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BOARDs > Prosthodontics: General > Flashcards

Prosthodontics: General Flashcards

1
Q

Anatomy of a Bridge

A
  • Abutment: the Tooth the bridge attaches to
  • Retainer: Crown that attaches to abutment
  • Pontic: FAKE TOOTH
  • Connector: Connects retainer to pontic
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2
Q

Bridge: Poor Prognosis Scenarios

A
  • Half or less bone support around abutment tooth
  • Single retainer cantilever (posterior region)
  • Multiple-splinted abutment teeth
  • Nonrigid Connectors
  • Intermediate Abutments=pier (aubtment tooth used to support a bridge all by itself, w/no adjacent teeth)
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3
Q

What teeth should not be used an abutment teeth in a bridge?

A

Compromised Endo Teeth
* removed dentin makes them weaker

Compromised Perio Teeth
* crown to root ratio=2:1

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4
Q

Bridges: Crown to Root Ratio

A

Ideal: 1:2
Realistic: 2:3
Minimum: 1:1
Poor: 2:1 (not used for abutments)

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5
Q

what should be done if replacing a maxillary canine w/a bridge

A

Splint central and lateral together
* prevent lateral drifting of the bridge

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6
Q

Ante’s Law

A

The PDL surface area of abutment teeth should be equal to or greater than the imaginary PDL SA of missing teeth

Abutment teeth PDL SA >/= Imaginary/Missing teeth PDL SA

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7
Q

Bridge: Splinting Teeth

A

Splinting: Distributes occlusal forces

Recommend when Ante’s Law is broken
* PDL SA of abutment tooth can’t support the bridge

If replacing a maxillary canine:
*splint central and lateral together
* prevent lateral drifting of the bridge

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8
Q

Bridge: Ideal Root Shape for abutment teeth

A

Roots:
* Divergent
* Multiple
* curved
* broad Roots

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9
Q

Partial Denture Indications

A

Distal Extension
Long Span edentulous space
Bone loss around Potential Abutments
Bridge or implant is too expensive

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10
Q

Complete Denture: Indications vs Contraindications

A

Indications
* all teeth are missing

Contraindications in maxillary whenCombination therapy
* Only mandibular anteriors are present
* cause severe damage to premaxilla

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11
Q

Overdenture: How many implants recommended for mandible vs maxilla

A

Mandible: 2 implants
Maxilla: 4 implants

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12
Q

Cement-Retained Implant: Pros vs Cons

A

Pros
* economical
* minor angle correction
* Easier in small teeth

Cons
* more chair time
* gets loose over time
* excess cement=peri-implantitis

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13
Q

Screw-Retained Implant: Pros vs Cons

A

Pros:
* Retrievability: crown removal
* good maintenance
* Access hole: Posteriors=Occlusal; Anteriors: Lingual

Cons:
* Screw loosens during function

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14
Q

Alginate

A

Aka Irreversible Hydrocolloid
* 1st choice for diagnostic casts
* Diatomaceous earth adds strength
* Trisodium Phosphate: Controls setting time

More bulk=less unwanted dimensional changes

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15
Q

Process of taking impressions with alginate and pouring up for diagnostic casts

A

Process:
remove tray: 2-3 mins
Pour impression within 15 mins
Casts set in 30-60 mins

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16
Q

Maxillo-Mandibular Relations (MMR)

A

CR
MI

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17
Q

Centric Relation (CR)

A

Condyles
* in the most anterior-superior position
* articulate the thinnest avascular portion of the discs
* against the articular eminences

Independent of teeth

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18
Q

Maximum Intercuspation (MI)

A

aka Centric Occlusion (CO)

Complete interdigitation of teeth
* independent of condyle position

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19
Q

CR Vs MI

A

CR=MI in only 10% of pts
* in 90%, they slide into each position

Casts are mounted in MI when MI can be maintained
* (Single fixed procedure-single crown or bridge)

Casts are mounted in CR when MI is impossible to maintain
* complete dentures
* multiple teeth being restored/replaced

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20
Q

What is the most reliable and reproducible jaw movement?

A

CR

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21
Q

Occlusal Harmony

A

Joint, Muscles, and Teeth MUST function in harmony

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22
Q

Bimanual Manipulation

A

most accurate method to get in CR
* Goal-Deprogram the jaw

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23
Q

What is Objective of a Facebow Record

A

Duplicate the relatinoship b/w
* maxilla –> skull
* mandible –> TMJ ratoational center
On the articulator

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24
Q

Facebow Types and describe each

A

Arbitrary Facebow:
* orients maxillary cast–> skull by external auditory meatus
* easier to use

Kinematic Facebow:
* placed on hinge axis of mandible
* more complex

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25
Q

Articular parts and corresponding anatomy

A

Upper Member: Maxilla
Lower Member: Mandible
Hinge Axis=TMJ

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26
Q

Nonadjustable Articulator

A

NO Full range of mandibular movement
* Shorter distance b/w hinge and teeth vs in patient

Result in:
* premature contacts
* incorrect ridge & groove direction of restorations

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27
Q

Semiadjustable Articulator

A

Can set:
Bennett Angle (15 degrees)
Horizontal Condylar Inclincation (HCI=30degrees)

Types:
Arcon:
* condyles are part of the lower member
* fossa are part of the upper member
* more anatomically accurate

Nonarcon:
* upper and lower membres are rigdily attached
* Not anatomically accurate

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28
Q

When casts are poured from alginate or elastomeric materials, they are more accurately mounted with what?

A
  • Alginate –> wax records
  • Elastomeric materials–>elastomeric materials (PVS) or ZOE paste
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29
Q

Disclusion: Define

A

Mandible protruded forward

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30
Q

Disclusion Types:

A

Condylar Guidance
Incisal Guidance
Canine Guidance
Anterior Guidance

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31
Q

Disclusion: Condylar Guidance

A

articular eminence slope
* varies among patients
* limits jaw movement

Represented by HCI on articulator

Posterior Determinant of occlusion

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32
Q

Disclusion: Incisal Guidance

A

pin and guide table on articulator

Anterior Determinant of occlusion

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33
Q

Disclusion: Canine Guidance

A

lateral movements, all posteriors disclude
* canines contact on working side only

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34
Q

Disclusion: Anterior Guidance

A

Incisal & Canine Guidance

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35
Q

Disclusion Summary:

A

During Protrusive
* incisal and condylar guidance provide clearance for all posterior teeth

During Lateral (excursive),
* canines on working side and condyle on balancing side provide clearnace
* for posterior teeth on balancing side

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36
Q

Guide Table

A

Anterior guidance must be preserved when restorany guiding surface of teeth

Mechanical Incisal Guide:
* insufficient info to reproduce lingual contours of maxillary anteriors

Custom Incisal Guide table
* made out of acrylic resin
* provids info needed

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37
Q

Mutual Protection:

A

Front teeth protect back teeth
* front teeth disclude posterior teeth during protrusive and lateral movements

Back teeth protect front teeth:
* back teeth have flat occlusal surfaces and strong root=protect anteriors from bite forces

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38
Q

Maxillary Labial Frenum

A

At or adjacent to midline

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39
Q

Maxillary Buccal Frenum

A

Either Side of Alveolar Ridge

Attach:
* orbicularis oris
* buccinator

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40
Q

Maxillary Labial Vestibule

A

Anterior to the 2 buccal Frena

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41
Q

Maxillary Buccal Vestibule

A

Posterior to buccal frenum to hamular notch

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42
Q

Hamular Notch

A

soft tissue

connects:
* distal end of maxilla
* pterygoid hamulus

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43
Q

Vibrating Line

A

Pt says AHH=Location
* from hamular notch to hamular notch
* 2mm away from fovea palatini

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44
Q

Buttery Fly Line

A

Junction b/w hard and soft palate
* anterior to vibrating line

Valsalva maneuver: butterfly line balloons down
* hold nose and try to blow through nose

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45
Q

Posterior Palatal Seal

A

part of denture that compresses soft tissue of palate=suction

Anterior Boundary=Butterfly Line
Posterior Boundary=Vibrating Line

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46
Q

Cornoid Notch

A

DB part of maxillary impression/denture

Pt moves jaw side to side during border molding
* Coronoid notch slides past DB region of impression

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47
Q

Pterygomandibular Raphe

A

Pt opens wide to capture on posterior part of impression

Connect:
* buccinator m.
* superior pharyngeal constrictor

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48
Q

What are the 2 most important movements for upper impressions?

A

Move the Mandible Left/Right
* coronoid process glides past the distobuccal corners of denture

Open mouth wide
* pterygomandibular raphe tightens and molds impression in back

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49
Q

Mandibular Labial Freenum

A

Attach:
* orbicularis oris

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50
Q

Mandibular Buccal Freenum

A

Attaches:
Orbicularis oris
Buccinator

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51
Q

Lingual Freenum

A

Mandible

Attaches:
Genoglossus

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52
Q

Mandibular Labial Vestibule

A

Anterior to buccal frena

Mentalis Muscle (Chin)=inferior border

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53
Q

Mandibular Buccal Vestibule

A

Posterior to buccal frena
Buccinator m=inferior border

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54
Q

Retromolar Pad

A

Mandible

marks the distal extension of edentulous ridge
* Ideally covered for support and retention (bc bone integrity is maintained)

Attaches:
* temporalis m.
* buccinator m.
* superior pharyngeal constrictor
* pterygomandibular raphe

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55
Q

Masseteric Notch

A

DB area on mandibular impression/denture (analogous to hamuler notch)
*Masseter contracts when the mouth closes against resistance

Have pt close against resistance to capture in border molding
* prevents masseter from impinging on overextended DB corner of denture

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56
Q

Alveolingual Sulcus

A

B/w mandibular alveolar ridge and tongue
2 S’s (Vertical S & horizontal S)

3 Regions:
Anterior Region
Middle Region
Posterior Region

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57
Q

Buccal Shelf

A

Main Support for Denture
* Perpendicular to occlusal forces
* lateral to posterior alveolar ridge

Attaches: Buccinator

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58
Q

Alveolingual Sulcus: Anterior Region

A

lingual freenum to premylohyoid fossa
* First curve in the S
* Sublingual gland sits above mylohyoid muscle
* Want shorter flange

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59
Q

Alveolingual Sulcus: Middle Region

A

premylohyoid fossa to distal end of mylohyoid ridge
* 2nd curve of S

Flange
* deflected medially away from the mandible
* due to mylohyoid ridge & contraction of mylohyoid medially

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60
Q

Alveolingual Sulcus: Posterior Region

A

Extends into retromylohyoid fossa

Mylohyoid
* attaches higher the more posterior you go, but posterior fibers are directed vertically

Flange
* longer and deflected laterally towards the mandibular ramus=3rd curve of S
* extension is limited by palatoglossus and superior constrictor muscles

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61
Q

Frenectomy

A

Complete removal of Freenum

High Freenum Attachment
* neart top of alveolar ridge

Most to least common:
Labial>Buccal>Lingual

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62
Q

Free Gingival Graft

A

widen band of keratinized tissue
* Below gingival margin

Requires revascularization from recipient bed

Graft=palate
*includes surface epithelium
* ideal thickness: 1-1.5 mm

Might Need for overdenture teeth

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63
Q

Hypermobile Ridge

A

Flabby edentulous ridges in anterior maxilla

Tx: tissue conditioner if inflamed
* electrosurgery or laser surgery if not effective, can also eliminate the vestibule

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64
Q

Epulis Fissuratum

A

Hyperplastic tissue reaction
* due to ill fitting denture or overextended flange

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65
Q

Fibrous Tuberosity

A

aka Pendulous Tuberosity

Large Tuberosities touch retromolar pads
* limits interarch space

Tx: Surgical excision

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66
Q

Papillary Hyperplasia

A

Multiple papillary projections on palate
* Etiology: Candidiasis

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67
Q

Combination Therapy:
* General
* Signs/Symptoms

A

Only have mandibular anterior teeth
* bone resorption in maxillary anterior

Signs/Symptoms:
* overgrowth of tuberosities (Fibrous tuberosities)
* Papillary hyperplasia in hard palate
* Extrusion of lower anterior teeth
* Bone loss under partial denture bases

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68
Q

Retained Root Tips

A

Residual RT (Non-RCT)-infection risk

Can be left if:
* intact lamina dura
* no radiolucency

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69
Q

Paget’s Disease

A

Etiology: Unknown

Dentures not fitting
* need to remake periodically

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70
Q

Alveoplasty

A

Surgical reshaping of alveolar bone
* sharp, spiny, or irregular ridges

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71
Q

Tori removal indications

A

Creates an undercut (lingual torus)
interferes w/posterior palatal seal (palatal torus)

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72
Q

Bone Augmentation

A

Horizontal>Vertical
* easier to restore horizontal ridge width vs height

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73
Q

VDR

A

Vertical Dimension of Rest

Distance b/w nose and chin at rest
* elevator and depresssor musccles are in equilibrium (PRP=Physiological rest position)

3mm of space b/w upper and lower premolars

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74
Q

VDO

A

Vertical Dimension of Occlusion

Distance b/w nose and chin when biting together
* =superior-inferior relationship b/w maxilla and mandible in MI

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75
Q

Interocclusal Space

A

VDR=VDO+ 3mm

the difference b/w VDR and VDO
* ideally 2-4 mm

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76
Q

Excessive VDO

A
  • Fatigue of Muscles of Mastication
  • Lips appear strained
  • Gagging
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77
Q

Insufficient VDO

A

**Aged appearance-lower 1/3 of face
Angular Cheilitis

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78
Q

Christensen’s Phenomenon

A

Distal space b/w maxillary and mandibular occlusal surfaces when mandible is protruded
* posterior open bite

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79
Q

Camper’s Line

A

imaginary line from ala of nose to tragus of ear

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80
Q

Interpupillary Oline

A

imaginary line b/w pupils of eyes

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81
Q

Complete Denture: Plane of Occlusion

A

Maxillary wax rim parallel to:
* Camper’s line
* Interpupillary line

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82
Q

Complete Dentures: Balanced Occlusion

A

Simultaneous anterior and bilateral posterior contnacts in centric and eccentric movements
* aka Tripodization
* avoid anterior guidance to prevent dislodgement

On balancing side
* maxillary lingual cusps –>lingual incline of mandibular buccal cusps

On working side:
* maxillary lingual cusps –> facial incline of mandibular lingual cusps
* Mandibular Buccal cusps contact lingual incline of maxillary B Cusps

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83
Q

Complete Denture: Lingualized Occlusion

A

Only maxillary posterior lingual cusps contact mandibujlar posterior teeth
* prevent dislodgement

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84
Q

Bennet Concepts: Bennett Angle vs Shit vs Movement

A

Bennett Angle:
* nonworking side condyle angle: From anteriorly and medial to sagittal plane
* 15 degrees

Bennett Shift:
* Lateral movement of mandible towards working side during lateral excursions

Bennet Movement:
* lateral movement of both condyles towards working side
* TMJ Looseness

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85
Q

Factors that Favor Disclusion(seperation) of posterior teeth (NO ECCENTRIC CONTACTS)
*Anterior Guidance
*Posterior Guidance
* Cusp Anatomy
* Tooth arrangement
*Occlusal plane orientation

A

Horizontal=protrussive
Lateral=excursive

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86
Q

Curve of Spee

A

AP Curve
* load on long axis of each tooth

More mesial tilted as you move distal

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87
Q

Curve of Wilson

A

Mediolateral Curve– along posterior cusp tips
* Load on long axis of each tooth

More lingual tilt as you move distally

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88
Q

Support

A

Resistance to Vertical Seating Forces

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89
Q

Support for Upper and Lower arch and form the Denture POV

A

Upper:
* Palate
* Alveolar Ridge

Lower:
* Buccal Shelf (mainly)
* Retromolar Pad

Denture:
* Denture Base

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90
Q

Stability

A

Resistance to horizontal dislodging forces

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91
Q

Stability for Upper and Lower arch and form the Denture POV

A

Upper/Lower:
* Ridge Height
* Depth of Vestibule

Denture:
* Denture Flange

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92
Q

Retention

A

Resistance to vertical dislodging forces

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93
Q

Retention for Upper and Lower arch and form the Denture POV

A

Peripheral Seal

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94
Q

Adhesion

A

Attraction of Unlike Molecules

saliva to tissues, saliva to denture base
* best seal created by intimate contact of denture base to tissues

Occlusal Prematurities break retention

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95
Q

Cohesion

A

Clinging of Like Molecules
* Saliva to Saliva

Unfavorable: Thick ropy saliva
Favorable: Thin and water saliva=better retention

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96
Q

Surface Tension

A

Combo of adhesion and cohesion forces
* maintain film integrity

Water molecules are more attracted to each other than surrounding air

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97
Q

Overextension

A

Denture Flange is too long
* get sore spot or ulcer after wearing for a while
* Tx: Relieve denture and re-eval in a few weeks
* trim the denture basck where it impinges on tissue

Denture extends too far back (Posterior)
* denture teeth are set so far back-go up onto ramus
* occlusal forces dislodge denture

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98
Q

Underextension

A

Denture Flange is too short
* No retention

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99
Q

What is the best indicator for success of a denture?

A

Ridge
* provides all 3: stability, suppport, retention
* Wide braod ridge=Best

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100
Q

Heat Cured Acrylic

A

PInk Acrylic on Dentures

2 components:
* PMMA=polymer (powder)
* MMA=monomer (liquid)

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101
Q

Liquid component of Heat-Cured Acrylic contains

A

Methyl Methacrylate (MMA): Monomer

Hydroquinone: Inhibitor
* prevents polymerization of MMA

Glycol dimethacrylate: cross-linking agent
* Increases Rigidity

Dimethyl-p-toluidine: Activator

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102
Q

Powder Component of Heat-cured Acrylic contains:

A

Polymethyl Methacrylate (PMMA): powder
Benzoyl Peroxide: Initiator
Iron and Cadmium salts or organic dye: Pigment

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103
Q

Denture Processing: Problems

A

Always shrink
* more shrinkage if excess monomer
* Ideal monomer to polymer ratio: 1:3

Porosity
* due to underpacking with resin at processing or heated to quickly

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104
Q

What are the 2 materials used to make denture teeth?

A

Acrylic
Porcelain

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105
Q

Acrylic vs Porcelain Denture Teeth

A

Acrylic:
* Better retention: bond to acrylic resin of denture base (Better Bonding)

Porcelain:
more esthetic
* more stain and wear resistant

Brittle

wear opposing teeth

Mechanical retention
* Anteriors=Pins
* Posteriors=diatorics

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106
Q

What do you need to do if your taking an impression w/a hypermobile ridge?

A

Large relief in a tray
OR
perforate custom tray

to avoid displacing the ridge

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107
Q

What treatment should be done if a hypermobile ridge is inflamed?

A

Tx=Tissue Conditioner
* Electrosurgery or laser surgery if not effective

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108
Q

Epulis Fissuratum Treatment

A

Tissue Conditioner & Adjust Flange

109
Q

What causes Papillary Hyperplasia?

A

due to:
* local irritation
* ill-fitting denture
* poor oral hygiene
* leaving dentures in all the time

110
Q

What is the etiology of Papillary Hyperplasia?

A

Candidiasis

111
Q

Papillary Hyperplasia: Treatment

A

Tx: OHI, leave dentures out at night, soak in 1% bleach and rinse thoroughly

112
Q

When can you leave retained root tips?

A

Can be left if:
* intact lamina dura
* no radiolucency

113
Q

Kennedy Class I

A

Bilateral Distal Extension

114
Q

Kennedy Class II

A

Unilateral Distal Extension

115
Q

Kennedy Class III

A

Unilateral Bounded Edentulous Space (BES)

116
Q

Kennedy Class IV

A

Bilateral BES (Crosses Midline)

117
Q

Applegate’s Rules

A
  1. Classify after All extractions
  2. Do not consider Missing 3rd molars
  3. Consider Abutment 3rd molars
  4. Do Not Consider Missing 2nd Molars
  5. Most posterior edentulous area determines classification
  6. Other edentulous areas=modifications
  7. extent of modification doesn’ t matter, only number
  8. Class IV can NOT have any modifications
118
Q

Major Connector

A

central component of metal framework
* connects all components

Provides rigidity

Not placed on movable tissue (Only on palate or lingual aspect of alveolar ridge)

119
Q

Maxillary Major Connectors: Types

A

Should cross midline at 90 degrees

Types:
* complete palatal plate
* Horseshoe
* Palatal Strap

120
Q

Complete Palatal Plate

A

Most Rigid Maxillary Major Connector

121
Q

When is a complete palatal plate for maxillay major connector indicated?

A
  • all posterior teeth are missing bilaterally (Class 1)
  • shallow palatal vault
  • periodontally compromised teeth
  • small mouth
  • flat or flabby alveolar ridges
122
Q

Horse Shoe major connector

A

Least Rigid Maxillary Major Connector

123
Q

When is a horse shoe major connector indicated to use?

A

Large palatal torus

124
Q

Palatal Strap

A

Maxillary Major Connector
* metal strap that goes from L to R

125
Q

Beading

A

Only for Maxillary Major Connectors

0.5 mm round groove in the cast at the borders of the major connector
* Adds Strength
* maintains tissue contact=prevent food impaction

126
Q

Lingual Bar

A

Mandibular Major Connector
* Lingual vestibule depth >/= 7mm
* simplest
* most common

127
Q

Lingual Plate

A

Mandibular Major Connector

Indications
* Lingual vestibule depth < 7 mm
* anticipate more tooth loss
* Lingual Tori
* Bilateral Missing Posterior Teeth(Class 1)

128
Q

Labial Bar

A

mandibular Major connector
* aka Swinglock

Indicated when:
* missing canine
* unfavorable soft tissue contour
* questionable perio prognosis

129
Q

What are the different types of mandibular major connectors?

A

Lingual Bar
Lingual Plate
Labial Bar (Aka Swinglock)

130
Q

Minor Connectors

A

connect major connectors to rests, indirect retainers, and clasps

131
Q

Rest

A

Rigid extension of RPD framework
* contacts occlusal, lingual, or incisal surface of abutment tooth

Provides Support
* directs forces down long axis

132
Q

Rest Seat

A

Prepped into occlusal, lingual or incisal surface of abutment tooth
* receive and support rest

133
Q

Occlusal Rest

A

Spoon Shaped
* rounded, semicircular outline form

1/3 MD width
1/2 intercuspal width (B/L)
1.5 mm depth

Floor inclines apically toward center
* < 90 degrees w/vertical minor connector

134
Q

Cingulum Rest

A

Inverted V or U Shape

2.5-3 mm MD Length
2 mm B/L Width (ledge)
1.5 mm Deep

135
Q

What are the benefits of a cingulum rest?

A

Distribute occlusal load (good)
esthetics
strength–due to how close they are to major connector (Dont need minor connector)

136
Q

When are cingulum rests contraindicated?

A

Mandibular Incisors

137
Q

Incisal Rests

A

Rounded notch at incisal angle
* used as indirect retainer
* less favorable leverage than lingual rest
* not esthetic

2.5 mm MD Length
1.5 mm Depth

138
Q

Proximal Plate

A

Metal plate that contacts proximal surface of abutment tooth

139
Q

Guide Planes

A

path of insertion and removal

1/3 Buccolingual width
extends 2-3 mm down from marginal ridge

140
Q

Indirect Retainer

A

Indirect retainer
* perpendicular and anterior to fulcrum line (Axis of rotation)
* fulcrum line=line through most distal rests
* anti-rotation of distal extension area

141
Q

What does a Direct Retainer consist of?

A

Aka Clasp Assembly
Consists of:
Rest: Support

Minor Connector: Stability

Clasp Arms
* Retentive Clasp Arm: Retention
* Reciprocal Clasp Arm: Stability

142
Q

Direct Retainer: Extracoronal Retainer vs Intracoronal Retainer

A

Extracoronal Retainer:
* more common
* conventional clasp design
* encircles tooth at least 180 degrees

Intracoronal Retainer:
* precision attachment
* key and keyway pattern
* most esthetic bc no clasps

143
Q

Retentive Clasp

A

Originates from minor connector & rest

Contacts tooth below HOC/Survey Line
* Retention

144
Q

Reciprocal Clasp

A

Aka Stabilizing Clasp
* Stability

Contacts tooth Above HOC/Survey Line
* not torqued by retentive clasp

145
Q

Suprabulge vs Infrabulge Clasps

A

Suprabulge: Originate above survey line/HOC

Infrabulge: Orginate below survey line

146
Q

Circumferential Clasp

A

Aka Akers Clasp
* Most commonly used
* rest seats adjacent to edentulous space

147
Q

Ring Clasp

A

Suprabulge

undercut=adjacent to BES
* molars and MF undercut

148
Q

Embrassure Clasp

A

Suprabulge

Rests on both teeth
* so clasps don’t wedge teeth apart

149
Q

T-Bar

A

Infrabulge
* T-Bar
* Modified T-Bar (R Bar)

150
Q

I-Bar

A

Infrabulge

  • needs enough vestibular depth
  • No Soft Tissue undercut
151
Q

RPI

A

Type of Direct Retainer
* Rest, Proximal Plate, I bar
* M Rest

152
Q

RPA

A

Aka RPC
Type of Direct Retainer
* Rest, Proximal Plate, Akers/Circumferential

153
Q

Clasp Selection: General Rules
* BES vs Distal Extensions

A

BES:
* use Akers clasps
* rest seats adjacent to edentulous space

Distal Extensions: (order of preference)
1. RPI
2. RPA
3. Wrought Wire

154
Q

Wrought Wire Indications

A

Periodontally Compromised tooth
Endo-Treated tooth

More Flexible
seperately positioned and sauntered onto framework
Less torque on teeth

155
Q

Cobalt Chromium

A

Framework material

2.3% shrinkage
* causes irregularities & porosity

Cold-working (aka plastic deformation or work hardening)
* manipulate metal at ambient temp
* Main reason why clasps break

156
Q

What are some examples of suprabulge clasps?

A
  • circumferential (Akers)
  • Ring
  • Combination
  • Embrasure
157
Q

What are some examples of infrabulge clasps?

A
  • I Bar
  • T Bar
  • Bar Type
  • Y Type
158
Q

Tooth Prep

A

Occlusal/Incisal reduction:
* Maintain Cuspal Anatomy

Functional Cusp Bevel:
* Secondary Plane
* maxillary: Lingual
* Mandibular: Buccal
* Posterior teeth Only

Axial Reduction
Margin/Finish Line

159
Q

Occlusal Table

A

Traced from cusp tip to cusp tip

160
Q

What do we do if theres a cavity interfering with this prep?

A

Remove All Decay
Core Build Up

161
Q

3 Principles of Tooth Prep

A

Biologic: Health of Oral tissues

Mechanical: Integrity and durability of restoration

Esthetic: Appearance of restoration

162
Q

Biologic Principle of tooth prep

A

Oral Tissues Health:

Mechanical Injury:
* thinnest gingival tissue: L Molars & B Premolars

Thermal Injury: How close to pulp
* use:
* Water spray
* sharp cutting instruments
* intermittent light pressure

Chemical Injury:
* soaked retraction cord
* certain cements

Bacterial Injury:
* leakage under crown

163
Q

Mechanical Principle of Tooth Prep: Retention Form Vs Resistance Form

A

Most important principle

Retention Form:
* prevent removal of crown from long axis of tooth prep
* (what holds the crown on, trying to pull off)

Resistance Form:
* prevent removal of crown by apical, horizontal, or oblique forces(occlusal force)

164
Q

Mechanical Principles of Tooth Prep: Taper

A

Aka Parallelism
*angle of convergence b/w opposite axial surfaces
* smaller the taper=more retention
* ideal= 6-10 degrees

Most operator control

165
Q

Mechanical Principles of Tooth Prep: Height, Length, Width,

A

Height or Length:
* from occlusal/incisal to crown margin
* Incisors/premolars/Canines=3mm minimum
* Molars: 4 mm minimum

Width:
* MD or BL dimension of base

166
Q

Mechanical Principles of tooth prep: Height to Base Ratio

A

Height is more important than width
* minimum ratio=0.4
* bigger ratio=taller prep=more tape
* smaller ratio= shorter prep, less retention

167
Q

If you have a short clinical crown, what mechnical properties would you add to increase retention and resistance?

A

Buccal Grooves=Retention

Proximal Grooves=Resistance

168
Q

What is the minimum metal thickness required for a Gold Crown?

A

Minimum Metal Thickness: (GOLD Crown)
* Margin=0.5 mm
* Non-contact areas=1.0 mm
* Contact areas=1.5 mm

169
Q

What is the minimum porcelain thickness for an all ceramic crown?

A

Minimum Porcelain Thickness:
* 1.5 mm

170
Q

What is the minimum and optimal PFM thickness?

A

Minimal PFM Thickness= Non-contact areas
* 1.5 mm (1.2 mm porcelain, 0.3 mm metal)

Optimal PFM Thickness= Contact Areas
* 2.0 mm (1.5 mm porcelain, 0.5 mm metal)

171
Q

Reduction vs clearance

A

Reduction:
* amount of occlusal tooth structure removed
* Ideal=1.5-2 mm

Clearance:
* amount of space b/w prepped tooth and opposing
* ideal= 1.5-2 mm

172
Q

Margin Location

A

Supragingival: Above gingival crest
* promotes periodontal health
* easier to clean

Equigingival:
* at the gingival crest

Subgingival:
* below the gingival crest
* more esthetic=anterior

173
Q

What are the different types of margins?

A

Featheredge
Light Chamfer
Heavy Chamfer
Shoulder

174
Q

Featheredge Margin

A
  • Best marginal seal
175
Q

Light Chamfer Margin

A

0.3-0.5 mm wide

Used for:
* Gold Crowns
* wide gold collars of PFM crowns

176
Q

Heavy Chamfer Margin

A

1-1.5 mm wide

Used for:
* PFM crowns
* some all ceramic crowns

Lab will onvercontour crown if not given enough room

177
Q

Shoulder Margin

A

1.0-1.5 mm wide
* maximizes esthetics-no metal shows
* Aggressive prep:

Used for:
* porcelain of PFM restorations
* All ceramic crowns

178
Q

3/4 and 7/8 Crowns

A

Hybrid b/w onlay and full crown
* conserves tooth structure
* Less margin close to gingiva
* Easier to seat during cementation
* normally gold, but rare now

179
Q

Crown: Occlusal Schemes

A

Occlusal Point contacts=broad and flat
* prevent wear

Cusp-marginal ridge: seen in
* class 1 occlusion
* unworn teeth

Cusp-fossa:
* class II malocclusion

180
Q

Hygienic Pontic

A

Aka Sanitary
* Posterior Mandible

Good Hygiene: 2mm space b/w pontic and ridge
* Requires enough VDO/restorative space

Poor Esthetics: Not recommended for anteriors

181
Q

Saddle Pontic

A

Aka Ridge-Lap
* never use

Bad Hygiene

182
Q

Conical Pontic

A

Molars
* similar to hygienic but slightly best esthetics

183
Q

Modified Ridge-Lap Pontic

A

Anteriors
* Good Esthetics

184
Q

Ovate Pontic

A

Anteriors only
* superior/best esthetics

Requires:
* surgery
* good ridge

185
Q

Bridge: Connector types

A

Rigid:
* either cast in 1 piece or soldered together

Nonrigid:
* can put together and take apart (puzzle pieces)
* use= No common path of insertion b/w abutments

186
Q

Bridge: Connectors

A

connect retainer to pontic

PFM Bridges: 3 mm Height minmum

187
Q

Tissue Management for impressions

A

Fluid Control: Saliva & GCF
* cotton rolls, suction
* Antisialogogues (atropine)

Tissue Displacement:
Retraction cords-stretch circumferential periodontal fibers
Impregnated cords: promote hemostasis
* AlCl=Hemodent
* FeSO4: Viscostat
* Epinephrine
Electrosurgery:
* contraindicated: pacemakers or insulin pumps
* electrode can’t contact teeth

188
Q

What are the 2 categories of impression materials?

A

Aqueous Hydrocolloids
* water based
* mix powder w/water

Non-aqeuous Elastomers:
* not water based
* do not mix powder w/water

189
Q

What are the different Aqeous Hydrocolloid Impression Materials?

A

Agar=Reversive Hydrocolloid
Alginate=Irreversible Hydrocolloid

190
Q

Reverse Hydrocolloid

A

Aka Agar
* Aqueous Hydrocolloid
* High accuracy=duplicate casts

Temp changes
* Heat=softer
* Cool=Hardens

191
Q

Irreversible Hydrocolloid

A

Aka Alginate
Most Innaccurate

Setting time: 3-4 mins
* Pour w/gypsum within 10 mins

Primary Ingredient: Diatomaceous earth
Active Ingredient: Potassium Alginate

192
Q

For Irreversible hydrocolloids, how do you increase or decrease setting time?

A

Decrease setting time
* Hot water
* Less water

Increase Setting time:
* cold water
* more water

193
Q

Imbibition vs Syneresis

A

Imbibition: Water Absorption

Syneresis: Water Loss

Avoid Both in Hydrocolloids (Alginate & Agar)

194
Q

What are the different types of NOn-aqeous elastomers?

A

Polysulfide rubber
Condensation Silicone
Addition Silicone (PVS)
Polyether

195
Q

Polysulfide Rubber

A

Water Byproduct

Moisture tolerant:
* hydrophobic
* Syneresis (most prone to drying out)

30-45 mins to pour up

196
Q

Condensation Silicone

A

Alcohol Byproduct
* shrinks impression when evaporated

30 mins to pour

197
Q

Polyether

A

Very stable, but easily influenced by water and humidity
* Hydrophilic
* Imbibition (swell up with water(

Very stiff-easy to break teeth on cast

60 mins to pour

198
Q

Addition Silicone

A

aka PVS (Polyvinyl Siloxane)
No Byproducts

Best of everything:
* fine detail, elastic recovery, dimensional stability

  • inhibited by sulfur in latex gloves and rubber dam

60+ mins to pour

199
Q

Gypsum

A

Mined as: calcium-sulfate dihydrate

Manufactured w/heat to get rid of water= Calcium-sulfate hemihydrate)

Type 1-5

200
Q

Type 1 Gypsum

A

Impression Plaster
* mount casts on articular

201
Q

Type 2 Gypsum

A

Model Plaster

Model for:
* Mouth guards
* essix retainers

Study Models

202
Q

Type 3 Gypsum

A

Dental Stone

  • Microstone
  • Removable prostheses
  • Diagnostic casts
203
Q

Type 4 Gypsum

A

Dental Stone
* High Strength/Low Porosity
* Low expansion

Best abrasion resistance
Least expansion & Gauging water
fabricate dies

204
Q

Type 5 Gypsum

A

Dental Stone
* High Strength
* High Expansion

Fabricate dies

205
Q

Gauging Water

A

extra water needed to to get a workable mix f material

does not chemically react with gypsum

206
Q

Gypsum setting time & Mixing time

A

20 second vacuum mix or 30 sec hand spatual

Setting time=45-60 mins

207
Q

Noble Metals

A

Gold
Platinum
Palladium

SILVER is not

208
Q

Silver

A

Not Noble Metal
* causes greening of porcelain

209
Q

Gold

A

Noble Metal

Tarnish corrosion resistance

210
Q

Platinum

A

Noble Metal

Strength
* increases melting temp

211
Q

Palladium

A

Noble Metal

Strength

212
Q

Metal Alloy

A

Combine 2+ metals
* greater strength or corrosion resistance

213
Q

High noble alloys vs Noble Alloys vs Base metal alloys

A

High Noble Alloys:
* >/= 60% noble–>at least 40%=Gold

Noble Alloys:
* >/= 25% noble

Base metal alloys:
* < 25% noble

214
Q

Type 1-4 Gold

A

Type 1: 98-99% Gold (Pure Gold)
* soft
* Class V restorations ONLY

Type 2: 77% gold
* Medium
* onlays

Type 3: 72%
* Hard
* Crowns

Type 4: 69%
* Very hard
*RPD castings
* Post & Core
*Clasps
* Bridges

215
Q

How to decrease setting time in Gypsum?

A

HOt water
Less water
Use slurry water
Increased spatula time

216
Q

Compressive Strength

A

Resist fracture during compression
Ex: Occlusal forces

217
Q

Tensile strength

A

Reesist fracture during pulling

218
Q

Flexural Strength

A

Resist fracture during bending

219
Q

Fracture Toughness

A

resist crack propagation

220
Q

What material has the best fracture toughness?

A

Zirconia

Undergoes fracture toughening
* normal tetragonal particles–>monoclinic particles=resist crack propagation

221
Q

Modulus Of elasticity

A

aka Elastic MOdulus

Measures stiffness or rigidity
SLope=Stress/Strain

Steeper the sloper the stiffer the material

222
Q

Brittle

A

Fractures easily w/o substantial dimensional changes

ex: Porcelain

223
Q

What material is brittle?

A

Porcelain

fractures easily w/o substantial dimensional changes

224
Q

Ductility

A

Deforms easily under tensile strength

ex; Wire

225
Q

What dental material is a good example of Ductility

A

wire

226
Q

Malleability

A

Deforms easily under compressive stress

ex: gold

227
Q

What dental material is a good example of malleablity

A

Gold

deforms easily under compressive stress

228
Q

Percentage Elongation

A

Can be burnished
* contact stress > Yield strength
* ex: Gold

229
Q

What material is a good example of percentage elongation?

A

Gold

Can be burnished
* contact stress > Yield strength

230
Q

Coefficient of Thermal Expansion

A

change in size per temp change
* Higher CTE=more tendency to change

Comopsite> MetOl> Tooth> Ceramic

231
Q

Desirable Mechanical Properties of a dental material

A

High Yield Strength:
* does not permanently deform

High Elastic MOdulus:
* does not flex

Casting Accuracy:
* gold is more accurate than base meetal

CTE close to tooth (11.4)

Biologic Compatability

Corrosino Resistance

Minimal wear of oopposing dentition

232
Q

Provisional Crown Fabrication

A

3 M’s
1. Method:
2. Mold:
3. Material:

233
Q

Provisional Crown Fabrication: Method

A

Direct:
* made in patients mouth

Indirect:
* on a cast
* prefabricated

234
Q

Provisional Crown Fabrication: Mold

A

Prefabricated Crown: Different materials:
* polycarbonate
* aluminum
* Stainless steel

Cellulose acetate crown form
* transparent plastic material

Putty or shim

235
Q

Provisional Crown Fabrication: Material

A

PMMA:
* indirect method
* exothermic

PEMA:
* not common

Bis-Acryl Composite
* Direct method

236
Q

Provisional Cements

A

Contain Eugenol:
* inhibits polymerization of resin

REMOVE as much as possible

237
Q

When making a PFM crown, what must be present for the porcelain to bond to the alloy/metal?

A

Monomolecular oxidative layer

238
Q

PFM Crown: Porcealin Layers

A

IN to Out

Opaque Porcelain:
* masks dark oxide color
* porcelain-metal bond

Body/Dentin Porcelain:
* most of the shade
* builds up most of crown

Insical/Enamel porcelain:
* most translucent layer

239
Q

PFM Crown: Porcelain-Metal Junction

A

Anterior teeth: Lingual
* only metal present
* conserve tooth structure

occlusal contacts >/= 1.5 mm away from porcealin-metal junction

240
Q

PFM Failures

A

Adhesive Failures (B/w different materials)

Cohesive Failures: (B/w samer materials)
* porcelain-porcelain= VOIDS
* oxide-oxide if oxide layer is TOO THICK
* metal-metal never happens

241
Q

All Ceramic Crowns: Types

A

Glass-infiltrated Ceramics

Ceramics w/no glass content

242
Q

All Ceramic Crowns: Glass-infiltrated ceramics

A

etched w/hydrofluoric acid
* treated w/silanecoupling agent
* bonded to tooth

243
Q

All Ceramic Crowns: Ceramics w/No Glass content

A

Zirconia or alumina
* luted to tooth with cement

244
Q

Porcelain Veneer Prep

A

Intra-enamel prep: all in eaneml layer; only facial surface

Gingival 1/3 reduction: 0.3 mm
Facial Reduction: 0.5 mm
Incisal Reduction: 1-2 mm

Incisal edge: Shoulder Butt Joint (90)
Gingival margin: Chamfer

245
Q

Maryland Bridge

A

Aka Resin-bonded bridge
* minimal prep
* PFM or porcelain
* bopnd to adjacent teeth

can experience Debonding

246
Q

Munsell Color System

A
  • Hue
  • Chroma
  • Value
247
Q

Hue

A

Color Family
* red, blue, grreen etc

248
Q

Chroma

A

color saturation or intensity

  • dull graying blue or more vibrant pure blue
249
Q

Value

A

Lightness or darkness
* most important

measured from 0(Black) to 100 (white)
* more towards 100=Light version of color
* More towards 0=Dark version of color

250
Q

Metamerism

A

color appears different under different lighting

251
Q

Fluorescence

A

Object emits visible light when in UV light

252
Q

Opalescence

A

Translucent material
* Reflected light=appears blue
* transmitted light=red/orange

253
Q

How to select proper shade and color for crowns?

A
  1. Chroma=Cervical 1/3 of crown
  2. Value=middle 1/3 of crown (most important)
  3. Hue=incisal 1/3 of crown
254
Q

Characterization of a restoratoin

A

Reproduce natural defects
* can add more color and make darker but not reverse

Types:
* Staining
* Glazing

255
Q

Staining vs Glazing

A

Staining:
* Lose Fluorescence
* Increase Metamerism
* Decreases VALUE=make darker

Glazing:
* surface porcelain fill in defects

256
Q

Crown Delivery Steps

A
  1. Shade (esthetics)=confirm the sahde is what you selected
  2. Proximal Contacts: Open-send back; Heavy-adjust
  3. Margins
  4. Fit
  5. R&R Form
  6. Occlusion
  7. Contour (anatomical)
  8. Cement
257
Q

Luting Agents

A

Aka Cements

6 types:
* Zinc Oxide Eugenol
* Zinc Phosphate
* ZInc Polycarboxylate
* Glass Ionomer
* RMGI
* Resin

258
Q

Luting Agent: Zinc Oxide Eugenol

A

Temp cement
* soothes pulp
* Eugenol=inhibits polymerixation of resin

259
Q

Luting Agent: Zinc Phosphate

A

Gold Standard
* Phosphoric acid=irritates pulp
* exothermic rxn: mix on child glass slab

260
Q

Luting Agent: Zinc Polycarboxylate

A

Calcium Chelation
* minimal pulp irritation

261
Q

Luting Agent: Glass Ionomer

A

Adheres to enamel and dentin
* releases Fl

262
Q

Luting Agent: RMGI

A

most commmon used today
* Higher strength and lower solubility than GI

Do NOT use with all ceramic crowns
* except zirconia

263
Q

Resin Cement

A

Most compressive strength
* bonds to dentin

Light cure, chemical cure or dual cure
* light cure=more color stable than dual cure

264
Q

What are the possible crowns used today?

A

Zirconia (Ceramic but no silica (Glass))

Metal: (PFM or Gold)

Lithium Disilicate (aka emax; glass ceramic)

Feldspathic porcelain (Veeners)

265
Q

What crowns do we use RESIN Cement vs Luting Cement?

A

Resin Cement: chemical bond dentin-bond-resin-silane-silica
* Lithium dilicate (emax)= dual cure resin cement
* Feldspathic porcelain (veneers)=light-cure resin cement

Luting Cement: (GI or RMGI)
* Zirconia (cermica but no silica/glass)
* Metal (PFM or Gold)

266
Q

Ditching a die

A

expose margin of prep

267
Q

Die spacer

A

room for cement

268
Q

Why do long span PFM bridges fail?

A

Fracture
* due to porcelains low ductility

BOARDs (47 decks)

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