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Finals > Prosthodontics > Flashcards

Prosthodontics Flashcards

1
Q

What 5 factors are associated with retention?

A

Gravity
Mastication
Tongue
Active
Speech

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2
Q

What features should be taken in a maxillary impression?

A

Maxillary tuberosity
Hamular notch
External anterior vibrating line
Functional depth and width of sulcus

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3
Q

What is the primary support of a maxillary denture?

A

Hard palate

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4
Q

What features should be taken in a mandibular impression?

A

Pear shaped pads
Buccal shelf
Retromolar pads
Extension into lingual pouch

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5
Q

What is the primary support in a mandibular denture?

A

Buccal shelf
Pear shaped pad

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6
Q

What is the posterior border of the maxillary denture?

A

1-2mm anterior to the vibrating line and palatine fovea

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7
Q

What materials can be used for a primary impression?

A

Impression compound
Alginate

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8
Q

What materials can be used for secondary impressions?

A

ZOE
Silicone
Alginate

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9
Q
A
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10
Q
A
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11
Q

What is balanced occlusion?

A

Simultaneous bilateral contacts when static

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12
Q

What is balanced articulation?

A

Continuous simultaneous contacts during excursive movements

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13
Q

What is the neutral zone?

A

Stable position
Equilibrium between soft tissues and tongue

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14
Q

What is Christensens phenomenon?

A

Dissocclusion of posterior rim when mandible protrudes

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15
Q

What are the Cawood and Howell Classification (1-6)?

A

1; pre-extraction
2; post-extraction
3; rounded
4; knife edge
5; flattened

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16
Q

What is occlusion? (Academy of Prosthodontics)

A

The static relationship between the incising or masticating surfaces of the maxillary or mandibular teeth or tooth analogues.

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17
Q

What is intercuspal position (ICP)?

A

The complete intercuspation of the opposing teeth independent of the condylar position.
May be referred to as the best fit of the teeth regardless of condylar position.

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18
Q

What is retruded contact position?

A

Guided occlusal relationship occurring at the most retruded position of the condyles in the joint cavities

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19
Q

What are index teeth?

A

Contacting facets of teeth in the intercuspal position

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20
Q

What are the features of intercuspal position?

A

Needs sufficient index teeth
Stable occlusion
May vary through life
Depends on tooth relationship
Sometimes more anterior than RCP

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21
Q

What are the features of retruded contact position?

A

Insufficient index teeth
Unstable occlusion
Most reproducible position
Is a condylar position
Sometimes more posterior than ICP

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22
Q

What occlusion is usually used when conforming the occlusion?

A

ICP

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23
Q

What occlusion is usually used when changing the occlusion?

A

RCP

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24
Q

When would you conform the occlusion?

A

Stable condition with sufficient index teeth

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25
Q

When would you change the occlusion?

A

Unstable occlusion with lack of sufficient index teeth

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26
Q

What can be used to articulate study casts?

A

Inter-occlusal record

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27
Q

What are three ways of recording an interocclusal record?

A

Bite registration paste
Wax wafer
Modified wax wafer (alminax)

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28
Q

What can be used to articulate study casts when there is insufficient teeth?

A

Record blocks

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29
Q

What are four types of record block?

A

Wax
Wire strengthened
CoCr Base
Shellac base

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30
Q

What is used to modify a record block?

A

Hot plate/ Bunsen Burner and Wax knife
Bite registration paste

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31
Q

What are options that can be used to solve denture design problems?

A

Modification of survey lines
Precision attachments
Two part denture
Swinglock denture
Connector for lingually tilted teeth

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32
Q

How can we modify survey lines?

A

Using composite

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33
Q

Why would we modify survey lines using composite?

A

To give more favourable clasping and improve denture retention

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34
Q

Where can you find the different types of precision attachments?

A

Cendres et Metauc catalogue

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35
Q

What are precision attachments made uo out of?

A

Socket in denture for ball
Lock for the tube

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36
Q

When would a two part denture be used?

A

Gross tissue loss and different paths of insertion

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37
Q

What is a two part denture formed of?

A

Split pins on cobalt chrome denture
Acrylic slots into pins on different path of insertion

38
Q

What does a swinglock denture consist of?

A

A lock and a hinge

39
Q

What are the benefits and drawbacks of a swinglock denture?

A

Engages bone and tissue undercuts for retention
Good oral hygiene is essential

Technically demanding

40
Q

What are the options for a connector for lingually tilted teeth?

A

Lingual tilt
Buccal bar

41
Q

What alterations can be made for dentures in bruxism patients?

A

Metal backing to teeth
Cobalt chrome to reduce fracture
Metal occlusal surfaves
Use of cross-linked teeth for better wear resistance
Acrylic post dam to increase retention

42
Q

What is retching?

A

Physiological mechanism
Involuntary contraction of the muscles of the soft palate or pharynx

43
Q

What part of the brain is associated with retching?

A

Higher centres in the medulla oblongata

44
Q

What are the two types of retching?

A

Psychogenic
Somatic

45
Q

What is psychogenic retching?

A

Occurs by sight, smell, sound or thought

46
Q

What is somatic retching?

A

Occurs by touching trigger zones

47
Q

What are examples of trigger zones in retching?

A

Palatoglossal fold
Palatopharyngeal fold
Base of tongue
Palate
Uvula
Posterior pharyngeal wall

48
Q

When can retching lead to difficulties in prosthetics?

A

Impression taking
Jaw registration
Toleration of dentures
Denture retention (palate may be reduced)

49
Q

How can you manage a retching patient?

A

Identification of problem
Identify trigger zones
Anxiety reduction
Patience and empathy

50
Q

What are passive relaxation techniques?

A

Dim lighting
Music
Avoid sight of dental instruments

51
Q

What are active relaxation techniques?

A

Controlled rhythmic or relaxed abdominal breathing

52
Q

What are examples of desensitisation techniques for retching patients?

A

Repeated brushing or stroking anterior palate or tongue with finger/toothbrush
‘Homework’ of brushing/stroking for patient pre-treatment
Swallowing with mouth open

53
Q

What are examples of distraction techniques for retching patients?

A

Talking to patient
Getting patient to concentrate on keeping their leg raised/wiggling toes
Get patient to press or tap their temple
Put salt on the tongue
Ask patient to close eyes
Rinse mouth with very cold water just before treatment

54
Q

What are examples of additional complementary treatments to accompany desensitisation?

A

Hypnosis
Acupressure
Cognitive Behaviour Therapy

55
Q

What does the MAGIC technique stand for?

A

Main Amelioration of Gagging Indoctrination by Communication

56
Q

Explain the process of the MAGIC technique:

A

Patient fills their lungs completely with air
Sends a strong message from lung stretch receptors to the medulla oblongata that there is plenty of air and no risk of choking or aspiration
Psychogenic gage reflex is subverted

57
Q

What modifications can be made during impression taking for retching patients?

A

Modify stock trays
Lower trays in upper arch
Modify special trays: palatal reduction
Use of rapid setting impression materials: dental composition, alginate mixed with warmer water

58
Q

What modifications can be made during denture design for retching patients?

A

Shortened dental arch
Horseshoe palate
Use of buccal bar connector
Use of CoCr rather than acrylic
Use of ‘essix’ retainer denture
Use of a training plate
Multiple post dams
Denture well adapted to tissues

59
Q

Why opt for multiple post dams in a retching patient?

A

Postdams provide pressure to palatal tissue that is helpful in reducing retching

60
Q

How can you provide a denture well adapted to tissues for a retching patient?

A

Palate not too thick
Cusps of posterior teeth may need to be rounded so they do not stimulate dorsum of the tongue
Consider no 2nd molars on prosthesis

61
Q

According to Carlsson, what proportion of patients are dissatisfied with their dentures?

A

10-30%

62
Q

What factors lead to patient’s dissatisfaction with their dentures?

A

Lack of retention and stability
Disconnect between patient and clinician expectations
Reduced self esteem due to wearing a denture and negative impact on socialisation
Facial aesthetics changed due to tooth loss
Decreased chewing efficiency

63
Q

What factors contribute to effective communication with pros patients?

A

Listen to patient ]
Know your subject
Avoid jargon
Be attentive
Answer questions
Respect confidentiality
Be empathetic

64
Q

What are key questions to ask a patient in the initial assessment for dentures?

A

How long ago were your teeth removed?
How many dentures have you had since you lost your teeth?
How old is the last denture you had made?
Are you wearing the last denture you had made?

65
Q

What features should you pay attention to when examining and palpating the denture bearing area?

A

Severely resorbed ridges
Flabby ridges
Tori
Prominent mentalis muscles, mylohyoid ridges, genial tubercles
High muscle attachments
Pain on ridge palpation

66
Q

What are some key statements that can be used to manage pros patient expectations?

A

I’m sorry to say that you may never be able to wear a denture that meets all your expectations to your complete satisfaction

Unfortunately, it is highly unlikely that you will ever feel that your denture is as firm as your natural teeth

You are going to need much perseverance in trying to cope with your dentures and it is likely that it will be a very difficult time for you

67
Q

What is a dental implant?

A

An artificial tooth root that is surgically anchored into the jaw to hold a replacement tooth or teeth in a denture in place.

68
Q

What is the benefit of implants?

A

They do not rely on the neighbouring teeth for support

69
Q

What can an implant restore?

A

A single tooth
Multiple teeth
Can secure a denture firmly

70
Q

What are the four stages for placement of an implant?

A

Raise flap
Place implant
Place cover screw
Suture

71
Q

What are the 6 stages for placement of an single tooth implant?

A

Uncover implant
Place abutment
Take impression with coping
Choose colour
Place temp
Cast impression with lab dummy

72
Q

What are the two methods of retention for multiple teeth implants?

A

Cement retained
Screw retained

73
Q

What type of abutments can be used in securing implant retained dentures?

A

Locator abutments
Ball adjustments
Gold bar
CAD-CAM titanium bar
Novaloc abutment
Magnetive retention

74
Q

What are common post implant treatment complications?

A

Peri-implant mucositis
Peri-implantitis
Loose/fractured components
Late implant failure

75
Q

What is the role od the GDP in implant patients?

A

Oral health advice
Triage and diagnosis (if possible) of a complication
Referral of the complication to an appropriately trained, indemnified and competent implant dentist
Manage taking account of SDCEP guidelines

76
Q

What are the SDCEP guidelines in regard to maintenance of dental implants?

A

Ensure the patient is able to perform optimal plaque removal around the dental implants

Examine the peri-implant tissues for signs of inflammation and bleeding on probing and/or suppuration and remove supra- and submucosal plaque and calculus deposits and excess residual cement

Perform radiographic examination only where clinically indicated

77
Q

What is peri-implant mucositis?

A

Inflammation of the peri-implant mucosa with no evidence of crestal bone loss. The tissues will appear red and swollen and may bleed on gentle probing

78
Q

How can you tell whether a patient has peri implant mucositis or peri-implantitis?

A

Radiographic examination to assess peri-implant bone levels compared with baseline radiograph

79
Q

What is peri-implantitis?

A

Infection with suppuration and inflammation of the soft tissues surrounding an implant, with clinically significant loss of peri-implant crystal bone after the adaptive phase.

The tissues will appear red and swollen, may bleed on gentle probing and there will be suppuration

80
Q

How is peri-implantitis managed?

A

Refer patient back to the clinician who placed the implant
Arrange a follow up appointment 1-2 months after, if no improvement seek advice from secondary care
If the inflammation has settled and stabilised, arrange radiographic follow up in 6-12 months

81
Q

What is the effect of the presence of natural lower teeth and a complete upper denture?

A

High forces can be developed against the upper maxillary edentulous ridge leading to trauma and instability of the dentures

82
Q

What is the effect of abuse of the soft tissue in the denture bearing area?

A

Mucous membrane damage
Ulceration and discomfort

83
Q

What is the effect of trauma to the maxillary denture bearing area?

A

Abuse of soft tissues
Alveolar resorption and fibrous tissue replacement

84
Q

What is the effect of alveolar resorption and fibrous tissue replacement?

A

Fibrous or flabby ridge

85
Q

What does combination syndrome consist of?

A

Bone loss from the anterior part of the maxillary ridge
Hypertrophy of the tuberosities
Papillary hyperplasia in the hard palate
Extrusion of the mandibular anterior teeth
Bone loss under the denture base

86
Q

How can you reduce trauma to the maxillary denture bearing area?

A

Maximise coverage of the denture bearing area by the prosthesis
Ensure prosthesis covers the primary load bearing sites

87
Q

How can we optimise stability of the maxillary denture?

A

Optimum border seal
Effective post dam

88
Q

How can we optimise loading of the denture bearing area?

A

Use of over denture abutments

89
Q

What factor can lead to instability of the maxillary denture?

A

Absence of lower posterior teeth
Incisor overbite
Irregular occlusal plane

90
Q

How can we manage an incisor overbite in patients with a complete upper denture?

A

Reduction of the incisor edges of natural teeth
Siting of the denture teeth

91
Q

How can you manage irregular occlusal planes of natural lower teeth with a complete upper denture?

A

No adjustments
Minimal localised occlusal grinding
Radical occlusal adjustment
Extraction of teeth
Overlay appliances

92
Q

What alteration can be made for complete lower denture and upper natural teeth?

A

Soft linings
Implants

Finals (20 decks)

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