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Removable Prosthodontics > Reinforcing Occlusal Rim Stage and Selecting Teeth for Complete Dentures > Flashcards

Reinforcing Occlusal Rim Stage and Selecting Teeth for Complete Dentures Flashcards

1
Q

What are acrylic base plates made from?

A

Heat cure acrylic resin with wax rim on top

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2
Q

What are acrylic base plates more rigid than?

A

Wax on a wax base

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3
Q

When is it more comfortable and less likely for occlusal rims to be displaced?

A

When base plates are carved to final shape of denture base

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4
Q

What enables jaw relation registration to be measured more easily?

A

When base plates are carved to final shape of denture base

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5
Q

What creates a raised area on denture base which creates a posterior seal/post dam?

A

Either a groove is cut into palate of master cast/area is compressed during impression taking?

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6
Q

What does depth of occlusal rim depend on?

A

Compressibility and is therefore a clinical decision

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7
Q

What is mucosa in midline?

A

Less compressible

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8
Q

When is retention for complete dentures with acrylic bases checked and corrected?

A

At jaw relation stage

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9
Q

What is it worth bearing in mind that problems with retention may be due to?

A

Denture bases

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10
Q

What does under-extension require?

A

New impression

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11
Q

What does inadequate width of flange require?

A

New impression

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12
Q

What does ineffective seal at posterior border require?

A

Adjust/new impression

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13
Q

What does poor fir of denture base require?

A

Adjust/new impression

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14
Q

What does over extension require?

A

Often seen if denture does not seat; adjustment

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15
Q

What is vertical dimension checked by?

A

A Willis bite gauge/calipers, with dots on nose and chin/by assessing closest speaking space of 1mm

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16
Q

What are the steps in checking vertical dimension?

A

Measure RVD first without blocks in place, ensure patient fully relaxed, repeat measures

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17
Q

What will give a better guide of vertical dimension?

A

Use of more than one method

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18
Q

What is checked with upper occlusal wax rim?

A

Lip and cheek support and neutral zone

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19
Q

How is labial contour of upper wax rim first restored?

A

By modifying maxillary wax block to a 90 degree angle between philtrum and columella/102-116 degrees

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20
Q

What are buccal corridors shaped to support?

A

Cheeks

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21
Q

What is rim slightly buccal to?

A

Ridge normally, as a result of resorption

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22
Q

Where is anterior occlusal plane registered for upper occlusal rim?

A

Usually 2-3mm below relaxed level of upper lip parallel to intra-pupillary line

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23
Q

What is checked with upper occlusal wax rim?

A

Lip and cheek support and neutral zone

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24
Q

How is upper block trimmed posteriorly?

A

By continuing anterior occlusal plane level posteriorly in a line paralell to ala-tragus line

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25
Q

What is a Foxes occlusal plane indicator/disposable wooden spatula used for?

A

To establish orientation and level of occlusal plane and produce correct shape for labial, buccal and palatal surfaces

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26
Q

What guides position of upper incisors using biometric guidelines?

A

Shape labial surface of upper rim

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27
Q

What is checked for lower rim?

A

Buccal labial and lingual surfaces and neutral zone

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28
Q

Why check space for lips, cheeks and tongue?

A

To ensure rim in neutral zone

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29
Q

What is orientation of occlusion governed by?

A

Upper rim

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30
Q

What is lower block trimmed until?

A

Rims contact evenly and at correct OVD

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31
Q

When may upper rim need further adjustment?

A

If lower rim will be too high (instability)/too low (no space for teeth)

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32
Q

What other checks to carry out once rims adjusted?

A

Check RVD again with rims in place, check facial proportions, get patient to talk..do rims hit, previous dentures can be helpful to establish OVD too

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33
Q

What is jaw relation registration?

A

Even occlusal contact between rims at chosen OVD whilst mandible is in CR

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34
Q

How is jaw relation registration checked?

A

Patient is relaxed and lower jaw is gently manipulated into CR

35
Q

What is final registration taken using?

A

A bite registration paste/alternative

36
Q

What other methods of registration of wax rims in occlusion?

A

Contact and softened wax/contact and fluid material

37
Q

How are wax rims in occlusion registered with contact and fluid material?

A

Ensure wax blocks are at correct VDO and then record JRR with fluid material without heating up wax again

38
Q

What may contact and softened wax loose?

A

Vertical height

39
Q

Where is midline marked on block?

A

Usually in centre of philtrum but varies in caries of facial asymmetry

40
Q

How are wax rims in occlusion registered with contact and fluid material?

A

Ensure wax blocks are at correct VDO and then record JRR with fluid material without heating up wax again

41
Q

How is use of a facebow to record relationship of upper cast to skull useful in complex cases?

A

So that a cast may be set up on a semi-adjustable articulator and an accurate balanced articulation achieved

42
Q

What may be useful as an alternative to wax occlusal rim?

A

A gothic arch tracing to measure position of CR and mandibular movement

43
Q

What are the next steps?

A

Casts (registered with/without blocks) should be stable, they are disinfected and sent to technician with information about shades and moulds for setting up a trial of teeth, and teeth are selected for dentures

44
Q

What is equation to calculate central incisor width?

A

Photographic width of incisor x actual PD/photographic PD

45
Q

What is PD?

A

Interpupillary distance

46
Q

What is height of tooth dependent on?

A

Height of smile

47
Q

What should extension of denture base correspond to?

A

Depth and width of extension of sulci (in upper to post dam and in lower to pear shape pads)

48
Q

What will extension of denture base do?

A

Distribute force and allow adjacent musculature to aid stability and retention

49
Q

What is extension if we have acrylic baseplates?

A

These were adjusted at previous stage to ensure a comfortable fit and good jaw relation

50
Q

What is extension if we have wax-based rims?

A

Wax may have been added in lab and we therefore may need to adjust this again to ensure bases are fitting comfortably first

51
Q

How check tooth positioning of lower teeth?

A

Posteriorly should generally be positioned around crest of mandibular ridge

52
Q

When is lower teeth position and whether they are in neutral zone more easily judged?

A

At clinical try in stage by dentist

53
Q

How check tooth positioning of upper teeth?

A

Should follow biometric principles using wax occlusal rim at jaw relation registration stage, consider skeletal base

54
Q

What are teeth generally set in?

A

Neutral zone, balanced between tongue and cheek to aid denture stability

55
Q

What is neutral zone very important for?

A

Lower denture where less surface area of denture bases

56
Q

When was neutral zone defined?

A

At occlusal rim tage

57
Q

What is there is space between buccal surfaces of posterior teeth and cheek mucosa?

A

There may be inadequate tongue space

58
Q

What can be challenging anteriorly?

A

Mentalis muscle

59
Q

What should occlusion be with complete dentures/partials with no natural teeth in occlusion?

A

Should be balancing contacts in dynamic occlusion to help keep dentures stable

60
Q

What should occlusion be in partial dentures where we are conforming?

A

Check to ensure that occlusion of natural teeth with and without dentures in place is same

61
Q

What if error not obvious with occlusion?

A

Stabilises both bases left finger and thumb hold upper up and lower dentures in place, while right thumb and finger gently guide on chin

62
Q

What should first contact not be on?

A

One/a few teeth but there should be widespread contacts around arch

63
Q

What if teeth close from ‘first touch’ to ‘all way’?

A

If it is more than a couple of mm movement, then redo jaw relationship

64
Q

How look at occlusion when patient grinds teeth?

A

This can be assessed more easily on articulator, but ask patient to gently grind their dentures

65
Q

What bear in mind when look at occlusion when patient grinds teeth?

A

Some of teeth may pop out of wax

66
Q

How is occlusal height re-checked?

A

Reassess RVD, OVD and FWS

67
Q

How are RVD, OVD and FWS reassessed?

A

Observe facial appearance, observe movement of lips, cheeks and tongue and movement of dentures, and phonetics

68
Q

What if OVD is too small?

A

Can add wax to teeth and may be able to retake JRR at this appointment

69
Q

What if OVD is too large?

A

Need to remove teeth

70
Q

What does correcting OVD depend on?

A

Aesthetics, amount of FWS needed, and ffect of increased OVD on tongue position (for lower teeth)

71
Q

What if OVD is too small due to an asymmetrical vertical error?

A

More wax can be added to one side of arch and jaw relation re-recorded in CR to ensure balanced occlusion, then jaw relation registration is retaken in CR

72
Q

What is useful to assess yourself in clinician and patient assessment?

A

Shape, mould, size of teeth, level of occlusal plane, orientation of occlusal plane, centre line, and lip support

73
Q

What use floss to confirm?

A

Dental midline in alignment with facial contours

74
Q

What is proportion between upper/lower and anterior/posterior teeth?

A

Upper front teeth are ‘subject’, and gingiva, inter-arch space, and lower teeth are ‘background’

75
Q

What is an occlusal plane issue?

A

Negative smile line not in harmony with soft tissues

76
Q

How is negative smile line not in harmony with soft tissues corrected?

A

Identify facial landmarks and lines to which smile will blend

77
Q

What will make dentition appear more natural?

A

Having some irregularity and crowding

78
Q

What should irregularity be balanced across?

A

Arch

79
Q

What can create a realistic appearance relative to age?

A

Selective grinding to create incisal wear and darker teeth

80
Q

What should be considered for denture characterisation?

A

Small spaces, a gold inlay, a clasp, silver amalgam restorations, gold inlay, irregular teeth arrangement, and chipped teeth

81
Q

What are errors at try in stage?

A

Appearance incorrect and occlusal error e.g., premature contacts and/or teeth are not occluding same on model as in mouth

82
Q

What may small changes be corrected by?

A

Adjusting/moving teeth at chairside/on articulated casts

83
Q

What should larger changes be?

A

Remounted in laboratory; new tooth position and repeat try in, in wax/repeat occlusal rim, jaw relation stage with/without anterior teeth in situ

Removable Prosthodontics (2 decks)

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