Removable Pros

Question 1

What is occlusion?

Answer 1

The static relationship between the incising or masticating surfaces of the maxillary or mandibular teeth or tooth analogues (The academy of prosthodontics 2005).

Question 2

What is intercuspal position?

Answer 2

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.

Question 3

What is retruded contact position?

Answer 3

Guided occlusal relationship occurring at the most retruded position of the condyles in the joint cavities.

Question 4

What are index teeth?

Answer 4

Contacting facets of teeth in the intercuspal position.

Question 5

When would you opt to do a retruded contact position for a patient instead of an intercuspal position?

Answer 5

1. Insufficient index teeth
2. Unstable occlusion
3. Most reproducible position
4. Sometimes more posterior than ICP
5. Is a condylar position

Question 6

When would you opt to do a intercuspal position for a patient instead of an retruded contact position?

Answer 6

1. Need sufficient index teeth
2. Stable occlusion
3. May vary through life
4. Depends on tooth relationship
5. Sometimes more anterior than RCP

Question 7

When can you miss out the occlusion stage?

Answer 7

If there are sufficient teeth, then occasionally casts can be articulated together without the need for a formal recording of occlusion.

Question 8

How can you record an interocclusal record?

Answer 8

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

Question 9

How would you use alminax?

Answer 9

1. Trim the wafer to the correct shape
2. Warm the wax with warm water
3. Place on occlusal surface of teeth
4. Ask patient to close on back teeth on the wax
5. Cool on cold water

Question 10

GDC Standard 6.3.1: states what regarding prescription to a dental technician?

Answer 10

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.

Question 11

What are the 4 basic information that are key features of a laboratory prescription?

Answer 11

1. Basic patient identifier (name/DOB)
2. Date the lab card
3. Put your name on the card (and supervising clinician)
4. Date the next appointment

Question 12

When requesting for special trays what must you include?

Answer 12

1. Materials to be used – e.g. PMMA
2. Spacer – usually 3mm
3. Tray handle and/or stops
4. Special instructions e.g horeshoe tray (for gagging)

Question 13

hat do you need to include on the laboratory prescription when requesting record blocks?

Answer 13

1. Upper / lower
2. What base (wax, wire strengthen, shellac, CoCr

Question 14

What must you include on the laboratory prescription form for the partial denture design stage?

Answer 14

1. Prescribe for the primary cast to be surveyed and articulated by the laboratory
2. Include all the components that are required for the partial denture and make sure it is written on the card.
3. Indicate design clearly on card and primary cast
4. Indicate material of base e.g.: CoCr or acrylic and materials for other elements e.g. Clasps

Question 15

When prescribing for a trial stage for a denture you must include information about what?

Answer 15

1. Shade
2. Mould
3. Cusped/cuspless teeth
4. Setting
5. Individual requirements e.g: 1mm diastema or no 7’s etc

Question 16

When prescribing for a finish stage you must include information about what?

Answer 16

1. Postdams – where, how many
2. Relief areas – tori/overdentures
3. Soft lining
4. Type of acrylic eg: high impact or heat cured
5. Special requirements eg: gum contouring – high lip line where they would show some of their denture.

Question 17

All laboratories must be registered with?

Answer 17

MHRA

Question 18

Patients must be offered a what for their dentures?

Answer 18

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.

Question 19

Which products does not require a statement of manufacture?

Answer 19

Gum shields, non medical device

Question 20

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.

Question 21

What are advantages of overdentures?

Answer 21

1. Correction of occlusion and aesthetics
2. Support
3. Tooth wear management
4. Preservation of ridge form
5. Proprioception
6. Denture retention – undercuts in roots
7. Can be used with precision attachments
8. MRONJ & radiotherapy patients – avoid extractions
9. Psychological benefits
10. Useful in elderly patients
11. Eases transition to edentulism

Question 22

What are the disadvantages of overdentures?

Answer 22

1. Need for good oral health
2. Increased caries / periodontal problems
3. Care homes – high risk for poor oral health
4. Denture fracture – cause take more space so less acrylic for strength
5. Discomfort/infection
6. Medical history
7. Potentially more traumatic extractions

Question 23

What is the best way to care for your overdentures?

Answer 23

1. Good oral hygiene
2. Fluoride toothpaste application to roots
3. Regular examination and radiographs
4. Denture hygiene

Question 24

What are some of the pathological changes we can see when wearing dentures?

Answer 24

1. Ulcers
2. Denture stomatitis
3. Angular cheilitis
4. Denture irritation hyperplasia
5. Flabby ridges
6. MRONJ/osteoradionecrosis
7. Allergic reactions

Question 25

Most ulcers are related to denture trauma, what are the features?

Answer 25

1. Particular site: lingual fraenum, mylohyoid ridge, undercuts
2. Causes: overextension, sharp bits on denture, loose fitting, pressing too hard, occlusal trauma,

Question 26

How can you identify where the denture is causing ulcers?

Answer 26

Pressure indicating paste can locate if it is in fact the denture that is causing pressure to the site of ulcer or something else.

Question 27

How can you ease a denture to prevent ulcers?

Answer 27

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

Question 28

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?

Answer 28

Non-healing ulcer despite adjustments then ulcers urgent referral pathway is required.

Question 29

What are the features and management for denture stomatitis?

Answer 29

1. Closely related to denture bearing area
2. Often denture hygiene issue
3. Red: oedema and erythema
4. Candida albicans
5. MANAGEMENT
6. Take denture out at night
7. Clean denture with soft brush
8. Steep denture
9. Possible use of chlorhexidine mouthwash
10. Use of nystatin or another appropriate antifungal
11. Possible new denture
12. Consider underlying issues – diabetes, folate, B12, ferritin
13. Related to angular cheilitis

Question 30

What are the features of angular cheilitis with patients wearing dentures?

Answer 30

1. Often co-exists with denture stomatitis
2. Overclosure – loss of OVD/excessive FWS
3. Use of miconazole
4. Candida albicans
5. Staph aureus
6. Beta-haemolytic streps
7. Consider underlying issues – diabetes, folate, B12, ferritin, xerostomia – polypharmacy of medication

Question 31

What causes denture irritation hyperplasia?

Answer 31

Often very old ill-fitting dentures – chronic trauma and hyperplastic response

Question 32

nce you have identified denture irritation hyperplasia, how would you treat it?

Answer 32

1. Major ease of denture
2. Tissue conditioner
3. Review and repeat if required
4. And then make new dentures for patient

Question 33

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?

Answer 33

Flabby ridges

Question 34

What is the solution for flabby ridges?

Answer 34

1. New denture covering whole denture bearing area with goof peripheral seal and apposing arch denture giving posterior support. Occasionally need special impression techniques.