quiz 1 Flashcards
What are 2 physical factors for retention that the dentist can control?
- optimal extension of the denture base
2. maximmaly intimate contact of the denture base to its basal seat
Define treatment planning
process of matching treatment options with the patients specific needs( needs to be signed by a faculty member)
what are common things to examin during the clinical exam of an edenticulous patient?
Edentulous ridges, undercuts, vestibular attachments, tori, frena attachment, tongue size, salivary flow
What are extra oral and intra oral examinations?
inside the mouth and outside the mouth
What is looked for during an extraoral evalutaion?
Facial contours and symmetries, the appearence of teeth and their relationships with the lips , jaw movement.
what is looked for during an intraoral evaluation?
soft tissue( mucoperiosteum) and bone health.
how is mucosa health diagnosed?
shape, color, and texture
why is saliva important?
thick saliva dislodges dentures and thing doesnt provide enough film for retention.
what are tori and where are they usually?
benign bony enlargments. Midline of hard palate or lingual aspect of madibular premolar area
a complete examination during the first apointment includes what 3 things?
general exam, extraoral exam, intraoral exam.
If your mirror sticks to a patients buccal mucosa during and inraoral exam what might be going on with the patient?
xerostomia or dry mouth
while examining the tonge where should you pay special attention to?
side of tongue and floor of mouth. ( cancers grow here)
name the 4 structures that are sometimes mistaken for lesions
- stensens duct- the duct of the largest saliva glans
- circumvallate papillae- V shape of rounded bumps on tongue
- lingual tonsils- on the back of tongue
- plica fimbriata- folds on underside of tongue
what are some variations in the mouth that are normal
fissured tonug, fordyce granules( extra sebaceous glands), varicosities( enlarged veins under tongue)
leukoplakia
asymptomatic white patch. More common in males . Precursor to cancer
erythroplakia
asymptomatic red velvety patch near floor or retromolar pad area. Precursor to cancer
risk factors for oral cancer
tobacco, alcohol, exposure to sunlight, age, gender, race
Class 1 of edentulous patient
residual bone height of 21mm or more, muscle location favors dentures, class 1 maxillomandibular relationship
Class 2 of edentulous patient
residual bone height of 16-20mm, muscle attachments have limited influence on denture base stability, Class 1 maxillomandibular relationship
Class 3 of edentulous patient
residual bone height is 11-15mm, muscle have moderate influence on denture stability, class 1,2,or3 maxillomandibular relationship, surgery is required
Class 4 of edentulous patient
residual bone height of 10mm or less, muscle influence retention, class 1,2,or 3 maxillomandibular relationships, surgery, history of dyesthesia or parasthesia
if a patient wants only a new mandibular denture do you do it?
you advise them that it is best to get a maxillary as well
what are the four general diagnostic criteria for dentures?
mandibular bone height, maxillomandibular ridge relationship, residual ridge morphology, muscle attachments
buccal shelf
bordered by the external oblique ridge near the posterior teeth area. It is the primary area of support when the alveolar ridge is flat. Denture border should extend 1-2 mm beyond the oblique ridge
mylohyoid ridge area
oblique ridge on lingual side of mandible. Provides attachment for mylohyoid muscle. Denture should go 4-6 mm beyond the ridge
retromolar pad area
fibrous connective tissue. Temporalis, buccinator, and masseter attach here and stimulate late it which keeps it from resorbing. This is a landmark for the occlusal plane. Denture reaches 2/3 retromolar pad
retromylohyoid fossa
a space distal to mylohyoid muslce. Forms the distolingual border of the denture base ( S-shape).
sublingual gland area
above the mylohyoid muscle. Serves as border of the denture base in sublingual region.
Labial flange area
bordered by orbicularis ors and metalis muscles. Denture border must not impinge on these muslces nor the inferior labial frenulum
incisive papilla
covers naso-palatine foramen. It has sensory nerves and vessels. Denture should not impinge on this
Rugae
vestigal masticaroty organs of fibrous connective tissue. Anterior 1/3 of palate
buccal space
extends posteriorly from the buccal frenum. Denture border must not overextend the height nor the width here. It will pop out if it does
hamular notch
between maxillary tuberosity and the hamulus of the medial pterygoid plate. Forms lateral posterior border of denture
vibrating line
from one hamular notch to the other. This is the junction of the hard and soft palate
whats an undercut?
bone growths that dont allow the denture to fit correctly
why does impression material need to be fluidy when put in the mouth?
so it flows around the anatomy to get a good impression
3 key properties for impression materials
accuracy, dimensional stability, tear resistance
taking an impression of a patient
rinse and dry the mouth( not to dry), explain to the patient always!!!
do you want to overextend a impression?
yes, to make sure you get everything
what is a reversible hydrocolloid?
heat reverses its form
Alginate
irreversable hydrocolloid, extracted from brown seaweed, hydrophilic so moist surfaces arnt a problem, fill tray with 3mm of paste and dissinfect with iodophor, bleach or a glutaraldehyde.
how to disinfect an alginate impression
wrap it in a soaked paper towell in a sealed plasatic bag for 10 min.
how long should the stone cast and impression stay inact?
minimum of 30-60 min.
2 things that affect the shelf life of alginate impression materials
storage temperature andmoisture contamination of ambient air
whats a diagnostic cast?
the first step of preposthetic surgery. This is studied to determine the amount of surgery needed if needed at all.
Making the diagnostic cast
pour within 15 mins of making the impression. Dental plaster is usually used because its cheap
why are casts poured in 3 pours?
1st- liquidy to get in all the grooes
2nd- a little thicker
3rd- is for the base
whats the first part of the process of making a custom tray
make an impression, then make a stone cast. Use resin dough ( triad) around the cast and cut is short 2mm above the vestibule, give the frenum 1 mm of clearence
why must someone block out the undercuts?
to make sure the custom trays dont get stuck. Make sure you dont over block out eiter
what does the air barrier do?
hardens the tray.
after the tray is hard whats next?
trim the borders so theyre smooth. Then you border mold
whats the purpose of the border mold?
it helps create a suction
which custom tray do you drill a hole in?
maxillary, this allows pollysulfide to flow out
before putting the polysulfide filled tray on the cast, what must you put on the cast?
2 coats of Al- Cote, this allows it to come off easier.
tightly attached mucosa
covers the crest of the residual ridge and the anterior 2/3 of the palate, When compressed it rebounds and dislodges the denture,
loosely attached submucosa
covers the soft palate and lines the vestibules, pressure is not passed to the supporting bone, forms the denture border seal
differentiated mucosa
posterior 1/3 of the hard palate and retromolar pad, pressure is directed on the boney support
what does the different colors( white, gray, gree, red, black) mean in impression compounds?
white has the lowest melting temperature and black has the highest.
what is tissue rest?
before putting dentures in you need to let the tissue recover for at least 24 hours.
tissue manipulation for maxilla impression
patient moves mandible side to side for maxillary impression ( this involves slight manipulation of lips and cheeks)
tissue manipulation for mandible impression
hold tray in position while patient puckers lips and lifts and moves tongue around
whats the purpose for boxing?
to make a base and preserve vestibular contours of the final impression
How do you make a final impression?
1:1 ratio of pumice and plaster. Mix the powders together first then add water ( at lecom we just use plaster)
what must you put on before the red boxing wax?
sticky wax
how thick should the base of the cast be?
9-15mm, if its thinner it can break easier, if thicker it doesnt fit in the processing flask
the finished microstone cast should have what lenght in the landing area and vestibular depth?
landing area -9mm
vstibular depth- 2mm
whats a record base?
temporary device representing the base of the denture and used for making jaw relation records. ( not part of final denture)
whats the neurtral zone?
where there is no forces applied to the denture
what are occlusal rims used for?
determine the neutral zone, establish level of occlusal plane, make maxillomandibular relation records
when using the triad for a record base do you cut 2mm short of vestibule?
no, go to the depth of the vestibule( remember to block out undercuts)
whats used to make the wax occlusion rims?
dental wax/ base plate wax, ( pink stuff)
what is baseplate wax made of?
75% paraffin or ceresin, beeswax, other waxes
Important factors to consider making occlusison rims
use sticky wax to attach the base plate wax, fold base plate wax many times, anterior segment of maxillary is slightly flared labially
whats the distance of the incissive papilla and labial surface of central insicor of baseplate model?
5-8mm
when fully occluded the 2 basplates measure what?
40mm ( 22 for maxillary, 18 for mandibular)
occlussal rim thickness by the incisors, premolars, molars should be what
incisors-3-5mm
premolars- 5-7 mm
molars- 8-10 mm
where is the frontal axis?
right through the middle of your face between the central incisors
where is the sagittal axis?
passes the TMJ and extends. both ways.
What are the 2 basic types of movement in the jaw?
rotation and translation. Rotation happens before the translation
know what is happening during each border movement
Centric relation, maximum intercuspation, edge-to-edge incisal, maximum protrusion, maximum opening
terminal hinge axis position
where the mandible stops before it starts translation.
maximum protrusion position
most anterior position
edge to edge contact
where incisors from both arches are edge to edge
what is mandibular opening?
line going from maximum protrustion to maximum opening
what does the articulator do?
reproduces the movement of te jaws, Maintains the relationship of the maxilla and mandible to the condys
what 3 types of records are used to transfer maxillomandibular relationships in a edenticulous patient?
- interocclusal relationhsips
- graphic records
- hinge-axis records
what measurements are used to get interocclusal relationships?
condylar guidance( condyle to eminence) bennett shift( medial to lateral)
describe the bennet shift
Lateral shift of the mandible
graphic records
recording movements between the static interocclusal records. This isnt possible in the edentulous patient because the recording devices are not firmly fixed to the riedges and may move
what are hinge- axis records?
the arc of the jaw as it opens and closes( facebow)
overjet and overbite relationships determine what?
phonetics and esthetics
what is vertical dimension
the distance between the mandible and maxilla when the dental arches are in maximal intercuspation
what is centric occlusion?
maximal intercuspation of teeth. Specifically the relationship of the maxilla and mandible while teeth are in maximal contact
what is centric relation?
is the position of the mandible while in its most superioanterior position. This is where the condyles articulate with the thinnest avascular portio of their respective disks. ( this position is independent of tooth contact)
is malocclusion strictly dental?
no it can be skeletal as well
who was the father of malocclusion?
edwar hartley angle
malocclusion type 1
the relationship of the first molars is normal and the upper and lower jaws are in a normal relationship
to each other, but the other teeth are crowded, irregularly spaced, or overlapped.
malocclusion type 2
the lower molars fit the upper molars, but are not in correct position. The bottom jaw grows into a more backward position than normal.
malocclusion type 3
occurs when the lower molars are too far forward and don’t fit into the upper molars.( usually most complicate and difficult to correct
