Removable Prosthodontics Flashcards
What are the 6 reasons for rendering a patient edentulous?
- Caries
- Periodontal disease
- Appearance
- Malocclusion
- Overload of opposing jaw (especially edentulous lower)
- Patient’s request
What are the 4 arguments against rendering a patient edentulous?
- Masticatory efficiency reduced
- Alveolar resorption
- Muscular skills required to manage F/F (this can be difficult for elderly)
- Medical conditions
What is the key alternative treatment plan to rendering a patient edentulous, where roots of teeth are caries free with good surrounding bone levels?
Use of an over-denture abutment (retain some roots that will support a denture)
What are the two main advantages to maintaining an over-denture abutment compared to extracting the full tooth?
- Preservation of alveolar bone
- Retain proprioception
Define, resistance of a denture to vertical movement away from the tissues.
Retention
Define, the resistance of a denture to displacement by functional forces.
Stability
What are four forces that could displace a denture? (The first answer is a force that only affects the upper denture)
- Gravity
- Muscle activity
- Sticky foods
- Function
Define, tension that is generated when a thin layer of fluid is present between two parallel planes of rigid material.
Interfacial surface tension
Define, the force holding two parallel plates together that is due to the viscosity of the interposed liquid (e.g. saliva).
Interfacial viscous tension
What happens to viscous tension when thickness of saliva increases?
Force falls rapidly
What type of saliva is best to allow for optimum adaptation between the denture and mucosa?
Thin saliva
Define, the physical attraction of unlike molecules for each other.
Adhesion
Define, the physical attraction between similar molecules (e.g. salivary film).
Cohesion
Why is a greater base extension achieved in the maxilla compared to the mandible for an edentulous patient?
Because loss of alveolar bone height is often greater in the mandible compared to the maxilla. Therefore, remaining basal bone left to support the denture will always have a greater surface area in the maxilla.
Where should post dam of a maxillary denture sit in relation to palatine fovea in order to generate a good border seal?
Just anterior to palatine fovea
Where is it important for a lower denture to extend over in order to offer some bracing to the denture?
Adequate extension into the retro-mylohyoid fossa (lingual pouch)
What is the advantages of utilising natural mucosal undercuts when placing a denture?
Increases retention
How do undercuts increase retention of a denture?
The denture will need to be tilted and rotated to fit into position in the mouth, there isn’t a straight line of insertion. This increases retention.
How does an atrophic ridge make denture retention and stability difficult?
There is less surface area that can be covered for retention of a denture and less scope to engage useful undercuts
Where are teeth normally positioned in a lower complete denture?
Over the centre of the ridge
Where are teeth normally positioned in an upper complete denture?
Buccal aspect of the ridge
Define, an area on the denture where the outward forces from the tongue are balanced by the inward forces from the cheeks.
Neutral zone
What are the advantages of placing teeth on a denture in the neutral zone?
Increase in stability, retention and comfort.
How does addition of “valves” to a denture achieve a good base fit?
Valves act by sucking air out from under base of denture
The presence of natural teeth against an opposing edentulous ridge can lead to what? (List 3 things)
- Trauma
- Increased resoprtion
- Lack of stability of dentures
What area of the edentulous maxilla is particularly affected when opposed by forces of natural teeth?
Pre-maxilla (anterior region)
What is the consequence of trauma to the edentulous maxillary denture bearing area?
- Soft tissue damage (ulceration and discomfort)
- Alveolar resorption (combination syndrome) and fibrous tissue replacement (flabby ridge)
What effect can a fibrous/flabby ridge have on a denture?
Cause tissue displacement and tipping of the denture
Why type of impression do you want to take of a fibrous ridge?
A mucostatic impression
For more severe fibrous ridge, what type of impression should be taken?
Two stage silicone impressions
What are two ways to reduce trauma to the maxillary edentulous denture bearing area?
- Maximum coverage of the denture bearing area with the prosthesis
- Ensure the prosthesis covers the primary load bearing sites
What is the advantage of using overdenture abutments?
Helps to support the denture and maintain alveolar bone (prevents flabby ridge formation!)
What are the 5 management options for an irregular occlusal plane on the natural teeth?
- No adjustment
- Minimal localised occlusal grinding
- Radical occlusal adjustment (crown tooth)
- Extraction of teeth
- Overlay appliance
Why are issues much more severe in the case of a complete lower denture with upper natural teeth, compared to a full upper denture with lower natural teeth?
Because there is excessive occlusal forces and imbalance, which may lead to accelerated resorption of the lower ridge.
What are the 3 management options for a complete lower denture with upper natural teeth opposing?
- Soft lining in denture
- Retain roots and provide overdenture
- Implants
What is a Reline?
Adding a more base material to the tissue surface of an existing denture in a quantity sufficient to fill the space which exists between the original denture contour and the altered tissue contour.
What is a rebase?
Replacing the entire denture base material of an existing denture (only complete dentures)
What are the three types of relines?
- Temporary
- Soft
- Permanent
What would be the indications for using a temporary Reline (tissue conditioner)?
- where lower ridge is inflamed and softer lining is required
- to improve fit of ill-fitting dentures
- for immediate dentures to improve adaptation
- after implant surgery while implant abutment integrates
When are soft relines indicated for dentures?
- patients with parafunctional habits
- patients with atrophic ridges
- cancer/cleft patients
What are the downsides to soft linings?
- Plasticiser leaches and deteriorates with time so needs regular maintenance
- Soft linings harbour microorganisms so patient is more prone to Candida infection
What are the 4 types of soft lining materials?
- Heat cured acrylics
- Self cured acrylics
- Heat cured silicones
- Self cured silicones
What is an example of a chairside self-cured acrylic soft lining?
Coe-soft
What is an example of a laboratory based heat-cured soft lining?
Molloplast B
What are permanent relines usually made of?
Heat cured acrylic
When is a permanent Reline a useful addition to a denture?
- If there are issues with the peripheral seal of denture 2.corrections need to be made following inadequate master impressions. 3. Immediate/post-immediate dentures. 4. Prolongs lifespan of some older dentures
What does a glossy/shiny fitting surface of a denture indicate?
That it is fairly worn
How do you rebase a denture? (8 steps)
- Remove undercuts from fit surface of denture
- Take wash impression with closed mouth technique
- Impression is poured in stone
- An overcast in plaster is used to ensure denture is in same location as when lining is placed
- Post-dam carved into working model
- The fitting surface and palate of denture has been removed to allow space for new acrylic
- Palate added in wax
- We flask this using injection technqiue
What type of fracture is commonly seen in complete dentures?
Midline fractures
Name 5 different ways damage to denture occurs.
- Midline fracture
- Tooth detached from denture base
- Loss of flange (usually from dropping)
- Acrylic saddle detached from Co/Cr baseplate
- Clasp fracture/bent
What is most common cause of midline palatal fracture of a denture?
Acrylic in thin section
Name 8 common reasons as to why dentures fracture?
- Impact
- Acrylic in thin section
- Work hardening of metal
- Parafunctional habits
- Occlusion- deep overbite
- Soft linings
- Denture processing problems- porosity
- Bonding between tooth and base acrylic or acrylic and Co/Cr
How would you repair a midline fracture of a complete denture if the pieces can be located together?
- Disinfect And send to lab
- Cast poured
- Fractured area removed
- New acrylic processed
How would you manage an acrylic denture which has a lost flange?
- Take impression with fractured denture in mouth
- Disinfect
- Cast poured
- New acrylic processed into defect
What are the three types of additions for partial denture?
- Immediate addition
- Post-immediate addition
- Retention
What is an immediate addition to a denture?
When a tooth is lost after denture construction and tooth added on the day of tooth extraction
What is a post-immediate addition?
When a tooth is lost after denture construction and at a later date a tooth is added
What is a retention addition?
When a denture has inadequate retention a clasp is added to try improve retention
What type of clasp is usually added in a retention addition case?
Stainless steel clasp
What is an overdenture?
Any removable dental prosthesis that covers and rests on one or more remaining natural teeth, the roots of natural teeth, and/or dental implants.
Name 10 advantages of overdentures?
- Correction of occlusion and aesthetics
- Support
- Tooth wear management
- Preservation of ridge form and bone
- Proprioception
- Denture retention (precision attachments)
- Avoids extractions in MRONJ and radiotherapy patients
- Psychological benefits
- Useful in elderly patients
- Eases transition to edentulism
Name 7 disadvantages of overdentures.
- Need for good oral health
- Increased caries/periodontal issues
- Care homes (diet can be high in refined sugars)
- Denture fracture
- Discomfort/infection
- Medical history (dry mouth)
- Potentially more traumatic extractions
What are the two components of precision attachments and their function?
There are ‘male’ and ‘female’ components.
Male component is fixed to the natural teeth.
Female component is incorporated into the denture.
These components lock together to yield a very stable prosthesis
What are the 4 important messages to tell patient for overdenture care?
- Good oral hygiene
- Fluoride toothpaste on roots
- Regular examinations and radiographs
- Denture hygiene