Removable Pros - Mock Oral Exam Flashcards
What are factors you evaluate in assessing a complete denture patient?
- Arch size/form
- Inter-arch space
- Muscle tone
- Saliva quantity/quality
- Ridge relationships/ridge form/ridge size
- Throat form
- Tongue position
- Vestibular depth
- Bound vs movable tissue
- Tori
How do you decide whether a patient will be a successful denture wearer?
- Largely by history and clinical evluation
- Check stability and occlusion
- Evaluate hard/soft tissues
- Talk to patient
What are goals with treating a patient with a denture?
- Preserve bone
- Provide support/stability/retention
What are some alternative to wearing dentures?
- Re-make/reline
- Implant-supported prosthesis
What are the primary stress bearing areas for a maxillary complete denture?
- Maxillary RESIDUAL ridges
What are the primary stress bearing areas for a mandibular complete denture?
- Buccal shelves
Name 3 different impression techniques for complete dentures
- Pressure less (mucostatic)
- Functional
- Selected Pressure
Describe Mucostatic Technique?
- Little or no pressure on ridge
- Employs ZOE, multiple impressions and metal bases
- Well short of conventional borders
Describe the functional technique…
- Iimpressions made under biting pressure (not recommended since dentures would then be made to compressed tisses)
Describe the Selective Pressure Technique…
- (FAVORED) Blackout wax is placed on preliminary cast so custom tray has additional space for impression material in areas that should be subjected to less pressure
- For example: crst of mandibular ridge
- This additional material is thought to exert less pressure while making impression
What are 6 purposes/benefits/reasons for a post-paltal seal?
- Maintains tissue contact during speech and swallowing
- Increases denture retention (maintains peripheral seal/atmospheric pressure)
- Compensates for polymerization shrinkage
- “Sunken” border less conspicuous to tongue
- Less gagging
- Cross-sectional strength
What are some advantages of/a rationale for doing overdentures?
- Maintain alveolar bone
- Proprioception
- Increased masticatory efficiency
- Increased stability and support
- Psychological
What is Lingualized Articulation?
- Articulates the maxillary lingual cusps with the mandibular occlusal surfaces in centric working and non-working positions
- Anatomic or semi-anatomic maxillary tooth opposing a semi-anatomic mandibular tooth in which cross arch balance is achieved (balanced) or opposing non-anatomic mandibualr tooth in which balance is not achieved (non-balanced)
What are advantages of Lingualized Articulation?
- Esthetics
- Simple technique
- Reduced lateral forces
- Can be used in Class 2, 3, crossbite, balanced or non-balanced situations
Name 6 chracteristics of combination syndrome…
- Maxillary anterior ridge resorption
- Downgrowth of tuberosity
- Maxillary papillary hyperplasia
- Mandibular anterior extrusion
- Mandibular posterior ridge resorption
- Over-closure of OVD
Name at least five factors that aid in retention of a maxillary complete denture…
- Adhesion
- Cohesion
- Capillary attraction
- Oral/facial musculature
- Interfacial surface tension of saliva
- Atmospheric pressure/peripheral seal
- Peripheral seal
- Occlusion
- Mechanical locking (retrymylohyoid fossa)
- Gravity
If a patient with multiple missing teeth, what are some factors that would make you tend toward removable prosthesis rather than fixed?
- Less than ideal oral hygiene and high caries risk
- Long span (re: Ante’s Law)
- No terminal abutment
- Poor root to crown ratio (<1:1)
- Inadequate crown hight (unless you’re willing to do crown lengthening)
- Large vertical soft tissue defect
Please describe the Kennedy Classification system for partially edentulous arches…
- Kennedy Class I: Bilateral edentulous areas located posterior to the natural teeth
- Kennedy Class II: A unilateral area located posterior to the remaining natural teeth
- Kennedy Class III: A unilateral edentulous area with natural teeth remaining both anterior and posterior to it
- Kennedy Class IV: A single bilaeral (crossing the midline), edentulous area located anterior to the remaining natural teeth
How many rules did Applegate describe?
Can you give me 5 of them?
- Classification is done post extraction
- 3rd molars generally don’t count
- 3rd molars, if used as abutments, do count
- If a 2nd molar is missing and will not be replaced, it doesn’t count
- The most posterior edentulous space always determines the classification
- Designation of modification spaces
- The extent of a modication space isn’t considered, only the number of spaces
- Class IV RDP cannot have modification spaces
Discuss the appearance of a properly designed circumferential clasp used for rentention…
- Clasp should originate from framework above the height of contour
- Retentive tip should be directed occlusally
- Should terminate at line angles
- Should be positioned as far apically as possible
What alternative could you use if your patient was allergic to nickel?
- Vitallium (chromium/cobalt)
- Type IV Gold
What are acceptable clasps for distal extension removable partial dentures?
- Comnbination clasp (cast lingual bracing arm, distal rest, wroght wire soldered to framework into M undercut)
- 18 gauge cast round clasp (same design as above)
- RPI, RPA
- Reverse circlet (mesial rest, lingual bracing arm or plating, circumferential clasp from rest into DF undercut)
- Rudd Design: Distal rest, lingual plating or bracing arm, modified T-Bar into DF undercut
Name 3 advantages to an implant-assisted RDP…
- Distal extension suport
- Reduced bone resorption
- Elimination of unesthetic retention elements
- Descreased stress on abutments
- Enhance support and rentention
- Improved comfort and patient satisfaction
When planning an implant-assisted RDP with a distal extension, where should the implant be located?
- As far distal as reasonable or at least as far as the most distal tooth being replaced
What is the minimum restorative space required for the use of an implant in an implant assisted RDP?
- 10 mm
- 2 mm tooth + 2 mm acrylic + 3 mm attachment + 3 mm of gingiva
A Class I removable partial denture should have 7 components. Name the 7 components…
- Major connector
- Minor connector
- Rests
- Direct retainer
- Stabilzing or reciprocal elements (as part of a clasp assembly)
- Indirect retainers (if the prosthesis has distal extension bases)
- One or more bases, each supporting one/several replacement teeth
Describe the purpose of an indirect retainer in your own words. What is the preferred location in an RDP design for an indirect retainer?
- The conmponent of a RPD that assists the direct retainer in preventing the displacement of the distal extension base in an occlusal direction (away from the tissue) or from rotating around a fulcrum line. Location should be perpendicular to and as far away from the fulcrum line as possible (usually mesial of 1 premolar or cingulum of canine)
What is the primary requirement of a major connector?
Rigidity
Describe 3 acceptable maxilary major connectors…
- Anterior-posterior paltal strap - 5 mm
- Palatal strap
- Full palatal coverage
What are the minimum dimensions that will allow the use of a lingual bar major connector?
- 3 mm from the gingival margin and at least 4 - 5 mm occlusogingival height
How do you record this dimension regarding measuring for a lingual bar?
- Use a perio probe to transfer the dimension to the cast with the floor of the mouth activated
Give 4 clinical situations that indicate use of a lingual plate, rather than a lingual bar as a major connector…
- When a lingual frenum is high or the space avilable for a lingual bar is limited
- In class I situations in which the residual ridges have undergone excessive vertical resorption. Flat residual ridges offer little resistance to the horitzontal rotational tendencies of a denture
- For stabilizing periodontally weakened teeth, splinting with a lingoplate can be of some value when used with definite rests on sound adjacent teeth
- When the future replacement of one or more incisor teeth will be facilitated by the addition of retention loops to an existing linguoplate
Describe the physical characteristics of an occlusal rest seat preparation on a maxillary premolar…
- Triangular and concave shaped
- Inclined toward the center of the tooth
- One third to one half the mesial distal dimension
- One half the dimension between the cusp tips
Name the requirements of a clasp assembly…
- Retention
- Support
- Stability
- Reciprocation
- Encirclement
Name 5 factors that affect the flexibility of RDP clasps…
- Length
- Taper
- Diameter
- Cross-Sectional Form
- Material
Explain the purpose of the mesial rest on tooth #21…
Indirect Retainer
What is the purpose of indirect retention?
- Prevents the displacement of the distal extension base when the denture base moves away from the tissues in pure rotation around the fulcrum line
Where is the indirect retainer generally located?
Anterior to the fulcrum line
When do you prepare guiding planes on teeth not receiving cast restorations if your case involves survey crowns?
Prior to crown preps for survey crowns
Why do you prepare guiding planes prior to crown preps if your case involves survey crowns?
- Survey crown guide planes are made parallel to path of insertion established by guiding planes of other teeth
- It’s easier than trying to prep guide planes after survey crowns are cemented!
According to Stewart, a retentive clasp constructed of cast chrom is normally placed in a ___ inch undercut?
0.01 inch
Clasps made of wrought wire normally are positioned in an undercut of ____ inch
0.02 inch
Which maxillary major conector is generally avoided?
Why?
- Horseshoe shaped palatal connector
- Too flexible
Are you aware of any classification system related to the mental attitude of denture patients? Please describe the classification and how it might affect our treatment…
House’s Classification (1935)
- Exacting - Excellent
- Philosphical - Good with education
- Indifferent - Unfavorable
- Hysterical (agressive) - Unfavorable
How do our goals in achieving an ideal occlusal scheme differ between complete denture restorations and fixed restorations?
- We generally try to develop a balanced (cross arch and cross tooth) articlation in complete dentures and a mutually protected articualtion in fixed restorations (anteriors protect posteriors in eccentric, posteriors protect anteriors in MIP). Ideally, centric occlusion and MIP should be coincident.
What are the components of Ticonium?
Nickel and Chromium
