Prosthodontics Flashcards
shortened dental arch
dentition of no more than 20 teeth with an intact anterior region but a reduced number of occluding pairs of posterior teeth
as bone is lost what happens mandible and maxilla
maxilla - becomes narrower
mandible - becomes wider
extra oral implications of edentulousness
upper and lower lip both become more retroclined
physiological changes in the edentulous (4)
loss of proprioception due to loss of PDL
changes in musculature & support leads to decreased masticatory & biting efficiency
decreased swallowing as jaws don’t have any guidance and will possibly be problems with speech due to tongue moving differently
Atwood classification of edentulous teeth
class I - dentate - pre XLA
class II - post XLA - tooth after immediate loss
class III - broad alveolar process - alveolus refilled with newly formed bone, resorption begins
class IV - knife edge alveolar process - shape of alveolar crest starts to alter to thick knife edge but body still adequate in height & width
class V - flat ridge - loss of alveolar process - further resorption
class VI - submerged ridge - resorption into basal bone
list clinical stages in complete denture construction (8)
- assessment of ptx & current dentures
- primary imps - ask for special trays
- definitive imps - ask for occlusal rims & bases
- registration visit - ask for tooth trial
- trial insertion visit
- insertion
- maintenance
- aftercare
factors that may affect denture wearing experience (5)
xerostomia
mucosal disease
arthritis
stroke
parksinson’s
factors that may affect denture wearing experience
xerostomia
mucosal disease
arthritis
stroke
parksinson’s
freeway space
difference in OVD & RVD
space between teeth / dentures when at rest
2-4mm
what should be examined when it comes to residual ridges
ridge height, width & consistency
muscle attachments affecting denture (2)
if mentalis attachment is unusually high then this will have to be relieved as to not displace the denture
frenal attachments must be relieved if large as they can predispose denture to fracture
denture extension
should be 2/3s over the retromolar pad - both individually and with both arches together
centric jaw relation
centric jaw relation is the most retruded position of the mandible to the maxillae at an established vertical dimension which is repeatable and recordable
primary impression poured in
50:50 plaster stone combination
master impression poured in
100% dental stone
negative replica
impression on tissues of the mouth
positive replica
when impression is converted to plaster / stone
what must not be used in dentate ptx
non elastic impression materials - can be used in edentulous ptx as there is less risk of impression getting stuck in undercuts
lower special tray in edentulous ptx
close fitting (1mm) spaced non perforated light cured acrylic resin tray
ZnO eugenol or silicone can be used in this tray & there should be no bony undercuts - if there are then 2mm spacing prescribed and elastic impression material used due to undercuts i.e. silicone or alginate
upper special tray
2mm spaced light cured acrylic tray for an elastomer
handles for edentulous special trays
should be intra-oral as they do not modify the soft tissues as much to allow for a more accurate impression
on lowers there must be stub handles on premolar region as well as incisal region
extension of special tray
should be 1/2-2/3s along the retromolar pad and also extend to around 2mm from the buccal sulcus to allow for sufficient thickness of impression material to not tear
use of tracing compound in upper special tray
should be added to canine & post dam regions to allow for accurate reinsertion of tray
will also allow for pre-formed space for alginate material
rests on canine region will stop too much pressure being placed on tray
should be added to outside periphery of tray to fill width of sulci allowing peripheral seal
should also resist downward displacement forces added to handle to create accurate representation of ridges and sulci
use of tracing compound on lower special tray
closer fitting tray of lowers doesn’t need tracing compound as they can be reinserted accurately
how to deal with displaceable flabby maxillary ridge
impression should be either with an open window over the ridge and modification with green stick OR perforate a spaced tray over the ridge - these both will use a low viscosity material in these areas i.e. mucostatic to not compress tissues
flat (atrophic) mandibular ridge
Atwood class V - take impression of ridge wth greenstick impression with a light bodied silicone reline over, or using the admix impression technique (3 parts impression compound, 7 parts weight greenstick)
when to use a reline impression
problems with pain or stability associated with underside of the denture - mainly for when dentures have failed previously or conventional techniques will be unsuccessful
what is the neutral zone
zone of minimal conflict between tongue, lips and cheeks
it is more likely to be buccally placed than in pre XLA sites as post XLA tongue will expand buccally; reducing the bucco-lingual width