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3rd Year - Module 5 > Removable Prosthodontics > Flashcards

Removable Prosthodontics Flashcards

1
Q

What is the role of the analysing rod?

A

Analyses tooth and tissue undercuts and determines path of insertion

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2
Q

What does the graphite marker on a surveyor do?

A

Scribes tooth and tissue undercuts on models

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3
Q

What is the role of the chisel on the surveyor?

A

Used to trim the blocked out undercut areas on a model

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4
Q

If a denture falls out, what is the relationship regarding the path of insertion and path of displacement?

A

The path of insertion and displacement are the same

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5
Q

Regarding the paths of insertion and displacement - how do you improve retention?

A

Paths of insertion and displacement must be different to improve retention

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6
Q

Where is the undercut area?

A

The undercut area is below the survey line and non-undercut is above

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7
Q

What information is gained from a survey line?

A

Indicates undercut and non-undercut areas and the type of survey line indicates what retentive component can be used on the denture.

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8
Q

Where should the final third of a clasp lie?

A

The final third should lie below the survey line into the undercut area

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9
Q

What kind of clasp should be used with a diagonal survey line?

A

Occlusally approaching clasp - SS or CoCr. Should taper towards the retentive tip of the clasp

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10
Q

What kind of clasp should be used with a high survey line?

A

Gingivally approaching clasp - positioned on or below the survey line

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11
Q

Where should a gingivally approaching clasp lie?

A

Positioned on or below the survey line

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12
Q

What kind of clasp should be used with a low survey line?

A

Gingivally approaching clasp can be used as is less visible as an occlusally approaching clasp

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13
Q

How much of an undercut can a CoCr clasp engage?

A

0.25mm - brittle material

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14
Q

How much of an undercut can a SS clasp utilise?

A

Up to 0.5mm - more flexible than CoCr

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15
Q

How much of an undercut can a gold clasp engage?

A

Up to 0.75mm - more flexible than both CoCr and SS

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16
Q

What do saddle areas of dentures consist of?

A

Replacement teeth and flange extension

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17
Q

What are the three functions of occlusal rests?

A

Provide support
Direct occlusal load down the long axis of the tooth
Can provide indirect retention

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18
Q

What are the two main lower major connectors?

A

PMMA plate or CoCr plate

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19
Q

What is a disadvantage of lower PMMA plate major connectors?

A

Easily fractured across the midline

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20
Q

What thickness of PMMA is required for strength in a lower major connector?

A

1.5-2mm

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21
Q

What is the thickness of CoCr in a lower major connector?

A

approx 0.5mm

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22
Q

How much gingival clearance between the sulcus depth and gingival margin is required for a lingual bar?

A

7mm minimum - allows 3.5mm bar width and 3.5mm clearance from gingival margin

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23
Q

What is the main function of cummer arms?

A

Resist posterior uplift of the denture, indirect retention

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24
Q

What is the minimum total crown height required for a dental bar?

A

9mm - bar width of 5mm and 2mm clearance from gingival margin and 2mm incisal edge clearance

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25
Q

How wide is a lingual bar?

A

3.5mm

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26
Q

How wide is a dental bar?

A

5mm

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27
Q

Name two variations of gingivally approaching clasps

A

T clasp (roach T clasp) and I bar clasp

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28
Q

Name 5 upper molar connectors

A

PMMA Plate
Mid palatal bar
Skeletal or ring design
Posterior bar
Horseshoe design

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29
Q

What is the typical bar width of a mid-palatal bar, posterior bar or anterior bar?

A

7-12mm

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30
Q

On a lab prescription sheet what colour is used for cobalt chrome?

A

green

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31
Q

On a lab prescription sheet what colour is used for stainless steel?

A

purple

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32
Q

Are there occlusal rests on PMMA designs?

A

No

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33
Q

What is the issue with a SS clasp on a CoCr framework?

A

SS cannot bond onto a CoCr framework

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34
Q

Why are plates extended onto the canines and by how much are they extended?

A

plates should be extended 1/3 up the canine to ensure lower teeth do not bite onto the chrome plate

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35
Q

In a 3 arm clasp, what is the reciprocating component?

A

palatal clasp

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36
Q

How much coverage of the retromolar pads is necessary for PMMA saddles?

A

approx 2/3 coverage

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37
Q

What is the difference between a lingual and sub-lingual bar?

A

the sublingual bar is positioned lower in the lingual sulcus, and can be made wider than the lingual bar

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38
Q

What is a partial denture?

A

a prosthesis that replaces some teeth in a partially dentate arch

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39
Q

What fungi causes denture stomatitis?

A

Candida albicans

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40
Q

What can cause denture stomatitis?

A

Wearing a denture full time (including night time)

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41
Q

What is a Kennedy class I denture?

A

Bilateral free end saddle

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42
Q

What is a Kennedy class II denture?

A

Unilateral free end saddle

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43
Q

What is a Kennedy class III denture?

A

single bounded saddle NOT crossing the midline

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44
Q

What is a Kennedy class IV denture?

A

single bounded saddle crossing the midline

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45
Q

How do you class a denture using Kennedy classification when there is more than one edentulous saddle present?

A

Use the most posterior saddle to define the main kennedy classification and then the amount of extra saddles is the amount of modifications

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46
Q

What are index teeth?

A

Points of contact (facets) of opposing teeth in the intercuspal position

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47
Q

What are the 8 stages involved in production of a partial denture?

A

Examination and assessment
Primary imps
Occlusion if needed (record blocks)
Design
Secondary imps
Trial insertion
Finish
Review

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48
Q

What are the two types of full denture?

A

Conventional and replica

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49
Q

What is a conventional full denture?

A

Denture started from scratch

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50
Q

What is a replica full denture?

A

start by replicating previous denture

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51
Q

Which denture usually has more issues with retention?

A

Lower denture

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52
Q

What is denture stomatitis and describe its presentation:

A

candida albicans fungal infection due to denture being worn full time. Redness, sloughing, can be related to anaemia, reversed by improved OH

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53
Q

What is denture hypoplasia and describe its presentation:

A

blanching caused by denture and over time gums become chronically inflamed. Overgrowth of fibrous tissue, solved by relieving PMMA in that area and replacing once hypoplasia has shrunk

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54
Q

How much spacer is used when making special trays for complete dentures normally?

A

3mm

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55
Q

List the 7 stages involved in the production of conventional full dentures

A

Examination and assessment
Primary imps
Secondary imps
Occlusion
trial insertion
Finish
Review

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56
Q

List the 6 stages involved in the production of a replica full denture

A

Examination and assessment
Replica imps
Secondary imps and occlusion
Trial insertion
Finish
Review

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57
Q

What are three differences in stages between conventional and replica full dentures?

A

Replication imps instead of primary imps
master imps and occlusion in the one visit for replica dentures
One less clinical and lab stage

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58
Q

What fungi and bacteria cause angular cheilitis?

A

Combination of candida albicans, staphylococcus aureus and streptococci

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59
Q

What can cause angular cheilitis?

A

when dentures are over-worn and patients are over-closed

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60
Q

What is trismus?

A

limited mouth opening

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61
Q

What is the primary support area for an edentulous upper arch?

A

Hard palate

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62
Q

What is the secondary support area for an edentulous upper arch?

A

Ridge crest

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63
Q

Where may require relief in the upper arch for a full denture?

A

Incisive papilla and midline suture

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64
Q

What is the primary support area for an edentulous lower arch?

A

Buccal shelf and pear shaped pad

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65
Q

What is the secondary support area for an edentulous lower arch?

A

ridge crest and genial tubercles

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66
Q

Where is the relief area in a full lower denture?

A

lingual ridge incline and mylohyoid ridge

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67
Q

What is retention?

A

the resistance to displacement of a denture away from the ridge

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68
Q

What is stability?

A

the ability of a denture to resist displacement by functional stresses

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69
Q

What is support?

A

Resistance to vertical movement of a denture towards the ridge

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70
Q

What is the purpose of primary impressions? name 4

A

Treatment planning
examination of occlusion on articulator
determine path of insertion and design
construction of special trays

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71
Q

What material is used for first impressions and what trays?

A

Alginate and stock trays

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72
Q

In replica dentures, what tray is used for master impressions?

A

the replica of the previous denture is used as the tray

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73
Q

Which materials can a special tray be made of?

A

VLC Resin PMMA
Shellac
Self cure PMMA (acrylic)

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74
Q

How is a special tray made?

A

Tray is accurately moulded over a uniform thickness of spacer (modelling wax is used)

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75
Q

What impression materials require a 3mm spacer for their special trays?

A

Alginate (partials)
Silicone elastomers/polysulphides (partials)

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76
Q

What impression materials do not require a spacer for their special trays?

A

silicone elastomers (complete-replica)
zinc oxide/eugenol impression paste (complete/replica & conventional)

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77
Q

what does thermoplastic mean?

A

plastic on heating and harden on cooling, and are able to repeat these processes

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78
Q

Comment on the handling of alginate after taking impressions

A

It must be kept moist and be cast up ASAP.

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79
Q

Comment on the handling of elastomers after taking impressions

A

More dimensionally stable than alginate
Don’t require moist environment
BUT cast to avoid damage

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80
Q

How do you disinfect impressions?

A

Rinse under tap
disinfect for two mins in 10,000ppm (1%) sodium hypochlorite or dichloroisocyanurate (artichlor) solution
rinse thoroughly for 2 mins
cover alginate in damp napkin
label and place in lab bag
mark on prescription that they have been disinfected

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81
Q

What is the definition of a bounded saddle?

A

A saddle with abutment teeth on both ends

82
Q

What is a free end saddle?

A

There is a single abutment tooth at the mesial end of the saddle

83
Q

What is a critical abutment tooth?

A

A tooth which, if it was lost, would turn a bounded saddle into a free end saddle

84
Q

What are the three different flange design options?

A

Full
Part
Flangeless

85
Q

What is a major connector?

A

A plate or bar which unites partial denture saddles, provides bracing, indirect retention or acts as a splint

86
Q

Name 5 major connectors for lower partial dentures

A

Lingual plate
Dental bar
Lingual bar
split lingual plate
swinglock denture

87
Q

What is a split lingual plate?

A

Lower plate design but there are areas cut out interdentally so that no metal will shine through and be visible in the mouth

88
Q

What is a swinglock denture?

A

Has a wing flange that comes around the anterior of the teeth, engaging the sulcus. There is a gate that can close and a small clip on the other side to lock it shut.

89
Q

What is a horseshoe design also known as?

A

An anterior palatal bar

90
Q

Name two dentures which can be used in a patient that has lost an anterior tooth

A

Spoon denture
T-denture

91
Q

What is a minor connector?

A

the connecting component between the major connector or base of a partial and other units like clasps or rests

92
Q

What forces retain dentures?

A

Saliva film physical force
muscle activity eg. buccinator
muscle activity eg. tongue

93
Q

What is bracing?

A

The resistance of lateral movement of a denture

94
Q

Where is the point of action on a clasp?

A

The tip

95
Q

Where should the terminal 1/3 of a clasp be?

A

Below the survey line

96
Q

What is reciprocation in regards to clasps?

A

clasps exert a sideways force on a tooth when it is removed from the undercut, a suitable element must be provided on the other side to act as a reciprocating balance to counteract the force

97
Q

What is a ring clasp and where are they often used?

A

Occlusally approaching clasp often used on critical abutment teeth

98
Q

Name 4 materials that clasps can be made from

A

Stainless steel
Cobalt chromium
Gold
Thermoplastic copolymer eg. dental D

99
Q

What is the proportional limit of a clasp?

A

the limit at which a clasp is deformed elastically

100
Q

State the characteristics of a cast cobalt chromium clasp

A

extremely hard, strong and rigid
can be used with CoCr base plate
thinner in section
low proportional limit
high modulus of elasticity

101
Q

What depth of undercut can a CoCr clasp engage?

A

0.25mm

102
Q

State the characteristics of a wrought stainless steel clasp

A

round section - more flexible than cast CoCr
Cannot be soldered - not used with CoCr base, only PMMA
higher proportional limit than CoCr

103
Q

What depth of undercut can a SS clasp engage?

A

0.5mm

104
Q

State the characteristics of a gold clasp

A

expensive
better aesthetics in some opinions

105
Q

What depth of undercut can a gold clasp engage?

A

0.75mm

106
Q

State the characteristics of a thermoplastic copolymer clasp

A

tooth coloured material
very flexible so can engage deep undercuts
must be fairly thick to use

107
Q

What does the force required to displace a clasp vary with?

A

depth of undercut
length/cross section
flexibility of arm (type of metal)
angle of approach (gingivally better than occlusal)

108
Q

List four types of tooth preparation that may need to be carried out

A

addition of composite
selective grinding for ball ended clasp engagement
crown placement to provide undercuts
tooth prep to alter survey line

109
Q

What does clasp choice and material depend on?

A

position and depth of undercut
aesthetics
occlusion
shape of sulcus
length of clasp

110
Q

What are guide planes?

A

two or more parallel axial surfaces on abutment teeth which can be used to limit the path of insertion and improve stability of a partial denture

111
Q

What do guide planes do?

A

increase stability
reciprocation
prevention of clasp deformation
improved appearance (less of triangle at gingival margin)

112
Q

What is an RPI system?

A

mesial Rest, distal guiding Plate, I-shaped retentive clasp (I-bar)

113
Q

When are RPI systems used?

A

In a free end saddle situation

114
Q

What is a benefit of the RPI system?

A

they distribute the load to the tissues more evenly, less stress placed on the abutment tooth

115
Q

What is the objective of a replica record block technique?

A

to create a replica prosthesis which is dimensionally accurate but allows for modifications where required

116
Q

How do you carry out the replica technique?

A

Adhesive on tray and lab putty
putty dispensed (4-5 scoops, catalyst applied to putty, 3cm per scoop)
mix until no stripes
put into tray
polished surface of denture placed in putty with upper border level as possible without occlusal surfaces breaking through putty or touching tray
smooth putty along flange
cut notches
apply vaseline onto exposed putty
next lot of putty in sausage shape into fitting surface
2nd tray (coated with adhesive on outer surface) placed on top of putty on the fitting surface
putty pulled up the side of tray to form seam
leave to set
separate trays
remove denture
cut sprue holes
disinfect, write lab card, deliver to lab

117
Q

What is a common fault in replica impressions?

A

Air bubbles

118
Q

How can you correct faults in a replica record block impression?

A

light bodied material/perfecting paste applied over fault and then impression containing the denture then seated back over it and pressure applied

119
Q

What modification can be made if a denture base is underextended?

A

Temporary addition of greenstick before replication

120
Q

What must you do when taking a replica record block impression of a CoCr base plate denture?

A

thicken the chrome plate with wax prior to taking the first impression, this ensures the area of the palate is thicker so you can accommodate the wax and shellac of the record block

121
Q

How do you construct a replica blocks from the impression?

A

Shellac melted over the base impression to form the special tray
This is then trimmed to short of the border of the base to allow a wax rim to be present for comfort
wax poured in sprue holes
completed replica blocks formed

122
Q

What can be added to a shellac special tray to strengthen it?

A

a wire strengthener

123
Q

What kind of impression do we aim for when taking second imps?

A

A “wash impression” - light bodied material, able to record detail in thin section

124
Q

What kind of material can be used for a wash impression?

A

Light bodied material - rapid liner or aquasil

125
Q

What is considered a normal freeway space?

A

2-4mm

126
Q

What occlusal relationships do we examine at the occlusion stage?

A

Vertical jaw relationship - presence of FWS
Horizontal jaw relationship - reproducible path of closure

127
Q

How do you know how “tall” a denture should be?

A

RVD (can measure) - FWS = OVD

128
Q

How do you record how the record blocks come together at the occlusion stage?

A

Bite registration paste

129
Q

Where do you apply bite registration paste?

A

Molar and premolar region

130
Q

What is the occlusal plane approximately parallel to?

A

the ala-tragal line

131
Q

What is used to examine the occlusal plane?

A

Foxes Guide Plane

132
Q

How far below the lip should the incisors sit with the lip at rest?

A

1mm below

133
Q

How can you correct the buccal corridor?

A

Can pull teeth out buccally

134
Q

How can you correct the centre line?

A

Draw a line with the wax knife marking where you want the centre line to be, last thing you do

135
Q

What landmarks do we look at when assessing the occlusion?

A

Labial fullness - upper lip, philtrum
incisal level
incisal plane
occlusal plane
centre line

136
Q

What do we look at when assessing the incisal plane?

A

inter-pupillary line

137
Q

What extra aspects of the prostheses do you prescribe for at the occlusion stage?

A

Shade
Mould
Tooth arrangement
Articulator

138
Q

Through what structures can support for a removable prostheses be achieved?

A

Teeth (tooth-borne) and mucoperiosteum (mucosa borne)

139
Q

Where is mucosal support gained from?

A

Saddles and connectors

140
Q

Where is tooth support gained from?

A

rests, onlays, over-denture abutments and connectors
via periodontal ligament and ultimately the underlying bone

141
Q

How deep and wide should a rest seat be?

A

1mm deep and 1-2mm wide

142
Q

What kind of support is provided in a bounded saddle?

A

tooth support possible

143
Q

What kind of support is provided in a free-end saddle?

A

Tooth/mucosa borne at best

144
Q

What kind of support is provided in a large saddle?

A

Mucosa borne

145
Q

What is the major clasp axis and where should it ideally be?

A

The axis closest to the saddle and it should be as close as possible to the saddle end

146
Q

What is the minor clasp axis?

A

any other axes formed other than the major clasp axis

147
Q

What is a clasp axis?

A

line drawn through the active portion of the direct retainer

148
Q

Which type of support is preferable and why?

A

Tooth support is preferred to mucosal support for indirection retention due to the compressibility of mucosa

149
Q

Where are tissue stops placed in a lower tray?

A

Incisal region and over retromolar pads

150
Q

Where are tissue stops placed in an upper tray?

A

Incisive papilla region and along post dam area

151
Q

How is mucocompression recorded?

A

Pressure is applied to the mucosa so that the shape of the tissues under load is recorded

152
Q

How is mucostasis recorded?

A

Minimum pressure applied to tissues to record their shape at rest

153
Q

How big is the spacing in normal spaced trays?

A

3mm

154
Q

How big is the spacing in a close fitting tray?

A

Spacing up to 1mm

155
Q

How can the impression taking be modified for a fibrous (flabby) ridge?

A

Either 2 stage process - one mucostatic and one mucocompressed imp OR
impression using perforated tray and low viscosity material

156
Q

Where should you be positioned when taking impressions?

A

In front of the patient for a lower imp
Behind the patient for an upper imp

157
Q

Name the three main stages of recording a jaw relationship with record blocks

A

1)upper block alone - labial fullness, occlusal plane
2) trim lower block to meet upper, ensure appropriate OVD
3) Tooth position - ensure neutral zone

158
Q

What position stays the same throughout life?

A

Retruded contact position

159
Q

What is the retruded contact position?

A

guided occlusal relationship when the condyles are at their most retruded position in the joint cavities

160
Q

What is the definition of OVD?

A

Distance between a set point on the maxilla and a set point on the mandible when the teeth are in maximum intercuspation

161
Q

What is the RVD?

A

Rest vertical dimension - mandible at rest in upright position

162
Q

What does a patient with an excessive FWS look like?

A

“over-closed” facial appearance and cheek biting

163
Q

What materials can be used for artificial teeth? name 4

A

Porcelain
Acrylic based
composite resin based
combinations

164
Q

What is the standard shade guide?

A

Vita shade guide

165
Q

What is metamerism?

A

depending on different lighting arrangements, different colours appear differently

166
Q

What is colour washout?

A

When you spend so long looking at a colour that you no longer see what it looks like

167
Q

What classification prescribes tooth shape depending on face shape?

A

Leon Williams classification - inverted face shape is shape of maxillary central incisor. Oval, square or tapering

168
Q

What classification is based on a persons sex?

A

Frush and Fisher classification
males - square, angular
females - curved, rounded

169
Q

Regarding the arrangement of teeth, what do these stand for? NN, SS, CC, TT

A

Necks normal, slightly spaced, crossed centrals, twisted tips

170
Q

State two facial appearance changes that occur with ageing

A

attrition of the natural teeth
loss of muscular tone in lips and face

171
Q

Are artificial teeth usually larger or smaller than normal teeth?

A

Smaller - to supply enough space for the tongue

172
Q

Where on the ridge are lower teeth positioned?

A

Placed on the crest of the ridge to ensure stability

173
Q

Where on the ridge are upper teeth positioned?

A

slightly buccal to the ridge without compromising the border seal of the denture

174
Q

When would cusp-less teeth be required?

A

When it is difficult to get a reproducible jaw relationship

175
Q

What is the only reproducible jaw position throughout life in edentulous patients?

A

Retruded contact position RCP

176
Q

What is a dynamic, balanced occlusion?

A

when we can achieve an even contact in all excursive movements from our static balanced occlusion

177
Q

What curve depicts the positioning of teeth antero-posteriorly?

A

Curve of Spee

178
Q

What curve depicts the positioning of teeth laterally?

A

Bi-lateral curve of Monson (Wilson)

179
Q

What are index teeth?

A

Occluding teeth with contacting facets

180
Q

What Kennedy classes can have modifications?

A

Class I, II and III

181
Q

What are two alternatives to removable prosthodontics?

A

Fixed bridgework
Implant retained restorations

182
Q

In what population are Upper jaw Kennedy IV dentures common?

A

Usually younger patients as a result of trauma, aesthetic reasons

183
Q

Name three consequences of reduced mandibular support of a denture

A

trauma to denture bearing tissues
instability of denture
bone resorption

184
Q

Name three ways to achieve optimum mucosal support

A

reduce load to the denture bearing area by reducing the number of denture teeth (eg. no 7s)
cover maximum area with saddle
extend saddle onto loading areas ie. primary stress bearing area eg, buccal shelf on mandibular ridge

185
Q

What is the principle behind the altered cast technique?

A

The saddle areas are recorded under load

186
Q

What is a stress breaker denture?

A

a lingual plate with a section cut away to allow the plate to flex and allow the saddles to move down the tissues without putting strain on the anterior part

187
Q

For the try-in appointment what material is the tooth set-up base made of?

A

Wax base
or if CoCr denture, framework with teeth set in wax around it
replica technique - teeth set in wax on shellac base used for master imp

188
Q

Are SS clasps present on the try-in set up?

A

No, so it may feel more loose than the the finished denture

189
Q

List the try-in checks

A

lip support
incisal level
occlusal planes
extensions, retention, stability
tooth positioning
occlusion, speech, aesthetics

190
Q

How long after the ‘finish’ appointment does the patient return for review?

A

1 week later

191
Q

What products cause halitosis?

A

Fusobacterial sulphur products

192
Q

How do you clean dentures?

A

Soap and soft brush
NOT toothpaste
Ultrasonic baths, microwave 20 secs can kill fungi (nothing metal containing)

193
Q

What is the active ingredient in an alkaline peroxide denture cleaner?

A

sodium perborate

194
Q

Name 5 types of denture cleaner

A

Alkaline peroxides
acids
alkaline hypochlorites
enzymes
abrasive cleaners

195
Q

Name two disadvantages of alkaline peroxide denture cleaners

A

do not effectively deal with calculus or darker staining
NOT suitable for soft linings

196
Q

Which denture cleaner is considered a light duty denture cleaner?

A

Alkaline peroxides

197
Q

Which denture cleaner is considered a very effective anti-fungal and anti-bacterial cleaner?

A

Alkaline hypochlorites

198
Q

What is a disadvantage of alkaline hypochlorites?

A

may corrode metal

199
Q

How are alkaline hypochlorite denture cleaners used?

A

10 minute soak if metal component on denture

200
Q

Regarding denture care, what do you tell your patients?

A

Rinse mouth/denture after every meal
remove denture at night
brush with soap and water holding over half filled sink or towel
no toothpaste
any chemical cleaners should be used with cold water
store in cold water overnight after cleaner
clean remaining natural teeth
record instructions given in notes

3rd Year - Module 5 (12 decks)

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