rem pros -ALL OF NATS Flashcards
- What are the reasons for rendering a patient edentulous?
Caries, perio, appearance, malocclusion, overload of opposing jaw - especially edentulous lower, patients request
- What are the reasons against rendering a patient edentulous?
Masticatory efficiency reduced, alveolar resorption, medical conditions, muscular skills required to manage F/F
- What is an alternative to edentulousness?
Overdentures, immediate replacement dentures
- What is needed in the mouth for overdentures?
Retained roots as overdenture abutments
- What are the advantages of IR dentures?
Maintains pre-extraction information, maintains appearance, continuity of denture wearing, maintenance of vertical and horizontal jaw relationships, denture covering XLA socket may protect initial blood clot, but won’t promote healing
- What needs to be considered for a case selection of IR dentures?
Only straight forward extractions, may need coordination around sedation or GA appts, ALWAYS advise pt before starting tx that denture will become loose and require replacement, regular r/v, can the patient cope?, molars out first, no. of teeth replaced?
- What are the 3 options for design of IR dentures?
Flanged, part-flanged, open-face
What is the problem with a flanged IR denture if the ridge is not displaceable?
- Undercut unable to fit over bulbosity of ridge, food + plaque trap
For you to be able to fit a flanged IR over the bulbosity, need to ease the fitting surface → gap created between ridge and fitting surface → food and plaque trap
- When could an open-face denture be considered?
If bulky upper alveolar ridge
What may be the problem with an open-face IR denture?
Resorption of ridge would lead to a gap between the denture and ridge, flawless transition is aesthetically difficult
- What is the most ideal IR design?
Full-flange
- What information should be given to the lab for IR dentures?
Which teeth are to be extracted (put an X on study model), arrangement, shade, flange type, material, date of denture insertion/XLA
- What aftercare instruction do you give the patient for IR Dentures?
Keep dentures in for 24hrs, r/v appt ideally on day after insertion, examine mouth for healthy clots, identify areas of inflammation, warm saline mw and remove at meal times
- What are the review periods of IR dentures?
1 day, 1 week, 1 month, consider temp reline, 6mth recall, rebase or replace?
- What is the difference between retention and stability?
Retention is the resistance of a denture to vertical movement, stability is the resistance of the denture to displacement by functional forces
- What is the interfacial surface tension?
The thin layer of fluid present between 2 parallel planes of rigid material
- What is the interfacial viscous tension?
The force holding 2 parallel plates together due to viscosity of the interposed liquid
- In which denture are you only really able to achieve a ‘seal’? Why?
Maxillary prosthesis as there is a greater surface area
- How can you achieve a better seal?
Border moulding, post dam
- What factors can make retention and stability difficult?
Atrophic ridge, damage to skin e.g. skin graft, trauma, damaged alveolar ridge, tori, pt that cannot tolerate base extension, insufficient saliva
- What can be used to aid retention and stability?
Denture adhesives and linings, valves, anchors
- What is periodontitis referred to when there is an implant?
Peri-implantitis
- What needs to be considered when taking a history + examination for a soon to be implant pt?
- Whether the pt is medically + dentally fit to undergo surgery and prolonged complex tx over the months along with aftercare
Can the pt afford the tx?
Is tx going to benefit pt?
Whether there are risks
Pt expectations
Would simpler tx be more appropriate?
- Upon examination of radiographs, what may be some considerations?
Whether there is enough space for implant, distance from IAN, radiolucencies present?
- What may be some post-op problems with implant surgery?
Failure, infection, immediate or major problems
- What type of abutments can be used to secure the denture firmly?
Locator abutments, ball abutments, gold bar, CAD-CAM titanium bar
- What is the advantage of the gold bar?
Has more stopping of rotation
- What are the common post implant treatment complications?
Peri-implant mucositis, peri-implantitis, loose/fracture components, late implant failure, implant failure, plaque, failure to integrate
- How to examine peri-implant tissues?
- Look for inflammation, BoP and/or suppuration, sub/supra PMPR
Measure baseline probing depth using fixed landmarks
BPE IS NOT INDICATED FOR IMPLANT ASSESSMENT
- What is peri-implant mucositis?
Inflammation of peri-implant mucosa w no evidence of crestal bone loss
(just like gingivitis in non-implant tissues)
- What are the clinical features of peri-implant mucositis?
Red, swollen tissues, may bleed on gentle probing
- How to manage peri-implant mucositis?
Exclude presence of peri-implantitis w r/g to assess peri-implant bone levels cd baseline
Treat as maintenance
Re-assess in r/v to ensure inflammation settled & stable situation achieved
- What is peri-implantitis?
Infection w suppuration & inflammation of soft tissues surrounding implant
W significant loss of peri-implant crestal bone after adaptive phase
- What are the clinical features of peri-implantitis?
Red, swollen tissues, may bleed on gentle probing, suppuration
- How to manage peri-implantitis?
r/g to evaluate peri-implant bone levels cf baseline
If clinically significant processing crestal bone loss found → REFER to the clinician who placed the implant, otherwise treat as maintenance + the following
r/v after 1-2/12 to assess outcome
If not improvement → refer to secondary care advice
If inflammation settled, and stable → r/g r/v 6-12/12
- What advice can you give an implant pt as a GDP?
OH advice, triage + dx if complication, referral, manage taking acc of SDCEP guidelines
- What are the SDCEP guidelines for maintenance of implants?
Establish baseline PA of implant (long cone paralleling) 1 years after
Assess OH level - plaque, smoking
Examine peri-implant tissues
sub/supra PMPR +/- LA
Assess risk level to schedule r/v intervals
- What is reline?
Adding new base material to tissue surface of existing denture
- What is rebase?
Replacing the ENTIRE denture base material of an existing denture
- What are the types of relines?
Temporary, soft, permanent
- What is temporary reline used for? Give an example of a temporary reline material
Cushioning, tissue conditioning for grossly ill-fitting dentures, inflamed tissues, keeping denture closely adapted post XLA
Coe-comfort
- What is soft reline used for?
Parafunctional habits, very atrophic ridges, cancer / cleft pt
- What are the disadvantages of soft reline?
Plasticizer leaches, deteriorate w time, harbour microorganisms, e.g. candida infections
- Give examples of soft reline
Heat cured acrylics
Self-cured acrylics, e.g. coe soft reline - chairside
Heat-cured silicone, e.g. molloplast B
Self-cured silicone
- What is permanent reline
Definitive, hard acrylic
- What is permanent reline used for
Correcting errors after inadequate 2nd imps, peripheral seal problems, immediate / post-immediate dentures
Prolongs lifespan of some older dentures, e.g. x fitting underlying ridge but otherwise good acrylic teeth
- What do you have to do before taking imps for rebase technique?
Remove undercuts on fitting surface of existing denture before taking imps → so wont get stuck on cast model
- What type of imps and how to take imps for rebase technique?
ZnOE or light body
Closed mouth technique
Border mould - lip and cheek movement
- What is an overcast in plaster used for in rebase technique?
Maintain denture position in relation to model
Maintain OVD
- How many post-dam(s) do you carved in retching pt?
2
Cut normal - post-dam carved at junction b/w hard and soft palate
Cut another one further forward so pt can cope afterwards
- What is the review interval for rebase technique?
1-2/52
- What are common types of denture fracture in both RPD & CD?
Midline, tooth detached from denture base, loss of flange, acrylic saddle detaches from Co/Cr baseplate, clasp # or bent
- Why do dentures #?
Accident (impact), acrylic in thin section (at palate), working hardening of metal (clasps overtime), parafunctional habits, occlusion (deep overbite), soft linings take up space so less acrylic, denture processing problem, e.g. porosity → weaker acrylic, bonding issues b/w tooth and base acrylic or acrylic and Co/Cr
- What is a simple repair?
E.g. midline # of CD
Only possible when all # pieces are located
Disinfect, send to lab → no need imps
Pour cast, # area removed, new acrylic processed
- What to do if pieces of denture are missing, e.g. part of acrylic flange lost?
No simple repair no more → need imps
Take imps w # denture in mouth
Rmb to send # denture to lab regardless simple / non-simple repair
- What material can be used for temporary repairs?
Self-cured acrylic
Cyanoacrylate glue
- What is deemed unrepairable?
Smashed into multiple pieces
- What are the types of additions?
Immediate addition, post-immediate addition
- What are additions for?
RPD only, not for CD
- What can you add in addition and what are they for?
Tooth - immediate and post-immediate addition
Clasp - retention
- What is an immediate addition?
When tooth is lost after denture construction & tooth added on the day of XLA
Imps → XLA → IR denture
- What is a post-immediate addition?
When tooth is lost after denture construction & tooth added AT LATER DATE
Allows socket heal for 2-3/52
- What is a retention addition?
Wrought SS clasp
Take imps w denture in mouth → cast → clasp added to improve retention
- What are the clinical issues associated w Co/Cr
Sometimes can’t add to a Co/Cr, e.g. lower incisor for an existing lingual bar connector
So can make temporary immediate denture instead, i.e. one stage IR denture
May need to add retentive tags, solder on tags and or use 4-META or silicoat Co/Cr to retain acrylic on Co/Cr
- What can overdentures rest on?
One or more remaining natural teeth / roots of natural teeth / implants
- What are the advantages of overdentures?
Correct occlusion & aesthetics
Support - mucosal borne / tooth borne (tooth borne more favourable)
Managing tooth wear
Preserve ridge from
Proprioception - PDL still preserved in natural & RR
Denture retention
Can be used w precision attachments to retain denture
PMH - MRONJ, radiotherapy → avoid XLA
Psychological benefits
Frail elderly pt on polypharmacy
Eases transition to edentulism
- What are the disadvantages of overdentures?
Need good OH, e.g. dry mouth → difficult to keep roots clean, otherwise abutments will fail
Increased caries / perio problems
Care homes (high refined sugar diet) - pt x self care → less effective OH → caries/perio
Denture # → limited to OVD → acrylic above the abutment tends to #
Discomfort / infection → possible PA pathology
PMH - polypharmacy, dry mouth
Potentially more traumatic XLA
- What advice do you give to your overdenture pt?
Good OH & denture hygiene - soft toothbrush, soap
Fluoride toothpaste applied to root - dont need high dose unless high risk, e.g. dry mouth, radiotherapy
Regular examinations & R/G - probe around roots for any perio stuff, caries, R/G roots for PA path, sometimes have sclerotic roots so no need RCT
- What happens when there are natural teeth opposing an edentulous arch?
Trauma, increased resorption, lack of stability of dentures
- What happens when there is an uneven occlusal plane?
Inability to achieve balanced occlusion, inadequate/excessive Freeway Space, difficulty recording jaw relationship, drifting of teeth especially after perio disease (can alter overjet, overbite), tooth wear of denture teeth, esthetic affected due to challenges when trying to position denture teef
- What types of trauma can you get from a maxillary denture bearing area
Soft tissue damage (ulceration and discomfort) or alveolar resorption and fibrous tissue replacement (flabby/fibrous ridge - usually anterior maxilla), tissue displacement (NOT firm), combination syndrome
- What are the characteristics of flabby/fibrous ridge?
Not firm, its mobile and blanches when you press against it
- What can fibrous/flabby ridge cause?
Tipping of prosthesis
- What is combination syndrome?
When your natural lower anterior teeth come in occlusion with upper full dentures and this can cause resorption of the anterior part of the ridge and overgrowth of tuberosity
- How do you take an impression of an arch with a less severe fibrous ridge?
Use a special tray thats perforated anteriorly, record using mucostatic impressions - the shape of tissues at rest
- Why do you not use a mucocompressive impression to record a fibrous ridge?
Despite having a better fit under loading pressure eg// eating, when pt relaxes the denture has a higher likelihood to drop out
- What impression technique is done to record a more severe fibrous ridge?
2 stage silicone impression
- How do you record a more severe fibrous ridge?
Using special tray with a window anteriorly, take 1st stage impression putty, cut away any access around fibrous ridge then carefully inject 2nd step light body material around fibrous ridge to get recording of that area
- How to minimise damage caused to maxillary denture bearing area?
Construct denture that is fully extended over denture bearing area, denture covers all primary load bearing sites and make sure to border mould sufficiently, make sure there’s no overextension of impression
- What are the sites that require extra care when taking impressions?
Labial sulcus, buccal sulcus, labial frenum, buccal frenum, hamular notch, post dam
- How do you ensure stability of maxillary denture?
Extension of denture (optimum border seal, effective post dam), optimising loading of denture bearing area (use of overdenture abutments, effect of absence of posterior teeth- combination syndrome)
- What do you do for pts who go from partial to full dentures?
Retain overdenture abutments to help support denture and maintain alveolar bone in those areas which in turn helps with long term prognosis of those dentures
- What is tipping effect in combination syndrome?
When natural lower anterior teeth occlude with upper dentures, they occlude behind upper anterior teeth and anterior part of the upper dentures get pushed up towards tissues and posterior part comes down as the seal breaks and hence, theres a tipping of the upper dentures
- How to prevent combination syndrome from happening?
Issue lower partial dentures for pt to even out and improve the occlusion (ESPECIALLY for Kennedy Clsass 1 - bilateral free end saddle) and prevent tipping movement
- What happens if overbite is too great?
Can lead to instability and tipping of upper denture
- How do you manage incisal overbite?
Check the position of denture teeth, and reduction of incisal edges of natural teeth
- What are the effects of an irregular occlusal plane of natural teeth?
Lead to inability to provide balanced occlusion against natural teeth leading to lack of stability and discomfort to pt - hard to eat and denture being loose
- How would you explain articulation of teeth in eccentric movements of the mandible?
- Even contact on both sides :
- Complete dentures in ICP occlusion
- Complete dentures in ICP occlusion w lower natural teeth
- Complete dentures in lateral excursion (articulation is balanced)
-
Complete upper dentures opposed by lover natural teeth in lateral excursion
- Occlusion is no longer balanced hence uneven contact on both sides leading to tipping of dentures
How do you manage an irregular occlusal plane on the natural teeth?
- No adjustment (just try and make the best occlusal plane that u can innit)
- Minimal localised occlusal grinding (of cusp tips of lover natural teeth)
- Radical occlusal adjustment (crowning some teef)
- XLAAAAAAAAAAAAA (damn extreme… if teeth have overerupted, occluding almost to the ridge and theres just no space to fit the denture)
- Overlay appliance (overdenture is useful if tooth is worn down leading to decreased OVD but increased FWS)
- NEED TO MAKE SURE PT HAS GOOD OH or else there’ll be plaque trap
- Babes, tell me about a situation where theres a complete lower denture occluding with upper natural teeth?
Its not so common but when its there, its wayyyy more severe due to lower denture having a smaller denture base foundation hence force applied to that is concentrated in a small area and not a large area as to upper dentures
- Potential significant trauma to lower ridge is mainly due to?
Excessive occlusal forces, occlusal imbalance and minimal denture base foundation area
- What happens when theres a lot of trauma to a lower ridge?
Leads to accelerated resorption of lower ridge - can end up w flat or inverted ridge
- How would you manage trauma to lower ridge?
Retain roots and provide overdentures, implants( gold standard for mnx for this situation buttttttt its expensive af and requires sufficient bone) or use a soft lining but this is unpredictable cause you’ll have to replace it frequently and needs frequent care and maintenance
- What is an implant?
A dental implant is an artificial tooth root that is surgically anchored into the jaw to hold a replacement tooth or teeth or a denture in place. The benefit of using implants is that they don’t rely on neighbouring teeth for support.
- What can an implant restore?
- A single tooth (implant crown)
- Multiple teeth (implant bridge)
- Can secure a denture firmly (implant overdenture)
- Ears, eyes, hearing aids, nose
- What is the equivalent to periodontitis in a pt w an implant?
peri-implantitis
How many screws can an implant have?
3 - Implant itself, abutment screw and the screw that holds the restoration and the implant
- Why is there no PDL?
Implant is a direct communication to bone by a process called osteointegration
- What are the stages for implant tx?
- Plan and consent (v v important)
- Placement of implant
- Uncover and connect abutments (3-4 mths later)
- Restorative procedures
- Restore
- Monitor & maintain over the years
- What are implants dependant on?
Variable time, protocols and complexity
- What would you check under social hx of a pt in terms of implant tx?
Smoking (inc. failure rate), drug use, dental phobia, anxiety
- What would you check under medical hx of a pt in terms of implant tx?
Chemoradiotherapy, polypharmacies (common result of dry mouth), immunosuppression, MRONJ risks, cardiac issues, mental health issues, diabetes (inc. failure rate), thyroxine (inc. failure rate)
- What would you check under pts dental hx of a pt in terms of implant tx?
Oral health, peridoontal diseases, uncontrolled caries, status of crowns/bridges/root treatments, dental anxiety, pre-existing implants, bruxism (inc. load - higher failure rate)
- What are the risks of implants?
- Minor surgical risks - pain, bruising, swelling
- Major surgical risks -
- Lower : IAN paresthesia
- Upper : perforation into nasal cavity/maxillary antrum
- Failure to integrate
- Late failure
- Bruxism and implants
- Peri-implantitis
- Failures of superstructures & components (since theres no PDL, you wont know how hard you’re biting)
- What falls under implant planning?
- Hx examination
- r/g
- Other imaging - cbct/ct
- Surgical and r/g templates
- Ridge mapping
a/w - associated with
r/o - radio-opaque
r/g - radiograph
r/l - radiolucency
d/s - disease
a/o - and/or
t/s - tissue
w/n - within
c/i - contraindications
SE - side effects
d/t - due to
m/c - most common
X - no / dont / not
P - pressure
Sig - significant
m/w - mouthwash
t/b - toothbrush
t/p - toothpaste
Dx - diagnosis
RF - risk factor
Ix - indications
s/t - sometimes
OD - once daily
BD - twice daily
TDS - three times daily
QDS - four times daily
STAT - immediately
x/12 - x months
x/7 - x days
x/52 - x weeks
c/w - cotton wool
Hypo - sodium hypochlorite NaOCl
HSMW - hot salty mouth wash who gargles w hot water fools stahp it anonymous python its called hot innit just so people dont try to melt salt in tap water hehahahahahah crow
C - clinical
c/o- complain of
C t/s - connective tissue
b/w - between
B v/s - blood vessels
Adj - adjacent; ADJ - actually ADJ
