Removable Pros Flashcards
Occlusion for partial dentures: 9 Effective communication with Laboratory: 10-20 Overdentures: 21-22 Patho changes to dentures: 23-
What is occlusion?
The static relationship between the incising or masticating surfaces of the maxillary or mandibular teeth or tooth analogues (The academy of prosthodontics 2005).
What is 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.
What is retruded contact position?
Guided occlusal relationship occurring at the most retruded position of the condyles in the joint cavities.
What are index teeth?
Contacting facets of teeth in the intercuspal position.
When would you opt to do a retruded contact position for a patient instead of an intercuspal position?
- Insufficient index teeth
- Unstable occlusion
- Most reproducible position
- Sometimes more posterior than ICP
- Is a condylar position
When would you opt to do a intercuspal position for a patient instead of an retruded contact position?
- Need sufficient index teeth
- Stable occlusion
- May vary through life
- Depends on tooth relationship
- Sometimes more anterior than RCP
When can you miss out the occlusion stage?
If there are sufficient teeth, then occasionally casts can be articulated together without the need for a formal recording of occlusion.
How can you record an interocclusal record?
Using the following
1. Bite registration paste – usually silicone paste
2. Wax wafer – modelling wax
3. Modified wax wafer – alminax has aluminium in the wax
How would you use alminax?
- Trim the wafer to the correct shape
- Warm the wax with warm water
- Place on occlusal surface of teeth
- Ask patient to close on back teeth on the wax
- Cool on cold water
GDC Standard 6.3.1: states what regarding prescription to a dental technician?
You can delegate the responsibility for a task but not the accountability. This means that, although you can ask someone to carry out a task for you, you could still be held accountable if something goes wrong.
You should only delegate or refer to another member of the team if you are confident that they have trained and are both competent and indemnified to do what you are asking.
What are the 4 basic information that are key features of a laboratory prescription?
- Basic patient identifier (name/DOB)
- Date the lab card
- Put your name on the card (and supervising clinician)
- Date the next appointment
When requesting for special trays what must you include?
- Materials to be used – e.g. PMMA
- Spacer – usually 3mm
- Tray handle and/or stops
- Special instructions e.g horeshoe tray (for gagging)
hat do you need to include on the laboratory prescription when requesting record blocks?
- Upper / lower
- What base (wax, wire strengthen, shellac, CoCr
What must you include on the laboratory prescription form for the partial denture design stage?
- Prescribe for the primary cast to be surveyed and articulated by the laboratory
- Include all the components that are required for the partial denture and make sure it is written on the card.
- Indicate design clearly on card and primary cast
- Indicate material of base e.g.: CoCr or acrylic and materials for other elements e.g. Clasps
When prescribing for a trial stage for a denture you must include information about what?
- Shade
- Mould
- Cusped/cuspless teeth
- Setting
- Individual requirements e.g: 1mm diastema or no 7’s etc
When prescribing for a finish stage you must include information about what?
- Postdams – where, how many
- Relief areas – tori/overdentures
- Soft lining
- Type of acrylic eg: high impact or heat cured
- Special requirements eg: gum contouring – high lip line where they would show some of their denture.
All laboratories must be registered with?
MHRA
Patients must be offered a what for their dentures?
Statement of manufacture, the laboratory is responsible for producing it, clinician responsible for offering it. Note it down in records what the patient has decided to do with statement.
Which products does not require a statement of manufacture?
Gum shields, non medical device
Remember that a lab card is a prescription. It is a clinical responsibility to prescribe accurately, effectively and clearly to the technician in the same way that a clinician would prescribe a drug to a pharmacist.
What are advantages of overdentures?
- Correction of occlusion and aesthetics
- Support
- Tooth wear management
- Preservation of ridge form
- Proprioception
- Denture retention – undercuts in roots
- Can be used with precision attachments
- MRONJ & radiotherapy patients – avoid extractions
- Psychological benefits
- Useful in elderly patients
- Eases transition to edentulism
What are the disadvantages of overdentures?
- Need for good oral health
- Increased caries / periodontal problems
- Care homes – high risk for poor oral health
- Denture fracture – cause take more space so less acrylic for strength
- Discomfort/infection
- Medical history
- Potentially more traumatic extractions
What is the best way to care for your overdentures?
- Good oral hygiene
- Fluoride toothpaste application to roots
- Regular examination and radiographs
- Denture hygiene
What are some of the pathological changes we can see when wearing dentures?
- Ulcers
- Denture stomatitis
- Angular cheilitis
- Denture irritation hyperplasia
- Flabby ridges
- MRONJ/osteoradionecrosis
- Allergic reactions
Most ulcers are related to denture trauma, what are the features?
- Particular site: lingual fraenum, mylohyoid ridge, undercuts
- Causes: overextension, sharp bits on denture, loose fitting, pressing too hard, occlusal trauma,
How can you identify where the denture is causing ulcers?
Pressure indicating paste can locate if it is in fact the denture that is causing pressure to the site of ulcer or something else.
How can you ease a denture to prevent ulcers?
Find out what caused it and then make adjustments, adjustments come in the format of:
1. Occlusal adjustments
2. Trim and polish base
3. Trim extensions
If you have made adjustments to a denture that has caused ulcer, if after two week the adjustment has not made an impact on the clearing of the ulcer what do you have to do?
Non-healing ulcer despite adjustments then ulcers urgent referral pathway is required.
What are the features and management for denture stomatitis?
- Closely related to denture bearing area
- Often denture hygiene issue
- Red: oedema and erythema
- Candida albicans
- MANAGEMENT
- Take denture out at night
- Clean denture with soft brush
- Steep denture
- Possible use of chlorhexidine mouthwash
- Use of nystatin or another appropriate antifungal
- Possible new denture
- Consider underlying issues – diabetes, folate, B12, ferritin
- Related to angular cheilitis
What are the features of angular cheilitis with patients wearing dentures?
- Often co-exists with denture stomatitis
- Overclosure – loss of OVD/excessive FWS
- Use of miconazole
- Candida albicans
- Staph aureus
- Beta-haemolytic streps
- Consider underlying issues – diabetes, folate, B12, ferritin, xerostomia – polypharmacy of medication
What causes denture irritation hyperplasia?
Often very old ill-fitting dentures – chronic trauma and hyperplastic response
nce you have identified denture irritation hyperplasia, how would you treat it?
- Major ease of denture
- Tissue conditioner
- Review and repeat if required
- And then make new dentures for patient
Trauma of denture hitting usually anterior ridge often when lower anteriors only present and no lower denture, this causes bone resorption and fibrous replacement resorption, what is the condition known as?
Flabby ridges
What is the solution for flabby ridges?
- New denture covering whole denture bearing area with goof peripheral seal and apposing arch denture giving posterior support. Occasionally need special impression techniques.
