use 4-meta or silicoat to retain acrylic on Cocr
  • If need to fix quickly (temporary) = self-cure acrylic or superglue
71
Q

In what way can you strengthen denture repair? (3)

A
  • Wire mesh
  • Glass fibre mesh (in bruxists)
  • Stainless steel wire in lowers
72
Q

What types of dentures are additions for?

A

Partial dentures only

73
Q

What is an immediate addition?

A

When a tooth is lost after denture construction & tooth added on the day of tooth extraction

74
Q

Give an example of an immediate addition?

A
  • Post-XLA immediate single tooth addition to existing RPD
75
Q

Give an example of a post-immediate addition?

A
  • Post-XLA after socket healing
  • Take impression with denture in situ
  • Send to lab
76
Q

Give an example of a retention addition?

A
  • poorly retentive RPD
  • impression in situ
  • send lab for addition or SS wrough wire

When denture retention is inadequate a clasp is added to try to improve retention

77
Q

What are the advantages of acrylic? (4)

A
  • Aesthetics
  • Cheap
  • Technically easy
  • Easy to add to, reline or repair
78
Q

Why is it not possible to repair flexibe dentures?

A

Due to weak bonding between acrylic tooth and nylon

79
Q

What is the disadvantages of acrylic? (5)

A
  • low impact resistance and strength - needs to be thick
  • poor resistance to fracture fatigue
  • Water absorption and candida growth
  • Allergies
  • Risks to technicians
80
Q

What does acrylic consist of?

A

Powder
* Polymer - PMMA beads
* Initiator - Benzoyl peroxide
* Pigment - organic dyes
** Liquid **
* Monomer - MMA
* Crosslinking agent
* Inhibitor - hydroquinone
* Activator - only in self cure

81
Q

What is the difference between relining and rebasing?

A
  • Relining (done chairside) = adding material to the base of denture to fill space between denture and altered tissue
  • Rebasing (done in lab) = replacing the entire acrylic baseplate
82
Q

Give 3 reasons for providing a temporary reline?

A
  • immediate denture no longer fits due to bone resorption
  • Tissue conditioning = aid healing in inflammation
  • After implant surgery
83
Q

In which 2 types of patients would we use a soft temporary reline?

A
  • Bruxists
  • Cleft patients (obturators)
84
Q

What risk can a soft lining pose?

A

Highly susceptible to candida bacteria

85
Q

Give 3 reasons for providing a permanent reline?

A
  • Issues with peripheral seals
  • Post-immediate denture
  • prolong lifespan of previous denture
86
Q

Give the clinical steps taken to rebase an upper denture that is loose? (5)

A
  • Use acrylic bur to remove undercuts from denture
  • Take a ** wash impression using the closed mouth technique**
  • Send to lab (asking for rebase)
  • Disinfect
  • re-insert and review within 1-2 weeks
87
Q

How can milled crowns be useful in denture design?

A
  • Can be modified to provide greater denture retention
    ** with **
  • guide planes (parallel preps)
  • undercuts
  • rest seats
88
Q

How to avoid single teeth saddles?

A

Anterior bridges combined with denture

89
Q

What are some pathological changes than can affect dentures? (8)

A
  • MRONJ/ORN
  • Denture stomatitis
  • Candida
  • Aphthous ulcers
  • Denture hyperplasia
  • Flabby ridges
  • Paget’s disease
  • Allergies
90
Q

Patient presents at denture review with an ulcer at the upper right maxillary tuberosity. How do you manage this?

A
  • Paint pressure indicator paste over area of ulceration
  • Seat denture and adjust area using straight handpiece
  • Polish
  • instruct the patient on HSMW for 3 days
91
Q

The patient returns after 3 weeks and the same ulcer is still present. What could this indicate and what should you do next?

A
  • Refer urgently to maxfax as it may be malignant
92
Q

A new patient presents to you with denture stomatitis. What are 2 different management strategies for this?

A

** Provide denture hygiene instructions **
* take dentures out at night
* clean with soft bush and soapy water
* consider daily rinse
** may prescribe antifungals **
** investigate MH **
* haematinics
* diabetes

93
Q

What is the aetiology of angular cheilitis?

A
  • Diabetes
  • Anaemia
  • immunosuppression
  • poor lip support
  • Candida or strep
  • low OVD
94
Q

How does denture hyperplasia happen?

A
  • overextension denture border
  • leading to chronic irritation of sulcus
  • leading to ridge resorption
  • leading to fibrous tissue replacement
95
Q

How to manage denture hyperplasia? (3)

A
  • Trim flange and apply tissue conditioner
  • review and repeat
  • make new denture when tissue shrinks back or to oral surgery for excision
96
Q

Can a bisphosphonate/radiotherapy denture wearing patient be at risk of MRONJ?

A

Yes

97
Q

What denture materials can be related to allergic reactions?

A
  • PMMA
  • Nickel from CoCr
98
Q

What is the difference between the effects of CoCr and acrylic denture on periodontal destruction?

A

CoCr less periodontally destructive

99
Q

What is a key aspect of RPD major connector design to maximise periodontal health in a periodontitis patient?

A
  • Reduce tissue coverage (less gingival tissue)
  • Use lingual bar connector
100
Q

What are 3 key teeth for retention and support to keep in dentures for periodontitis?

A
  • Last standing molars
  • Canines
  • Premolars
101
Q
  • 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 and why? 3 reasons

A
  • Lower acrylic RPD
  • Easier transition for patient to edentulism
  • Reduce the mobility of anterior teeth
  • Reduce rate of flabby ridge formation
102
Q

What are the advantages of providing no prothesis in periodontitis patients?

A
  • Better hygiene
  • Less priodontal damage
103
Q

Disadvantages of providing no prothesis to periodontal patients with free end lower saddles?

A
  • Lack of posterior support lead to increased mobility of remaining teeth
  • Lack of denture wearing experience making it hard to transition
104
Q

What is the difficulty related to dentures in periodontal disease patients? (4)

A
  • Impression taking
  • Fitting Cocr denture
  • Path of insertion
  • Positioning denture teeth
105
Q

What medical problems can be related to dentures? (6)

A
  • Xerostomia
  • Anaemia
  • Frality
  • Tremors
  • Anti-resorptive medications
  • Dementia and capacity issues
106
Q

What is the aetiology of xerostomia?

A
  • Dehydration
  • Drug induced
  • conditions : Sjogren’s , Sialosis , HIV , cancer treatment
  • Trauma
  • developmental deficiency of acinar tissue
107
Q

What might be the consequences of xerostomia related to dentures? (3)

A
  • Poor denture retention
  • Candida infections
  • Traumatic ulceration
108
Q

What is the aetiology of anaemia? (5)

A
  • Poor intake of Fe / B12 / folate
  • Increase blood loss through menstruation or internal bleeding
  • Leukaemia
  • Reduced Hb production
  • Increased Hb loss
109
Q

What are the consequences of anaemia that might affect dentures?

A
  • Recurrent apthous ulcers and other conditions irritating the mucosa
  • Angular cheilitis
  • Immunosuppression leading to infections
110
Q

What are the types of anti-resorptive drugs? (3)

A
  • Bisphosphonates - Alendronic acid
  • RANKL inhibitors - Denusomab
  • Anti-angiogenics - Bivacizumab
111
Q

What is the risk associated with anti-resorptive drugs?

A
  • MRONJ
112
Q

How to manage someone with risk of MRONJ who wants dentures?

A
  • Retain the teeth if possible to prevent the risk and provide overdentures with roots in situ
113
Q

Causes of tremors? (3)

A
  • Parkinson’s
  • Huntinston’s chorea
  • Strokes ( cerebral vascular accident)
114
Q

What denture related issues might be associated with tremors?

A
  • Achieving RCP in jaw registration
  • Issues with taking impressions
  • Insertion and removal of dentures
  • Need simple treatment plans - use cuspless teeth
115
Q

What is frality

A
  • Vulnerability after a stressor event due to poor resolution of haemostasis
116
Q

What are the characteristics of Frality? (3)

A
  • Reduced strength
  • Slow walking speed
  • Low energy

Can be associated with multiple long term conditions

Associated with multiple hospital admissoins and care home addmision

117
Q

What is the difficulty related to dentures in patients with Frality?

A
  • Difficulty to tolerate complicated treatment
  • Better to provide replica dentures instead of making a new denture
118
Q

What is dementia ?

A

Umbrella academy for disorders or conditions characterised by a decline in memory , cognition and language making everyday activities difficult

119
Q

What is the name of the ACT associated with people that have dementia?

A
  • Adults with Incapacity Act 2000
120
Q

What is AMCUR?

A

** Factors of identify capacity to consent **
* Acting
* Making a decision
* Communicating the decision
* Understanding the decision
* Retaining the decision

121
Q

What are the principles of adults with incapacity act? (5)

A
  • Patient benefit
  • Minimum intervention
  • Take into consideration patient wishes
  • Consult relevant others
  • Encourage residual capacity
122
Q

Who can consent for dental treatment on behalf of a patient who lacks capacity to consent? (4)

A
  • Combined power of attorney
  • Welfare power of attroney
  • Welfare gaurdian
  • Dentists who have completed training to complete section 47 of AWI
123
Q

What are some basic questions you could ask to assess patient capacity? (4)

A
  • What is this place?
  • How old are you ?
  • What is your date of birth?
  • What year is it?
124
Q

What dental issues might arise with patients with dementia? (4)

A
  • Ability to consent
  • Remembering appointments
  • Remembering instructions
  • Manual dexterity
125
Q

What details should dentists include in section 47 when treating patients with lack of capacity? (4)

A
  • The lack of capacity
  • The proposed intervention
  • Who they have consulted
  • That the Act principles has been observed
126
Q

Who are vulnerable adults?

A
  • Adults that cannot safeguard their wellbeing, properties or rights due to physical or mental disability who are at risk of harm
127
Q

What act is there for vulnerable adults?

A

Adult support and protection Act 2007

128
Q

Give some examples of Adult support and protective services ? (4)

A
  • Social services
  • GP
  • Police
  • Indemnity organisation
129
Q

According to the 3 point test in the ASP act, an adult is at risk of harm is one that ..?

A
  • Unable to safegaurd their wellbeing / property
  • Is at risk of harm
  • Because they are affected by disability

BDS4 (63 decks)

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