removable pros Flashcards
what is an immediate denture
denture inserted at the same appt as XLA
can an immediate denture be a complete?
yes
name 5 advantages to immediate dentures
- aesthetics
- speech
- maintain function/eating
- avoid drifting of teeth
- self esteem
what are the clinical stages of immediate dentures
the same as for partial dentures
what are the clinical stages of immediate dentures
the same as for partial dentures
- imps
- occlusion
- design
- 2nd imps
- try-in
- XLA and fit
what must you always do before taking out the tooth at an immediate denture fit
check its the correct tooth on the denture
what instructions have to be given to the lab for immediate dentures
- which teeth for XLA
- arrangement
- shade
- flange type
- material
- date for XLA
what is a full flange?
engages entire sulcus depth
what is a partial flange
engages only partially into the flange
what is flangless?
tooth directly onto the ridge
what material is most often used for immediate dentures
heat cured acrylic
on what occasion would you NOT use acrylic for an immediate denture
if the pt is allergic to the monomer in the acrylic
what will lab mark on the cast when making the immediate denture
angulation and incisal level
when should an immediate fit be reviewed
24 hrs after
what should the pt be told to do for the first 24 hrs after immediate denture fit
keep the denture in
why should the pt keep the immediate denture in for the first 24 hrs
swelling will prevent reinsertion
why is immediate denture reviewed 24 hrs later
pt wont be able to tell anything about fit at date of insertion due to LA
what should you do at the review appt of immediates 24 hrs later
- remove dentures
- examine for healthy clot
- ease accordingly
what should the pt be advised after 24 hours of wear of immediate dentures
- warm saline rinses from that appt
- remove denture after mealtimes to rinse mouth and clean denture
- use soft toothbrush and soap to clean denture
when should the 2nd review of an immediate denture be
1 week later
why is the immediate denture reviewed at 1 week
further adjustments
when is the 3rd review appt of an immediate denture
1 month
why are immediate dentures reviewed at 1 month
assess adaptation
what should be considered at the 1 month review appt of immediate dentures
- self cure acrylic addition
- temp reline
why do you need to be careful when placing self cure acrylic to immediate dentures
be careful not to engage undercuts in case they cant get the denture out
when should the dentist and pt decide whether to replace or keep an immediate denture
6 months post XLA
what may be a consideration at 6 months if the immediate denture is complete
rebase
what lies at the posterior junction between the hard and soft palate
palatine fovea
what lies just behind the maxiallry tuberosity that can be captured on an impression
hamular notch
what should primary imps record
- clinically relevant landmarks without excessive tissue distortion
what are 2nd imps also called
working imps
what should 2nd imps record
entire functional denture bearing area
what is most crucial to capture in a denture imp
full extensions into the sulcus
what are primary imps used for
construction of special trays
what can primary imps be modified with
wax or putty
what should a primary imp never be used for
to construct a prosthesis
what does a special tray allow for
refining of tray to pts own anatomy
what can be used to modify a special tray
greenstick
where should a special tray be relieved around
frenum attachments
what should you consider for imps if the pt has a deep palate
pre-packing the palate
what should a working imp record
depth and width of functional sulcus
what can be done to indicate the sulcus depth to the technician
mark the imp with an indelible pencil
what else might be marked on an imp for the technician to see (apart from sulcus depth)
areas where relief may be required eg tori
what should be done to accurately record a flabby ridge in an imp
2 stage imp
- mucocompressive imp of the non-compressible areas
- mucostatic imp of the fibrous areas
what should be done if there are no suitable undercuts in denture design
modify the survey lines
how can the survey lines be modified when unfavourable
addition of composite to create an undercut
what does modifying the survey lines do when there are no suitable undercuts
improves denture retention
when combining removable and fix pros, what is done first, the denture design or crown prep?
denture design
what can be incorporated into fixed pros to aid in removable pros
rest seats prep, guide plane and undercuts
what might the dentist have to coordinate if combining fixed and removable pros
multiple technicians
what is made first, the denture or fixed pros?
fixed pros
if making denture and crown at the same time, what should be fitted when and why?
crown 24 hrs before denture to ensure that cement is fully set
what should be done at the try-in stage of denture if also making a fixed prosthesis
try them both in together to ensure fit and function
what do you have to be really careful of when fitting a fixed prosthesis before a removable one
ensure crown is fully seated as this could offset the fit of the denture
what can precision attachments be used for
- on retained roots for overdentures
- on crown/inaly for dentrues
where are precision attachments more often found if on a fixed prosthesis
premolar
name 2 types of precision attachements
- ball and post
- tubelock
what type of precision attachment is used for overdentures
ball and post
what type of precision attachement is used for fixed pros
tubelock
what are 2 downfalls of precision attachments
- technically demanding
- difficult to repair if break
when would a two part denture be useful
gross tissue loss and different paths of insertion –> eg trauma pts
what are used in two part CoCr dentures
split pins
how does the acrylic part fit into the CoCr two part denture
acrylic fits into the pins on the different POI
how does a swinglock denture work
engages bone and tissue undercuts for retention
what is essential to ensure before constructing a swinglock denture
pt has good OH
what type of denture would a swinglock usually be constructed for
lower partial kennedy class 1
what type of denture would a swinglock usually be constructed for
lower partial kennedy class 1
what type of denture would a swinglock usually be constructed for
lower partial kennedy class 1
what type of denture would a swinglock usually be constructed for
lower partial kennedy class 1
what type of denture would a swinglock usually be constructed for
lower partial kennedy class 1
what type of connector might be constructed for lower lingually tilted teeth
buccal bar
what may be added to dentures for bruxists
metal backing to teeth to stop anteriors dislodging
what type of teeth may be added to dentures for bruxists
cross linked
what will you receive from the lab for the try-in stage if doing a replica denture
teeth in wax with shellac base
what does the try in base being in wax give us the opportunity to do at try in
move teeth as required
what might changes needed at finish result in
remake
what should stress and request from the pt at try in
this is their opportunity to change things shade etc - request honest opinon
what should you check the teeth for at try in stage
- postion
- aesthetics
- occlusion
what should you check for try in of CoCr denture
- fit
- rest seats flush to teeth
- index teeth occlude
- clasps engage
what should you do initially if the CoCr denture is not fitting at try in
remove the teeth and wax and try in the framework alone
what might be the reason for a try in CoCr denture not fitting if the framework fits fine
posterior occlusion
what should be the first three try in checks
- lip support
- incisal level
- occlusal planes
what are 2nd three try in checks
- retention/ stability
- position of teeth in relation to ridge
- base extensions
what are the 3rd two try- in checks
- vertical dimension
- even occlusal contact
what are the last two try in checks
- speech
- aesthetics
how to you assess lip support at try in
look at pt from the side
how do you check incisal level at try in
check where it sits in relation to the upper lip and the pt is showing the correct amount of teeth when smiling
how do you check occlusal plane at try in
foxes guide plane
why might there be poor adaptation at try in
poor imps
how do you check the vertical dimension of a denture at try in
- index teeth meeting
- adequate FWS
- no sliding on occlusion
what should you do if the vertical dimension is off at try in
compare on the articulator to in the pts mouth
what are you trying to figure out if the vertical dimension is off at try in
is the problem with articulation or master imp
what should you advise the pt to do when seeing the denture at try in
hold the mirror at arms length to see how others will see them
what should you do at the end of the try in appt before going to finish
get the pts permission
how can you fix an aesthetic issue at try in appt
clinical photographs to show lab issue
what can you do if the denture is overextended at try in
trim until happy
what can you do if the denture is underextended at try in
draw on cast where you want the extensions to finish then retry appt
what should you do if the imp doesnt record full sulcus depth and the denture is underextended at try in appt
new imps and retry
what does poor adaptation in the mouth but good fit to cast indicate
error in imp or casting
what should you do if theres a problem with adaptation at try in
new imp, wax up, retry
what should do if theres a small error with CoCr framework at try in
if small then attempt adjustment
what should you do if theres a large error with CoCr framework at try in
new imp, cast and try in
what is the problem with retrying a CoCr framework
expensive mistake
what should you do if theres an issue with occlusion at try in
- if one tooth then reset it
- if multiple then retake occlusion
- then retry both
what should you do if the FWS is correct but the teeth dont occlude properly at try in
add wax until teeth meet
rerecord occlusion
retry
what should you do if theres inadequate FWS at try in
- remove occluding teeth
- replace with wax
- establish correct OVD
- record occlusion
- retry
what do you request from the lab when you take a denture to finish
post dam placement and size
what are the 3 types of acrylic that you can prescribe a denture for
- heat cure
- cold cure
- high impact
what is the first step at a fit appt before trying the denture in
check its the correct work
what do you check at a fit appt
- comfort
- retention and stability
- base extensions
- appearance
- speech
- occlusion
- vertical dimensions
what do you do if a clasp isnt engaging at the fit appt
adjust with adams pliers
how might you tell the denture is overextended just by looking at it in the mouth
the tissues blanch
when does an overextended denture need to be adjusted by the lab
if significant changes
what should you do if on review the pt is struggling with the palatal extension of a new denture
ask them to persevere one more week to try and adjust to the new changes
what appearance changes to the denture can be made on review
- shortened
- single tooth replaced
what will be required if the pt wants to change the shade or shape of the teeth at the final fit of a denture
remake
what changes to the teeth will cause changes to the pts speech
- changes to OVD
- anterior tooth position
will a change in speech settle over time with a new denture?
yes
what should you do if there is premature contact of occlusion
indentify with articulating paper and adjust with bur
what might the pt struggle to do if there have been changed made to the occlusion
bite in a consistent way
what should you ALWAYS remind a pt at the fit of a denture
they need to persevere in wearing it
when should a review be made after a denture fit
1 week
what should new denture wearers be advised at the fit appt
they will salivate more than normal
when would you arrange an ease appt earlier than normal
if the pt is new to wearing dentures
how often should ease appts be made after fitting a new denture
1-2 weeks subsequently
when should you stress is important for the pt to wear their denture before an ease appt
24 hrs before
why do we want the pt to wear the denture consistently before an ease appt
makes areas causing trauma easier to identify
what areas commonly hurt after the fit of a new denture
- frenum
- tuberosity
- sulcus’
what would the pt complaining of a denture moving indicate
poor adaptation
how do you assess adaptation of a denture
apply vertical forces to see if it rocks
what can you do for a denture with poor adaptation
reline
what oral med condition may affect the retention of a denture
dry mouth
can you help movement of a denture due to flabby ridge
not really - counsil pt
what might cause a pts jaw to hurt after the fit of a new denture
OVD adjustments
will pain in the jaw resolve after a new denture fit
not always
if pain in the jaw doesnt resolve after having a new denture fitted what can you do
remake
what should you check if the pt is complaining of a sore jaw after having a new denture fitted
check sifficient FWS
what should you advise the pt if they are complaining of their bite feeling wrong with their new denture, but O/E its all good
may take some time for them to adapt and muscles to retrain
what do anterior aesthetic complaints about dentures often require
remake
what appearance can dentures with an incisal level thats too low give
horse like
when should the initial ease appt for an IR be
24 hrs after fit
what should you check at IR ease appt
- any areas hurting
- flanges extending into the undercuts
what should you check the pt is able to do at an IR ease appt
take the denture in and out
where can a reline be done
chairside or in lab
why should you not reline an IR too quickly
further healing and gapping may occur
when should a ridge be fully healed after XLA
6 months
what should you do if there are significant changes to the fit of an IR 6 months after XLA
new denture
what factors may affect a reline/rebase
- is pt willing to be without denture while changes are being made
- financial
how often are pts with complete dentures recalled
annually
what might you also want to do if having to tighten clasps on a loose denture
teach pt correct way to take it in and out
what may cause discolouration of a denture
- calculus
- bleached by cleaning agent
