Rem Pros Flashcards
give an alternative to making a pt edentulous
over dentures - retaining and restoring roots to support an overlying denture
define resistance and stability
resistance = resistance of a denture to vertical movement away from the tissues
stability = resistance of denture displacement by functional forces (moreso lateral movement)
what is interfacial surface tension?
thin layer of fluid between 2 parallel planes of rigid material
what is interfacial viscous tension?
force holding 2 parallel plates together that is due to viscosity of the liquid in between
how does viscosity of the interposed liquid affect interfacial viscous tension?
as thickness of the liquid increases interfacial viscous tension falls
thinner saliva is better for tension
explain the difference between adhesion and cohesion
adhesion = the physical attraction of unlike molecules for each other i.e. saliva to mucous membranes
cohesion = they physical attraction of similar molecules i.e. salivary film
what does the post dam provide? where is it placed?
adequate seal for the maxillary denture
it is placed behind the hard palate border and in front of the palatine fovea & vibrating line on the soft palate
what ensures optimal adaptation of denture to mucosa?
good surface detail of impressions
what structure does adequate extension of the impression into the lingual pouch ensure you reach?
retromylohyoid fossa
how should teeth be positioned over mandible and maxilla?
over central aspect of mandible
bucally positioned on maxilla
what can be added to denture to ensure good base fit? what do these allow?
valves - they suck out the air from under the denture and act like suction cups
what else can be placed to aid denture retention?
anchors - implants placed into bone
minimum of 2 implants required to retain prosthesis
give 3 consequences of natural teeth opposing an edentulous ridge
trauma
inc resoption - especially anterior maxilla
lack of denture stability
explain combination syndrome - who is it commonly seen in?
commonly seen in pts w/ completely edentulous maxilla and partially edentulous mandible but preserved teeth in anterior mandible
leads to severe anterior maxillary resorption w/ hypertrophic and atrophic changes in diff quadrants of maxilla and mandible
overgrowth of tuberosities
papillary hyperplasia of mucosa of hard palate
extrusion of mandibular anterior teeth - over erupt
loss of alveolar ridge height from below denture
how will a fibrous ridge present?
flabby & blanches/moves w/ pressure
what impression taking technique should be used for fibrous ridges? explain 2 ways this can be done.
mucostatic - can by done via:
1. perforations in impression tray - prevents distorting of flabby ridge during impression taking
- 2 stage impression - 1st putty impression, remove excess putty around fibrous area then use light bodied silicone around fibrous ridge
where should denture finish?
at junction between hard and soft palate
how should borders of impressions be?
well rounded border - not knife edge
how will absent lower posterior teeth affect stability of upper denture?
upper denture will tip backwards
what is meant by a balanced occlusion?
opposing teeth contact evenly on both sides
explain what is meant by reline & rebase? only what kind of dentures are rebased?
reline = adding new material to tissue surface of an existing denture - fills space between original denture controur and altered tissue contour
rebase = replaced entire denture base material of an existing denture - only rebase completes, not partials
list 3 types of reline materials
- temporary - not resilient and only last for short period
- soft - cushioning
- permanent - resilient
where can relines be fabricated? which is better?
chairside or lab - lab tend to be more reilient
temporary relines - also known as? good for? when are they used?
“tissue conditioners”
good for inflamed ridges
can improve denture fit whilst allowing tissues to heal preventing further trauma
used post immediate dentures and after implant surgery
when are soft relines useful?
parafunctional habits
atrophic ridges
cancer/cleft pits
what is likely to happen w/ soft linings? why?
candida infections
plasticiser in soft linings leaches and deteriorates - can harbour mircoorganisms
list 4 materials used for soft linings - what kind is molloblast b?
heat cured acrylic
self-cured acrylics
heat cured silicones (molloblast B)
self-cured silicones
permanent relines - usually what material? useful when/for? (3) prolongs? often created where?
hard acrylic
useful when:
1. issue w/ peripheral seal
2. correcting errors following inadequate master impression
3. immediate or post immediate denture
prolongs lifespan of old dentures
often lab based
when does appearance of denture suggest worn surface? what does this suggest?
if denture fit surface looks glossy/shiny
denture no longer well adapted
give clinical technique for rebase/reline - what impression material & technique is used?
- use acrylic bur to remove undercuts of denture on fitting surface
- use close fitting tray to record new impression
- take wash impression with zinc oxide eugenol light bodied material and using closed mouth technique
- send denture and impression off to lab and request rebase/reline
what will lab then do to denture for reline/rebase?
- overcast denture in plaster - maintains position and OVD of denture
- denture removed from cast and post dam carved
- fitting surface and palate of denture cut away
- denture placed back over cast
all parts put back together using sticky wax - palate added in wax and flasked using injection method
- wax removed and acrylic injected into mould
how would you repair a midline fracture in complete denture?
locate fractured pieces, disinfect and send to lab, no impression required
how would you repair as lost acrylic flange?
impression taken w/ fractured denture in mouth and send to lab
how would you repair debond between acrylic and Co/Cr? what materials can be used to retain Co/Cr to acrylic?
add retentive tags - solder on and use 4-META or silicoat Co/Cr to retain Co/Cr to acrylic
what materials could you use to repair temporary denture? (2) where can this be done?
use self cure acrylic or cyanoacrylate glue
can be done chairside
how would you repair denture smashed into multiple pieces?
unrepairable
list 3 types of denture additions
immediate - when tooth added on day of XLA
post-immediate - tooth added onto denture 2-3 weeks after XLA
retention - clasp added to improve retention
only what kind of dentures can additions be done on?
only on partial - not complete
what kind of impression technique do additions require?
denture in mouth during impression
what denture material is harder to add to?
Co/Cr
what is an overdenture?
any removable prosthesis that covers and rests on one or more natural teeth, roots or implants
what precision attachments are used in overdentures? how can they be replaced?
Zest Anker male and female components (ball and socket)
replaced by cold curing into new denture
when are immediate replacement dentures used/not used?
used for straight forward XLA
not if many XLAs at once - as lots of resorption will occur
give 3 designs for immediate replacement dentures
flanged
part flanged
open face
what does open face design lack? when is it useful?
lacks an upper labial flange
good when bulky upper anterior alveolar ridge - doesn’t add to bulk, avoids fat lip
what is a disadvantage of open face design?
resorption can cause gap between denture and ridge - part flange may be useful here
immediate denture replacement after care - how long must be kept in for? when to review? what should be examined on review? what should pt do after 24hrs?
- must be kept in for 24 hrs
- review appointment day after insertion
- on review remove denture and examine for healthy clots, assess for inflamed areas
- after 24hrs - warm saline mouthwash, remove and clean denture after meals
when is one stage immediate denture used? how is this done?
to replace 1 or 2 anterior teeth in an otherwise intact arch
- upper/lower imps taken
- wax squash bite to confirm occlusion
- choose shade and prescribe to lab including design
- XLA and insertion of denture at next visit
list order steps for construction of immediate replacement denture - what is this order the same as?
- exam
- primary imps
- occlusion
- design
- second imps
- try-in
- XLA & finish
order same for partial denture construction
what disease can occur around implants (instead of periodontitis)?
periimplantitis
what radiograph technique is good for implant planning and placement?
CBCT
give 2 ways implants replacing multiple teeth can be retained
advantages & disadvantages of each?
cement or screw retained
cement - no screw hole, excess cement can cause inflammation/bone loss, may be too retentive
screw - easily replaced, screw hole present
give 3 structures on implants to secure denture firmly
- ball and socket
- gold bar - prevents anti-rotation more so than ball and socket
- CAD CAM titanium bars - stronger than gold bar
what do SDCEP guidelines say about role of GDP in implants/overdentures
- baseline PA to be taken 1 yr after connection
- OH TIPPS important
- probe gently around implant - assess for cement, submucosal plaque, cement
- assess inflamm, BOP, suppuration
- BPE not necessary
what is peri-implant mucositis?
inflammation of the peri-implant mucosa
no evidence of crestal bone loss
tissues red and swollen
may have BOP
what is peri-implantitis
infection and suppuration/inflammation oft soft tissues around implant
significant crestal bone loss around implant after adaptive phase
tissues red and swollen
may have BOP
suppuration
