Rem Pros 4 Flashcards
What are the evaluation criteria of Yellowstone study casts of alginate impressions?
- Yellowstone mix is homogenous and smooth - think streakless mix with minimal airbubles
- Yellowstone has set adequately before removal of impression - think smooth surface with no drag lines
- Adequate amount of yellowstone - think good anatomy, no airbubles, good thickness
- Articulation of models - no soft tissue or air bubble interference
What are some of the common reasons for tooth loss?
- Decay and periodontal disease
- Trauma
- Pathological causes
- Radiotherapy
- Impacted or congenital missing teeth
What are the options for replacement of loss teeth?
- Removable denture
- Implant
- Fixed pros
- No treatment
What are the contraindications for a partial denture?
- Lack of suitable abutment teeth
- Rampant caries
- Perio disease
- Poor oral hygiene
- Patient can not tolerate them
- Post readiotion tratment - osteoradionecrosis
What are the aims of rem pros?
- Restore dentition to a satisfactory condition
- Comfort
- Aesthetics
- Function
- Speech
- Preservation of remaining soft and hard tissues
What is OVD?
Occlusal vertical dimension.
The distance between two selected anatomic or marked points (usually one on the tip of the nose and the other on the chin) when in maximal intercuspal position; syn, VERTICAL DIMENSION OF OCCLUSION
What is MIP?
Maximal intercuspal position.
The complete intercuspation of the opposing teeth independent of condylar position, sometimes referred to as the best fit of the teeth regardless of the condylar position; comp, CENTRIC OCCLUSION
What is RVD?
Rest vertical dimension.
The postural position of the mandible when an individual is resting comfortably in an upright position and the associated muscles are in a state of minimal contractual activity syn, PHYSIOLOGIC REST POSITION, VERTICAL DIMENSION OF REST.
What is free way space?
freeway space obs, slang: syn, INTEROCCLUSAL REST DISTANCE, INTEROCCLUSAL REST SPACE
What are the appointments for a conventional acrylic denture?
- Consult + alginates
- Secondary impressions
- Bite reg + shade, mould selection
- Try-in
- Insert
- Reviews
Book all with 2 weeks gap
What are the appointments for a cobalt chrome denture?
- Consult + alginates
- Secondary impressions
- Frame try-in, bite reg + shade, mould selection
- Try-in
- Insert
- Reviews
Book session 2 a fortnight after 1, appointment 3 4 weeks after that
What are the appointments for a valplast denture?
- Consult + alginates + shade, mould selection
- Try-in
- Insert
- Review if required
What code do we used for a denture fabrication stage?
799
What code do we use for a denture review?
741_NEW
What code do we use for a denture rest?
731
What code do we use for a retainer?
732
What code do we use for a denture tooth?
733
What are the steps to the extra oral exam for rem pros?
- TMJ
- Facial thirds
- Facial shape
- Lip and cheek support
- SMile line
How do you calculate the new OVD during the examination?
Resting dimension minus freeway space. Think about it if OVD is between 2 point at occlusion, rResting vertical dimension minus freeway space will give you that!
What are the material available for the primary impressions?
Alginate with periphery wax
What are the materials available for secondary impressions?
- Alginate
- PE
- PVS
What are the materials available for bite registration?
- Wax rims
- Exabite
What is the definition of dental impression?
Dental impression creates a negative imprint of hard and soft tissues in order to create a positive cast or model.
What is a primary impression?
It is an initial impression taken using a stock tray and alginate impression material. Used to produce study models
What is a secondary impression?
Secondary impression is a detailed impression to produce a master cast from which a denture is fabricated. AKA a master impression.
When do you need a secondary impression?
- Acrylic partial for multiple edentulous areas
- Chrome denture
- Complete denture
- Some immediate dentures
When don’t you need secondary impressions?
- Valplast denture
- Small acrylic
- Temporary denture or short immediate
What brand is the PVS material?
Honigum
When do you use a wash impression?
Reline of full denture
What is a pick up impression?
Denture in the alginate for tooth replacement. FItting surfaces are okay
What is an overall impression?
Pick up + wash impression together
What is a bite registration?
It i the impression of patient’s occlusion when upper and lower teeth bitting together.
Purpose - registration of maxillo-mandibular relationship so that lab can articulate the casts and set up teeth
What do you want to record for bit registration in an edentulous patient?
Centric relation.
Centric relation is a maxillomandibular relationship, independent of tooth contact, in which the condyles articulate in the anterior-superior position against the posterior slopes of the articular eminences; in this position, the mandible is restricted to a purely rotary movement; from this unstrained, physiologic, maxillomandibular relationship, the patient can make vertical, lateral or protrusive movements; it is a clinically useful, repeatable reference position
What is the significance of curve of spee in dentures?
- it maintains occlusal harmony
- Supports efficient mastication
- Allows posterior disocclusion during portrusive movement
What is the significance of curve of wilson in dentures?
- Allows lateral mandibular excursion
What are the materials available for bite registration?
- Exabite - best for good dentition
- Modeling wax
- Copper wax
- Wax rims - best for edentulous
What should you mark on the wax rims?
- Mark mid line
- Mark canine lines
- Mark smile line
After taking the bite registration what is important to note in the lab form?
Overbite and overjet values
What is the purpose of a trial denture appointment?
- To check aesthetics
- Confirm patient satisfaction
- Obtain patient’s consent to process the denture
What should you try during the denture try in stage?
- Denture articulation
- In patient mouth
- Aesthetics
- Occlusion
- Fitting surface
- Check function and pronunciation
- Obtain patient consent
When checking for pronunciation what can you use?
- Misisipi
- 55 and 33
- Emma
How do you check for high pressure spots?
PIP creame on fitting surface
What are the initial post denture instructions?
- Excessive saliva
- CHange in speech
- May feel bulky
- FOod might get stuck
- Denture move to some extend
- Migh have high spots
- Remove dentures and clean after meals
- Brush denture as brushing teeth
What do you need to write on lab form for a partial denture?
- Describe saddles
- Describe support and draw rests, major connector or plate
- SPecify abutment tooth/teeth
- Specify clasps
- Speicy flanges - gum fitted vs buccal flange
- Specify the extension
- Fill lab form and draw design
What are the steps for chrome denture design?
- Saddle
- Support
- Retention
- Connectors
- Simplification
In which Kennedy’s class would you use exclusively tooth support?
Kennedy 3 and 4
In which Kennedy class do you use exclusivley soft tissue support?
Not Kennedy but complete denture
In which Kennedy’s class would you use both soft tissue and tooth support?
Kennedy 1 and 2
What kind of clasps do you use for molars and premolars?
Occlusal approaching
What kind of clasps do you use for anteriors?
Gingival approaching
What is the minimal length for clasps?
15 mm for cast clasps
7 mm for wrought clasp
What is the location of clasps?
0.25mm undercut for cobal chrome
0.5 mm for wrought wire
What are the steps for evaluation of alginate impressions?
1.Alginate mix is homogenous and smooth – no streaks or air bubles
2.Tray appropriate size – tray not shwoing through
3.Alginate has had adequate time to be inserted into the mouth, seated onto the teeth and set prior to removal – smooth surface with no drag lines
4.Adequate amount of alginate in tray and has been seated and muscles trimmed correctly anatomical featyres, tray is centered, no large air bubles
5.Tray has been removed correctly – no tearing of the materials
What are some of the factors that may influnces the choices of denture material suggestion during a denture consult?
MHx – diabetes, cancer, arthritism osteoporosis, blood thinners
SHx – smokers, soft drinks or busy lifestyle
DHx – bad oral hygiene, perio, decay, denture intolerant
What are the signs of lost of OVD?
Flat filtrum
Hollowing of the cheeks
Collapsed appearance of the jaws
The distance between the tip of the nose and tip of the chin reduced
Increased naso-labial grooves
Increased marionette lines
What are the options for a patient for rem pros?
Removable dentures
Implant – if it is an option
Fixed pros
Nothing
How to write a diagnosis for rem pros?
Type of edentulousness
Edentulousness
Location
Tissue or tooth support
Associate issues
Example: Bilateral edentulous maxillary arch with localised periodontitis and unilateral edentulous mandibular arch with large mandibular tori
What are the basic of acrylic denture designs?
Flange
Base
Teeth
Clasps
What are the basics of partial chrome dentures?
Major connectors
Minor connectors
Direct/indirect retainers
Denture base
Denture teeth
What are secondary impressions used for?
For constructions of master models
For construction of wax bite or to make C/C frame
What is a purpose of a wash impression?
For denture reline
What is the purpose of overall impression?
For denture repair
What do you need a secondary impression for?
Acrylic partial denture for multiple edentulous areas
Chrome denture
Complete denture
Some immediate dentures
What rem pros appliances do not need a secondary impression?
Valplast denture
Acrylic denture for a small saddle replace one or two teeth
Temporary denture
What materials are available at ADH for secondary impressions?
Alginate
Polyether – impregum – use if no undercuts (hard or soft tissue) are seen
Polyvinyl Siloxane – honigum – use if undercuts are present
What is the neutral zone?
Neutral zone is the area where the outward forces from the tongue are neutralised by the forces of the lip and chicls.
What is the neutral zone impression technique used for?
The neutral zone impression technique is applied for taking imp of atrophy and mandibular ridge.
How do we take a reline impression for a partial denture
Light body on denture sadled to record soft tissue
Pop the denture into the patients mouth
Take and alrginate impression
What are some of things that we should mention on a lab prescription form?
Type of saddle
Support of the denture
Specify abutment tooth/teeth
Draw rest seats
Specify clasps
Specify the extension of the denture
Fill lab and draw desing
What are the steps of making a secondary impression?
Discuss with tutor if rest seats are required
Try on special tray and see if border molding is needed
Rest seats cut
Request impression material and prepare tray with adhesive
Load the mono/heavy body in the tray
Load light body imp material on teeth or rest seats
Seat tray and wait
If constructing full denture, create a second layer with light body
Remove the impression
Assess and wash blood and debris
If it is alginate cover with damp immediately
When would you do a wash impression for a denture reline?
Using the denture itself, apply a heavy material and after using that impression apply ligth material and take the impression again. This is used for reline.
Why would you do a pickup impression?
For denture repair! Use only alginate and leave the denture in the impression
Why would you do an overall impression?
For complex denture repair. Using all 3 material using the overall+wash techniques.
What should you write on a lab form prescription for partial chrome denture?
Describe saddles
Describe support
Specify abutment teeth
Draw rest seats – scoop them outh on the model
Speciy clasps and flanges
Specify the extensions of the denture
Fill lab form and draw design
What is a bite registration?
It is the impression of patient’s occlusion when upper and lower teeth biting together. The purpose of the bite registration is to register maxillo-mandibular relationship so that lab can articulate casts and set up teeth. For partial dentures used maximal intercuspal position, for complete dentures use centric relation.
What type of bite registration position would you use?
Partial denture with stable tooth contacts: maximum intercuspal position
Partial denture with no tooth contact or unstable contact: centric relation
Completed denture: centric relation
What is the same as centric relation?
Retruded contact position. Most stable and comfortable posion of the mandible regardless of condylar position. It is reproducable
What is the same as centric occlusion?
Intercuspation position. When the maxilla and mandible is in a balanced occlusion.
What is the vertical jaw relationship?
It is OVD.
You can calculate it by taking the Resting vertical dimension - 2-4 mm of free way space.
What are the significant problem that could occur if the curve of spee is not maintained appropriately?
It could cause interference during protrusive movements thus may require adjustments to upper 7s
What are the significant problems that could occur if the curve of wilson is not maintained appropriately?
There could be interference during lateral mandibular excursion and needs to be adjusted
What matterials are used for bite registration?
Exabite
Modeling/beuty wax
Copper wax
Wax rims – use only in large edentulous areas with unstable contacts
What are the steps for bite record using wax rims for complete dentures?
Check wax rims on cast
Try wax rims in patients mouth
Determine incisal negth
Check lip support, facial profile and OJ
Check facial midline
Determine new OVD
Trim wax rims to OVD +1mm
Check wax rim using Fox bite plane – it needs to be parallel
Soften wax rims
Patient bite together in centric relation to new OVD – mark mid line, canine line and smile line
Wait for about 1 minute
Wax rims should be sealed
Select mold and shade
After write everything on a form “set teeth on…”
What are the steps for a trial denture?
Check denture on articulator
Try dentures, check aesthetics and pronunciation – check occlusion with articulating paper
Show patient dentures
Obtain patient’s consent to process the denture
Draw post dam line and lab form prescription
Send back to lab to process the denture
What is important to undrstand about the status of the teeth during a denture try in and denture insert?
At denture try in – teeth can still be resent. After the denture is fabricated, it is nearly impossible to reseat the teeth.
What do you do if your secondary impression for a full denture is not adequate and you unticipate that denture may not be as retentive as you would like?
You can request a temporary acrylic base mixed with wax (cold cure acrylic)! After denture try in – take a wash impression to improve retention! You can also take the bite registration with this tool. A 2-in-1.
What if a patiet has problem with gaggin?
The extension of the denture may need to be modified.
Following options:
- Remove the palatal extension of the denture
- Reduce the buccal extension of the denutres
- Desensitisation therapy
- Re-do the denture with a reduced secondary impression
Patient complains of lack of power when chewing – wat is the problem?
OVD of the denture is lackin, new OVD needs to be calculated:
1. denture may need to be redone with wax calculation
2. Denture may need to be relined
3. Consider a trial denture at new OVD
4. Immidiate, soft reline might be beneficial in shoprt term
What to do if the patient comes in with an immidiate denture, that is loose and they are unhappy with it’s aesthetics?
Construction of a new denture is the best option!
What do you do during insert appoitment?
Look at the denture and try in patient mouth
Check esthetics
Check phonetics – make them count to 25 or say missisipi a few tmes
Check occlusion – with horseshoe paper and it need to be very balanced
Check fittin surface using PIP
SHow to patient
Ask patient how they feel, any tissue impingment
Let them know that excessive salivais possible
What to do if a patient is complaining of a sore spot?
Check occlusion and adjust it
If it is not enough – use PIP cream and adjust the fitting surface
How does PIP cream work?
Put the PIP in the denture and insert intot he patient mout. Make them chew nicely. Remove the denture. Where you see spots of missing PIP are usually high spots that cause patient to be in pain! Adjust with straight hand piece.
What are the post insertion instruction that we give to the patient?
Excessive saliva is nomrmal
It may feel bulky and alter speecha and taste
Food might get stuck under denture
Might have a high spot or ulcer – DO NOT CONTINUE IF AN ULCER FORMS
Remove denture and clean after meals
Brush denture as brushing teeth
Wear religously if you can
When constructing an acrylic denture for the upper jaw, what kind of strep do you want ot go for?
Go for the anterior strap as it easier to replace those teeth later on and it helps with gagging
When do we usually have a denture review?
One week after insertion
What are the aims of the review appoitment?
Receive feedback from the patient
Reassess dentures
To adjust denture to patient’s satisfaction
Test phonetics and polish the denture
To provide further support
What kind of questions should you ask a patient during denture review?
How is your denture
Can you eat and speak with it
Does it cause any sore spot on the gum or teeth
Can you eat with your denture
Can you pronounce words normally?
Do you have a list of what you would like me to adjust your denture?
What kind of areas are we assessing in partial denture review?
Check aesthetics, comfort and function
Check occlusion
If the denture is loose – bend the clasps
IF there is food impaction under denture – check denture retention and stability
What is a denture review code?
741_New
What sound will a person make if the teeth are set too lingually?
Th sound like D
What sound will a person make if the teeth are set too buccaly?
D sound like th
What are the whistling and lisping sounds?
S whistling is due to narrow air space between tongue and upper teeth
S lisping broad airspace between tongue and upper teeth or thick plate you will need to thin the plate.
What to do if a denture is retentive but falls out during chewing?
You might need to adjust occlusion. If it happens during speech you might need to change the extension or smooth the surface
What should you put on a lab form?
Describe saddles, cross teeth which are not restored
Describe support and draw rests, major connector/plat
Specify abutment tooth/teeth
Specify clasps: rest, retentive, reciprocal
Specify flanges gum fitted vs buccal flange
Specify the extensions
Fill lab form and draw design
Obtain tutor signature
What is a gold standard material used for bite registration?
Wax rims but if the saddle is small, you can use exabite
What are the codes for a valplast denture?
721/722
What are the steps to a chrome denture design?
Saddle
Support
Retention
Connectors
Simplification
What are some of the effective major connectors for a maxilla?
Posterior palatal strap
Anterior palatal strap
What are some of the effective minor connectors for mandible?
Lingual bar – need 4mm space at least below the teeth
Lingual plate - need 4mm space at least below the teeth
Sublingual bar - need 4mm space at least below the teeth
Cingulum bar
What is an example of direct retainer?
Clasp or precision
What is an example of indirect retainer?
Rest, minor unit or major connector
What are the ideal dimensions for a rest?
1.5mmx1.5mm with 1.5mm occlusal depth. Meaning if the occlusal is 1.5mm no prep is needed
What are the steps of drawing a denture design?
Cross teeth not to replce
Outline denture saddles
Decide & draw clasp units and clasp types
Decided major connector
Decide denture base and denture teeth
Join all components together
Draw saddles
Draw support and draw major connectors
Indicate abutmnet tooth/teeth
Draw rests and clasp
Draw flanges (gum fitted vs buccal flange)
Specify/draw the extension of the denture
Tutor signature
WHat is a code to replace a broken tooth?
071+766
What is a code for adding a tooth ona denture?
768+071
What is a code for a broken clasp replacement?
762+071
What are the two different saddle design for a cobalt chrome denture?
Free-end Saddle design
Bounded saddle
What are the two aspects of tooth convexity that are important?
Maximal convexity is survey line. In denture design the area below the survey line is used for retention clasp. The area above is used for bracing for stability especially with free-end saddles.
When do you cut rest sits?
Rest sits must be cut prior to secondary impression to be taken. DO NOT CHANGE IT
In free saddle design, how can you achieve higher resistance and stability for the saddle area?
By including indirect retention through moving a retention point further anteriorly of the saddle. Thus, put a rest seat with a cirucmventional clasp on the mesial of the closest tooth.
What do you do if a cobalt chrome denture is loose?
Adjust the clasps
What are the benefits and limitations of immediate dentures?
Benefits: aesthetics, preservation of OVD
Limitations: Unpredictable, painful, number of appointment and cost
What are the indications for an immidiate denture?
Aesthetic reasons
Functional reasons
Convivence taking occlusal record
Mandatory requirements – caries and perio free on abudment teeth
Material of choice: acrylic
What are contraindications for immediate denture?
Patient on bisphosphonate/blood thinner medications
Any contraindication for extraction
How would go about the extraction stage?
First you need to extract the posterio teeth and give a few months for healing and boney remodeling. Anterior teeth will be extracted before denture insert
What are a steps to an immediate denture?
Consult pateitn, primary impressions
Stabilisation fo conditions
Scondayr impressions
Bite registration
Trial denture
Extraction and insert
Reviews (24 hours, one week, one month. 6 months)
Reline (temporary at 4 weeks, 3months with Coe Soft (751/752) and permanent at 6 months (must book with lab))
What should you do with mobility 2 teeth before primary impressions?
Splint them
What do you do if you have a mobility 3 tooth?
You need to extract it and recall the patient in 3 months
What can we repair on a denture?
Broken/cracked denture base
Broken/lost clasp
Chipped/broken/debonded denture tooth/teeth
Broken rest
What denture can’t we repair?
Valplast
When do we need to take an impression for denture repair?
When you have a broken acrylic base or broken clasp
What do we NOT need to take an impression for denture repair?
Debonded teeth or fractured or chipped tooth
What are the clinical steps for denture repair appoitment or reline?
Book with lab
9am – send denture to lab with alginate
4pm insert the denture or if cobal chrome allow 3 days if you need mollopalst reline, allow 24 hours
Review in 1 week
What can you do to reline the denture to new OVD?
You can use CCA stopper or a wax compound + border molding + taking impression of upper and lower dentures with Upper first.
So the wax compound needs to increase the OVD and ned reline will ensure that soft tissue retention and supprot can be achieved.
Always use adhesive
