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random ICC Flashcards

1
Q

what is Hanau’s quint?

A
  • 5 factors important in the development of a balanced occlusion/articulation
    1 condylar guidance angle
    2 incisal guidance angle
    3 orientation of occlusal plane
    4 cuspal inclination
    5 depth of compensating curve
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2
Q

average condylar guidance angle

A

25-30º

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3
Q

what is Christensen’s phenomenon?

A

if incisal guidance angle is 0º with a flat occlusal plane with cuspless teeth, the posterior teeth will disclude due to the 30º condylar guidance angle

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4
Q

what is the incisal guidance angle usually set to and why?

A
  • 0º
  • if it matched condylar guidance with cuspless teeth = better aesthetics but extreme and tongue would not be able to stabilise the denture as occlusal plane would be 30º
  • cuspal inclination used to compensate for incisal guidance angle
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5
Q

what should the occlusal plane be parallel to (complete dentures)?

A
  • ala-tragal/Camper’s plane posteriorly
  • interpupillary line anteriorly
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6
Q

what is the cusp angle?

A

angle between the slope of the cusp and the horizontal

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7
Q

what is the effective cusp angle?

A

sum of cusp angle and angle of tilt of tooth

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8
Q

why may you use a shallower cusp angle?

A

for older pts who those who bite together in many different ways (unreproducible) = less likely to destabilise denture

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9
Q

what is a compensating curse and what is it for?

A
  • curve of Spee, curve of Wilson
  • changes the effective cusp angle without adjusting the form of the denture tooth
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10
Q

define balanced occlusion and balanced articulation

A
  • balanced occlusion = simultaneous contacts of upper and lower teeth on both sides and anterior and posterior aspects, static, preventing tipping or rotating or sliding of denture base in relation to supporting tissues
  • balanced articulation = bilateral simultaneous contact of anterior and posterior teeth in excursive movements, dynamic
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11
Q

when is balanced occlusion/articulation desirable and when can it not be achieved?

A
  • desired with complete dentures (C/C)
  • cannot be achieved with natural teeth present - occlusal interferences
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12
Q

give a simple classification of articulators and when they would be used

A

1 non-adjustable: single unit restorations (conformative)
- hinge (class I)
- average value (class II) - also simple denture cases

2 semi-adjustable (class III): more extensive restorations (conformative or reorganised)
- ARCON (condyle part on lower arm)
- non-ARCON

3 fully adjustable (class IV): specialist, not often used due to skills and cost and time

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13
Q

what is an articulator?

A
  • mechanical instrument that represents the TMJ and jaws
  • to which maxillary and mandibular casts can be attached to simulate some or all mandibular excursions
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14
Q

what are the values of an average value articulator based on?

A

Bonwill’s triangle (equilateral triangle between condyles and lower incisors ~10cm)

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15
Q

difference between semi-adjustable ARCON and non-ARCON articulators

A

ARCON = condyle part on lower arm = more anatomically correct to humans

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16
Q

possible presenting complaints if there is an occlusal error in complete denture (8)

A
  • instability, movement on function, tipping, difficulty chewing/speaking
  • TMJ pain
  • lack of retention (eg when swallowing)
  • OVD too short = angular cheilitis with some medical conditions
  • OVD too high = speech issues
  • tongue/cheek/soft tissue trauma
  • alveolar ridge pain on one side (uneven force)
  • sliding of denture = pain on denture bearing area
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17
Q

what is a facebow?

A

instrument used to record the spatial relationship of the maxillary arch to some anatomical reference point(s) and allow this to be transferred to an articulator

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18
Q

how may single standing teeth +/or over-erupted teeth affect retention and stability of a denture? (3)

A
  • posterior = may be clasped
  • roots = overdenture abutment but prevents formation of complete border seal (decreased retention)
  • over-erupted = increased OVD, instability if denture teeth not at the same level, cannot get balanced articulation
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19
Q

why do we set ICP to coincide with the retruded jaw position (centric relation) with complete dentures?

A

condyle-dependent so reproducible

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20
Q

what factors affect the rest position of the mandible? (4)

A
  • posture (ideally upright, head unsupported)
  • presence of lower denture (prevents relaxation)
  • neuromuscular disorders (Parkinson’s, stroke, loss of proprioception) and medication (tranquilisers)
  • stress
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21
Q

7 features indicating involvement of lower 8 with IDC

A
  • close proximity of lower third molar with IDC
  • loss of cortication of the inferior dental canal (IDC)
  • darkening of third molar roots or ‘banding’
  • deviation of the IDC away from tooth roots
  • localised narrowing of the IDC
  • dilaceration of roots (excess curvature)
  • narrowing of the third molar roots (apical area)
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22
Q

indications for lower third molar extraction (7)

A
  • recurrent episodes of pericoronitis
  • unrestorable caries, or caries extending into the pulp
  • untreatable PA pathology
  • horizontal or mesioangular lower third molar causing disto-cervical caries in the lower second molar (to facilitate restorative treatment of 7)
  • third molars with odontogenic cysts or tumors
  • third molars impeding surgery (eg orthognathic or tumour removal)
  • in the line of a mandibular fracture
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23
Q

copy denture techniques (3)

A
  • reline copy denture (direct)
  • early wash/Dundee (indirect)
  • late wash (indirect)
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24
Q

pros and cons of copying complete dentures (3/3)

A

+:
- quicker, simplified occlusal registration techniques
- more acceptable for pt
- reproduces successful features
-:
- easy to increase OVD by accident
- changes to base/arch shape or appearance (eg diastemas, crossbites)
- mould production errors

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25
Q

describe the reline copy denture technique (indications, pros/cons, steps)

A
  • direct technique for small changes (eg fit surface adaptation), spare dentures
    • = easy, technician can directly compare to existing denture
    • = pt without denture, skilled technician needed

1 wash impression, jaw reg (tech sets teeth)
2 wax try in (processed)
3 fit
4 review

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26
Q

describe the early wash copy denture technique (pros/cons, steps)

A
  • most common method, uses wax replica (indirect)
    • = more base stability, easier to maintain OVD, pt keeps dentures, can use with open faced dentures
    • = risk of damaging cast with tightly fitting pour-cure acrylic and ridge form IV

1 2-part mould made from denture (wax/acrylic replica made)
2 adjust clinically, wash impression, jaw reg
3 wax try in
4 fit
5 review

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27
Q

describe the late wash copy denture technique (pros/cons, steps)

A
    • = pt keeps denture, fewer steps
    • = base is not completely stable (jaw relationship errors, movement/centreline shift on impression), not suitable for open faced

1 2-part mould, jaw reg (wax/acrylic replica made)
2 wax try in with careful wash impression/positioning
3 fit
4 review

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28
Q

ideal type of denture for lower edentulous arch (McGill consensus)

A

implant retained overdenture (two implants in canine region)

29
Q

5 principles of crown preparation

A
  • preservation of tooth structure
  • retention and resistance form
  • structural durability
  • marginal integrity
  • maintenance of periodontal health
30
Q

ideal retention and resistance form for crown preps (3)

A
  • TOC 6-10º
  • height (3 or 4mm)
  • height:width at least 0.4
31
Q

pros and cons of addition-cured silicones as impression materials for edentulous pt (4/4)

A

+:
- dimensionally stable
- good surface detail
- various viscosities available
- elastic
-:
- hydrophobic (air blows)
- cannot be adjusted after set
- more expensive
- longer set

32
Q

pros and cons ZOE as impression material for edentulous pt (5/4)

A

+:
- good surface detail, low viscosity
- quick setting (accelerated by heat/humidity)
- cheap, stable, good shelf life
- can be adjusted after taking
- good for gagging (thin layer)
-:
- flakes easily so not for undercut areas
- poor taste
- may cause burning/irritation esp if xerostomic, can be allergic to clove oil
- messy

33
Q

describe mucostatic vs mucocompressive impression

A
  • mucostatic = soft tissues not displaced by impression material (gain support from firm areas of arch, better retention)
  • mucocompressive = displacement of soft tissues by impression material (better support)
34
Q

three factors affecting displacement of tissues during impression taking

A
  • viscosity of material
  • pressure on seating
  • spacing of tray
35
Q

what features in the design of a denture may cause trauma to the denture bearing area? (6)

A
  • overextension into sulci or deep undercuts
  • not relieving tori or fraenal attachments
  • damage or processing issues on fit surface (pearls, roughness)
  • deep post dam
  • occlusal faults
  • poor fit
36
Q

what conditions affecting the denture bearing areas may need treating before provision of (new) dentures? (6)

A
  • denture-related stomatitis
  • denture-induced hyperplasia
  • enlarged tuberosities
  • flabby ridge
  • tori
  • sharp residual ridges or sharp mylohyoid ridge
37
Q

how do the upper and lower alveolar ridges resorb once teeth are removed? how should the denture teeth be placed relative to the ridge?

A
  • upper = 2.5-3mm height, resorbs buccal TO palatal (smaller arch)
    – teeth buccal to ridge
  • lower = 9-10mm if severe, FASTER, resorbs lingual TO buccal (wider arch)
    – anteriors placed more labial, posteriors over ridge or lingual
38
Q

extraoral biometric guides for placement of denture teeth (5)

A
  • upper occlusal plane parallel with interpupillary line
  • posterior occlusal table parallel to Camper’s line (ala-tragus)
  • midline of teeth = midline of face
  • tips of canines = alae of nose
  • nose width = 4x centrals’ width
39
Q

intraoral biometric guides for placement of maxillary denture teeth (3)

A
  • incisive papilla - labial of centrals should be 8-10mm anterior, canine tips should be in line with back
  • palatal cusps over centre of posterior mandibular ridge
  • teeth placed buccal to residual ridge
40
Q

intraoral biometric guides for placement of mandibular denture teeth (3)

A
  • occlusal level = lower edge of RMP, at or below maximum convexity of tongue
  • centre of alveolar ridge = central fossae
  • anterior teeth placed labial to ridge, no further anterior than relaxed labial sulcus
41
Q

how is retention obtained for complete dentures? (6)

A
  • soft tissue undercuts with displaceable mucosa
  • cohesion-adhesion of saliva (surface tension, negative pressure)
  • close base adaptation
  • overdenture precision attachments
  • peripheral seal
  • oral musculature and tonue
42
Q

define support, retention and stability for complete dentures

A
  • support = resistance of the denture (to horizontal or rotational forces) towards the tissues along the POI
  • retention = resistance of the denture away from the tissues along the POI
  • stability = resistance of the denture to horizontal and rotational forces created during function
43
Q

landmarks on an upper edentulous impression and their significance (10)

A
  • labial and buccal frenums (for relief)
  • labial and buccal sulci (periphery)
  • alveolar ridge (tooth placement, posterior ridge for primary support)
  • incisive papilla (tooth placement)
  • rugae (secondary support)
  • midpalatine raphe if cleft palate or tori
  • vault of hard palate (primary support)
  • vibrating line (part of soft palate that has limited movement during function and movable part)
  • fovea palatinae (indicates junction between hard and soft palate, should not be encroached upon)
  • maxillary tuberosities and hamular notches (posterior border)
44
Q

landmarks on an lower edentulous impression and their significance (12)

A
  • labial, lingual and buccal frenums (for relief)
  • labial, lingual and buccal sulci (periphery)
  • raised FOM (prevents displacement during function)
  • alveolar ridge (tooth placement, posterior for primary support)
  • buccal shelf (support)
  • external oblique ridge (do not encroach)
  • retromylohyoid fossa (stability, divergent flanges), AKA lingual pouch
  • mylohyoid ridge
  • retromolar pad and pear shaped pad (occlusal level, support)
  • pterygomandibular raphe (do not encroach)
  • tori (lingual premolar region)
  • genial tubercles (genioglossus)
45
Q

where should the posterior border of the complete upper denture lie? (2)

A
  • anterior to fovea palatini (prevent obstruction of fluid secretion)
  • extend into hamular notches (retention)
46
Q

how to manage dentures with palatal tori?

A
  • relieve tori
  • change major connector design
  • surgical removal
47
Q

what is the point of the post dam on an upper complete denture?

A
  • allows formation of posterior palatal seal
  • aids retention
  • prevents food trapping in posterior region (gagging, retention issues)
48
Q

define overdenture

A

removable dental prosthesis covering and resting on one or more remaining natural teeth/roots +/or implants

49
Q

why preserve roots of teeth in overdentures? (5)

A
  • preserve bone height for stability
  • improve support for denture
  • improve retention with attachments or tissue undercuts
  • tactile/proprioceptive feedback
  • psychological benefit
50
Q

disadvantages of preserving tooth roots for overdentures (6)

A
  • lower canines = lose stabilising feature
  • upper canine eminences too deep to engage with flange
  • RCT of abutment (time, cost)
  • teeth provide better stability than roots usually (unless precision attachments)
  • increased risk of denture base fracture (thinner acrylic)
  • maintenance (increased perio and caries risk)
51
Q

factors affecting suitability of a tooth to be used as overdenture abutment (5)

A
  • perio = at least 50% of root within bone, pocketing ≤2mm, no inflammation
  • number and location in arch - ideally bilateral, symmetrical, canines best
  • integrity of tooth structure
  • suitability for RCT if needed
  • depth of bony undercut (shallow ideally)
52
Q

maintenance following overdenture creation (4)

A
  • reinforce OHI, denture hygiene
  • regular topical fluoride (TP, FV)
  • temporary or permanent relining (alveolar resorption)
  • replacement of precision attachments as needed
53
Q

complications of implant-retained lower overdenture (8)

A
  • denture fracture
  • implant fracture
  • wear/corrosion of retention elements
  • fracture of retention elements
  • abutment fracture
  • abutment screw loosening or fracture
  • attachment screw loosening or fracture
  • gingival hyperplasia
54
Q

define immediate denture

A

denture inserted immediately after removal of natural teeth

55
Q

why bother making immediate dentures? (3)

A
  • aesthetic - lip and tissue support, face height maintenance
  • prevent excessive speech and mastication changes
  • protective splint - aids haemostasis and protects sensitive extraction sites from irritation during healing
56
Q

disadvantages of immediate dentures (5)

A
  • often cannot have try in stage
  • short term solution
  • significant maintenance required after insertion, eg reline, denture hygiene
  • usually less than optimum retention
  • increased cost of treatment as two sets of dentures required
57
Q

what are the features that may be seen when anterior mandibular natural teeth oppose an upper edentulous arch? (5)

A
  • fibrous change of upper anterior ridge (flabby ridge)
  • overgrowth of tuberosities
  • papillary hyperplasia of hard palate
  • extrusion of mandibular anterior teeth
  • loss of alveolar bone beneath a lower RPD
    (combination syndrome is NOT a real syndrome)
58
Q

components of an implant (3)

A
  • fixture
  • abutment
  • restoration
59
Q

describe the shortened dental arch concept (what, why)

A
  • minimum of 20 teeth, premolar to premolar in both arches
  • gives enough teeth to satisfy appearance and function needs of some pts
  • free-end saddle dentures poorly tolerated, easier to maintain OH on anterior teeth
60
Q

define relining (denture)

A

addition of material to the fitting surface of a denture base

61
Q

indications and contraindications of denture reline (4/5)

A
  • indications:
    – loss of retention, instability
    – food trapping
    – abused mucosa
    – maintain function of temporary denture
  • Contraindications:
    – worn out dentures
    – loss of VD >7mm
    – significant mucosal inflammation
    – poor aesthetics
    – functional issues
62
Q

define rebasing (denture)

A

partial or complete removal and replacement of denture base

63
Q

indications and contraindications of denture rebase (6/4)

A
  • indications:
    – warped bases
    – base constantly fracturing along a line of weakness
    – immediate denture after 3-6 months
    – diabetic pt complaining of continuous poor retention and stability due to bone resorption
    – cannot bear construction of new dentures
    – economic considerations
  • contraindications:
    – severely resorbed ridge (just make new denture)
    – aesthetically unacceptable denture
    – flabby ridge
    – functional issues
64
Q

stages of a treatment plan generally (5)

A

1 acute
2 stabilisation, prevention
3 reassessment
4 restorative/rehabilitation
5 maintenance

65
Q

template for periodontitis diagnosis

A
  • generalised/localised
  • periodontitis
  • stage
  • grade
  • currently stable/unstable/in remission
  • risk factors
66
Q

difference between generalised and localised periodontitis

A

generalised = ≥30% of teeth involved
(localised = <30%)

67
Q

staging of periodontitis

A
  • stage 1 = 0-15% bone loss or <2mm attachment loss from CEJ
  • stage 2 = 15-33% (coronal third)
  • stage 3 = 33-66% (mid third)
  • stage 4 = >66% (apical third)
68
Q

grading of periodontitis

A
  • % bone loss divided by age
  • grade A = <0.5
  • grade B = 0.5-1
  • grade C = >1
69
Q

difference between currently stable/unstable/in remission periodontitis

A
  • stable = <10% BoP, PPD ≤4mm with no BoP at 4mm sites
  • in remission = ≥10% BoP (PPD ≤4mm with no BoP at 4mm sites)
  • unstable = PPD ≥5mm or ≥4mm with BoP

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