removale pros Y5 lecture Flashcards
when managing pt with poor prognosis teeth (using dentures) what do you need to consider?
- Pt wishes
- Pt previous experience wearing dentures
- Medical history
- Life expectancy of teeth, active disease
- Pt ability to maintain optimal oral health
- position of the poor prognosis teeth
- Pt attendance/number of visits available
- Long term tx plan for pt
what to consider in terms of pt wishes
- does pt want denture to replace missing teeth?
- is the pt wearing a denture already
what to consider in terms of pt previous experience wearing dentures
- pt weating a denture that can be added on
- acrylic easier to add on than cobalt chrome
- new denture can be made later once all teeth extracted and tissues have healed (6-8 weeks)
what is a transition denture?
usually a partial denture with teeth added until it becomes a complete denture
what to consider in terms of medical history
- poor healing response or resistance to infect may influence choice of tx (endo vs. XLA)
- poor general health or mobility may make travel or time spent in chair difficult (shorter/fewer appt. better)
what to consider in terms of life expectancy of teeth, active disease or pain
- try preserve natural teeth
- balance this with managing active disease/pain
- consider postpone XLA until tried to stabilise disease
- if natural tooth crown is unrestorable, root may be saved as over denture abutment
- overdenture abutments should always be above gingival level, cleansable, well maintained by pt
what is considered as the pt ability to maintain optimal oral health
- dentures increase risk of perio
- always stabilise perio disease and improve OH before denture
Ideally plaque <20% before starting dentures
ideally marginal bleeding <10% - pt should understand the risks and why good OH is important
- XLA poor prognosis teeth allow 6-8 weeks)
what to consider about pt with poor prognosis teeth
- over-erupted, tilted or drifted natural teeth can disrupt occlusal plane, fitting denture teeth around poorly positioned natural teeth can be tricky
- upper complete rely on suction (peripheral seal)
- retaining 1 upper natural tooth each side can facilitate direct retention (1 clasp on each side better than only 1 side)
- lower denture, gravity helps denture stay in place (no peripheral seal)
- retaining lower teeth helps denture stability
what to consider about pt attendance/number of visits available
- pt need to know exactly how many visits needed
- planning tx incl. soft tissue management, perio,direct &indirect resto, XLAs (incl. healing)
- all denture stages (6 visits)
what to consider about long-term tx plan for pt
- is pt having more teeth XLA later? (acrylic easier to add on)
- CoCr more expensive and time consuming, teeth can be added to if metal extends in that area
- can have temp. acrylic denture first then CoCr later?
- wear cases need proper planning (e.g. Incr OVD)
- denture worn to allow healing before bridge?
steps for new immediate replacement dentures to replace previous XLA teeth +teeth to be XLA
- start to make new partial acrylic denture around teeth to be extracted (use acrylic not CoCr)
- Add extra teeth to denture before being finished
- XLA teeth and fit immediate denture at same visit
how to make immediate acrylic denture to replace 2 anterior teeth
- upper and lower alginate impressions +shade+jaw reg (interocclusal record)
- show wax tooth try in to pt
- XLA teeth and fit immediate denture at same visit
why need to make mouth healthy?
- dentures more comfortable
- Dentures last longer (other tx may change fit of denture)
- Dentures can make denture disease worse
what structures are affected?
- Oral mucosa
- Teeth and periodontal tissues
How to manage pt with denture stomatitis (denture sore mouth)
- candida albicans (cause)
- soak in miltons solution for 2 weeks (not metal)
- keep dentures clean
- take out at night
- medication options (nystatin oral suspension or miconazole gel)
- look out for angular cheilitis
- pt susceptibility - referral for tests?
ulcers
- mouth ulcers usually resolve 2-3 weeks
(arrange review and urgent referral to OM for persistent ulcers) - BRONJ - need referral
- traumatic ulcer from poorly fitted dentures - routine management
how to help pt with ulcers
- denture border too long for sulcus
- identify area with pressure paste
- trim back with acrylic bur
- soft lining may help (viscogel)
why articulate study casts
easier to view incisal tx from palatal aspect
what is meant by jaw relationship
3D spatial rx between upper and lower teeth
- both horizontal and vertical component
what is ideal occlusion for partial dentures?
- reprodicable ICP
- all need is facebow
if you cannot hand articulate cast, what to do then?
no natural teeth to record ICP, so we always record jaw rx using retruced position such as centric rx
1. mount cast on articulator
2. need occlusal rims
3. interocclusal record
4. facebow
what can occlusal rims be made out of
- wax
- self-cured acrylic
- heat-cured acrylic
why use a facebow
-facebow used to record the 3D rx between the upper occlusal plane and terminal hinge axis in pt
- then transfer this rx onto articulator
enables articulator to simulate the pt jaw movements better - If articulator simulates pt better , then any restos made on the articulator (e.g. dentures) are more likely to conform to pt occlusion and be more acceptable to the pt
what are only on CoCr dentures
guide planes and rest seats
what are the steps to make a denture
- primary impressions
- secondary impressions (master impressions)
- if CoCr - make fit cobalt framework (& add wax rims to do jaw reg)
- tooth try in- pink wax - flask pack finish
- denture tooth try in
- denture fit
- denture review
explain denture fit
- apply pressure indicating paste on fit surface,seat denture with even pressure on both sides
- adjust white spots with acrylic bur
- check occlusion
- give denture instruction!
what are mouth care instructions for pt
- brush natural teeth
- ensure you can remove place dentures easily
- brush dentures 2x/day, soft brush over sink
- don’t wear at night
- if soreness, leave out and book appt.
- advice annual check-ups teeth
what are benefits of CoCr denture
- more hygienic
- stronger
- less bulky/chunky
- less soft tissue coverage
what does it mean if pt says teeth too big
- overall denture shape too large
- teeth too forward
- dentures generally bulky
what to do if pt no complaints or problems at denture review
- check occlusion (GHM paper)
- remove dentures and check the health of tissues underneath
- check oral and denture hygiene
why does pt need time to adapt to dentures
- previous poor denture experience
- degree in change compared to old dentures
- quality of denture
- pt factors (age, oral, general health)
- pt expectations (pt complaint)
what are some possible sources of error on final cast?
- using wrong type of impression material
- not following instructions
- using flexible impression tray
- not rinsing off disinfectant before leaving clinic
- not storing impression properly
- airbubbles trapped whist casting impressions
- excess liquid inside impression when casting
what can be the reasons for pain under the denture
- denture fit wrong shape
- tissue under denture more sensitive
- occlusal load transmitted through denture is more than mucosa can tolerate
what can you use to determine optimum shape for lower denture. (denture space)
piezograph
then convert piezograph to wax to make occlusal rim
then adjust to record vertical and horizontal jaw rx
possible causes for gagging
- upper denture too far back
- upper denture loose
- excessive OVD
- lack of tongue space
broken dentures
ask pt
1. whats cause
2. previous repair
3. pieces fit together properly
4. opposing cast
5. reoccurance likely
causes of midline fracture
- open flange
- deep frenal notch
- midline diastema
- unfavourable occlusal forces
how to fix acrylic fractures
- clean fracture
(fix together with sticky wax, pour plaster cast and repair in cold-cure in lab) - complex fracture
(need alginate impression of all or some pieces in situ so can relocate them) - can be difficult better to remake likely instead
how to prevent fractures
- adequate thickness of acrylic
- strengtherners (selenese fibres or SS)
- high impact acrylic
denture reline and rebase
reline: resurface tissue side of a denture to make it fit more accurately
rebase: a method of refitting a denture in which the base material is more or less completely replaced
what are the indications for reline/rebase
- where the fit surface doesnt fit
- bone resoption
- quick fix - alternative to new dentures
- fractures
- want to add flanges
- want to add soft lining
what is the impression technique used for relines
remove undercuts
use light bodied, flexible impression material
what are some problems with reline or rebase?
- increase OVD
- occlusal errors
- damage during lab processes
choice of reline materials
- perm or temp
- heat or cold cured
- chairside reline or lab reline
- hard or soft material
explain temp hard reline material chairside
- colacryl (powder or liquid)
- poor colour match
- fairly durable
- quick and easy use
- similar to impression material
- use close mouth technique
BE AWARE GET STUCK IN HARD TISSUE UNDERCUTS
explain temp soft reline chairside
viscogel (powder and liquid_
- poor colour match
- lasts few weeks
- cushions mucosa
- quick and easy to use
- use closed mouth technique
explain permanent soft reline chairside
-eversoft (powder and liquid)
-reasonable colour match
- last months or years
- cushions mucosa
- quick and easy
- closed mouth technique
explain permanent hard reline or rebase (lab)
- heat cured acrylics
- excellent colour match
- permanent
- need chairside impression
- thin layer blue extrude
- remove undercuts beforehand
- closed mouth technique
explain permanent soft reline lab
- heat cured flecible
- 3 mm thickness needed
- lower dentures
- reasonable colour
- cusions mucosa
- thin later blue extrude
remove undercuts beforehand
use closed mouth technique
how do we measure freeway space for edentulous pt
- 2-4 mm for edentulous pt
- willis gauge
- measure OVD with dentures in
- measure RVD with least 1 denture out
- FWS = RVD- OVD
what could happen if there is not enough freeway space
- might get soreness under 1/both dentures
- aching jaw
- pt may want to leave dentures out
- appearance may be unacceptable (too much tooth visible)
what could happen if there is not enough FWS
- deep creases corner of pt mouth
- might see infection/redness
- might have denture stomatitis
- poor appearance (poor lip support)
- jaw muscle ache
- pt may show very worn teeth /have difficultly chewing food
