Removable Pros

Question 1

What is an immediate denture?

Answer 1

A complete or partial denture that is inserted on the same day as the tooth or teeth are removed.

Question 2

What are the 5 advantages of immediate dentures?

Answer 2

1. Aesthetics
2. Speech
3. May maintain function
4. Avoid drifting/tilting of remaining teeth
5. Self-esteem

Question 3

What are the 2 disadvantages of immediate dentures?

Answer 3

1. A space is likely to develop between the denture and the ridge as healing occurs
2. May need to be replaced after initial resorption - additional cost

Question 4

Outline the clinical stages of immediate denture construction:

Answer 4

Same sequence as for partial dentures

1. Examination and assessment
   - assess teeth clinically and radiographically if required
2. 1st Imps - stock trays
3. Occlusion
4. Design - always simple acrylic plate
5. 2nd Imps - special trays
6. Try-in - limited to teeth already missing
7. Once happy with try-in, prescribe to finish
   - write clear instructions on which teeth you wish to be added to the denture, tooth arrangement, shade, flange type (e.g. full, part, flangeless), material, and date for the denture to be ready for insertion.
8. Check denture before extractions
   - make sure the correct teeth have been added onto the denture
9. Extraction teeth and finish - care with extractions and insertion of denture, may require slight adjustment at this stage, try not to put the denture in and out too much at this stage as it can dislodge the clot and cause haemorrhage
10. POI, denture hygiene advice, and instructions of wear
    - wear for 24 hours after placement
    - r/v appointment usually on day after insertion
11. Review

Question 5

Outline the steps of a denture review after placing an immediate denture:

Answer 5

Usually takes place on on day after insertion

1. Remove dentures and examine mouth for healthy clots
2. Identify areas of inflammation and ease denture appropriately
3. After 24 hrs advise warm saline mouthwash and pt to remove denture after mealtimes, to rinse mouth and clean denture - soft toothbrush, soap, and water
4. Review after 1 week - further adjustment as required
5. Review after 1 month - assess adaptation
6. Consider temporary reline
7. Need for regular recall - 6 months
8. Rebase or replace if necessary

Question 6

Which landmarks should be covered in a primary impression of the upper arch?

Answer 6

• labial sulcus
• labial frenum
• incisive papilla
• palatine rugae
• buccal frenum
• palatine raphe
• buccal sulcus
• hamular notch
• tuberosity

Question 7

Which landmarks should be covered in a primary impression of the lower arch?

Answer 7

• labial sulcus
• lingual frenum
• buccal sulcus
• labial frenum
• buccal frenum
• lingual sulcus
• buccal shelf

Question 8

Which impression technique can be used for a flabby/fibrous ridge?

Answer 8

2 stage impression technique:
- Mucoscompressive impression of the non-compressible tissues
- Mucostatic impression of the flabby/fibrous ridge

Question 9

After surveying your models you find there are no suitable undercuts for a clasp arm to engage.

What can you do to resolve this issue?

Answer 9

Modify the survey lines of one or more of the teeth by the addition of composite to create undercuts for the clasp arm to engage.

Question 10

What procedural considerations must be addressed when combining fixed and removable pros?

Answer 10

1. Denture design must be done before the crown preparation
2. Preparation has space for rest seats and guide planes
3. Imps must be accurate for crown prep&denture bearing area
4. Dentist needs to coordinate different technicians
5. Crown made first, denture base made to fit around crown

Question 11

Briefly outline the procedure followed when combining fixed and rem pros?

Answer 11

1. Need buccal undercut on crown suitable for clasp
2. Try-in chrome framework
3. Crown cemented the day before the denture is inserted
4. Insert the bridge the day after the crown is inserted
5. Increased time with the temporary crown

Question 12

When are precision attachments useful?

Answer 12

When there is an issue with denture retention.

Question 13

What are the issues with precision attachments?

Answer 13

Requires accurate imps
Technically demanding
Difficult to repair/replace

Question 14

When are two-part dentures useful?

Answer 14

When there is gross tissue loss and different paths of insertion

Question 15

What can be used to carry out a two part denture method?

Answer 15

Split pins and a CoCr denture

Question 16

How do swinglock dentures gain their retention?

Answer 16

By facilitating bone and tissue undercuts

Question 17

What are the issues with swinglock dentures?

Answer 17

Require immaculate OH
Technically demanding - requires good technician

Question 18

What connector can be used to facilitate lingually tilted teeth?

Answer 18

A buccal bar

Question 19

What design features can be incorporated into a bruxists denture in order to prevent denture fracture?

Answer 19

• Metal backing to teeth
• CoCr or high impact acrylic
• Metal occlusal surfaces
• Use of cross-linked teeth

Question 20

What must you warn your patient before commencing the try-in of a denture?

Answer 20

Give their honest opinion as changes can be made

There will be a difference in:
- Retention - less retentive
- Colour of flange - more pink
- Feel of flange - more bulky