REMOVEABLE PROS Flashcards
1
Q
What are the reasons for rendering a patient edentulous?
A
- Caries
- Periodontal disease
- Appearance
- Malocclusion
- Overload of opposing jaw, especially edentulous lower
- Patients request
2
Q
Why is root caries more prevalent in the elderly?
A
- Gingival recession (shrinks as you get older)
- Medication that reduces salivary flow
3
Q
What are the contraindications for rendering a patient edentulous?
A
- Masticatory efficiency reduced
- Alveolar resorption
- Muscular skills required to manage f/f (special difficulty in the elderly)
- Medical conditions
4
Q
An alternative to rendering a patient edentulous, would be to have overdentures, what are the benefits of opting for overdentures?
A
- Retain some roots and restore to be used to support dentures.
- Preserve alveolar bone
- Retain proprioception
5
Q
What are the advantages of an immediate replacement denture?
A
- Maintain pre-extraction information
- Tooth mould, shade, arrangement
- OVD
- Appearance
- Continuity of denture wearing
- Protect initial bloodclot
6
Q
What do you need to make aware to the patient in reference to financial implication?
A
That the denture will become loose and will require replacement overtime.
7
Q
What do you need to consider before preparing a patient for immediate replacement dentures?
A
- Take molars out first and allow healing
- Number of teeth to be replaced
- Risk of haemorrhage
- Post extraction swelling
- How much LA you have to administer.
- Healed areas
8
Q
How many designs are available for immediate replacement dentures?
A
3
9
Q
What are the three flange designs available?
A
- Flanged
- Part flanged
- Open face
10
Q
In some situations, it is not possible to put a full flange on the denture at all, that maybe due to what?
A
- undercut in the buccal sulcus
- When the bone is particularly bony
11
Q
This flange design supports, retention, undercuts, and aesthetics, which flange design is this?
A
Flanged
12
Q
In some instances, the denture will not fit over the alveolar ridge, thus opting for a denture that sits over it, with the consequence of having sections of the denture that presents itself for food packing and a plaque trap. What design would you opt for instead of this?
A
Part flange or open face denture.
13
Q
What must you consider when making an open face flange design, in reference to a gap forming?
A
Resorption of ridge will lead to gap between denture and ride.
14
Q
How long should the dentures be kept in for post extraction?
A
24 hours
15
Q
When you remove the dentures after 24 hours, after an extraction has been completed and IRs has been placed, what are you looking for?
A
Examine mouth for healthy clots and identify any areas of inflammation.
16
Q
What would be the after 24-hour post op instructions after IRs has been placed?
A
Advise warm saline mouthwash and patient to remove denture after mealtimes, to rinse and clean denture with soft toothbrush and soapy water.
17
Q
If a 24-hour review is not possible after an IRs, what must you ensure?
A
Ensure patient gas post op instructions and details of how to make contact.
18
Q
A
19
Q
What is the definition of retention in relation to dentures?
A
Resistance of a denture to VERTICAL movement away from the tissues.
20
Q
What is the definition of stability in relation to dentures?
A
The resistance of a denture to displacement by functional forces (more lateral direction).
21
Q
What are the four displacive forces that can make the denture move
A
- Gravity
- Muscle activity
- Sticky foods
- Function
22
Q
Which denture would gravity have an affect on?
A
Upper denture, you would try to make the upper denture as light as possible to minimise this.
23
Q
Gravity would have a greater force on an acrylic or cobalt chromium upper denture?
A
Cobalt chromium.
24
Q
When muscles are activated during smiling or speaking, what does it to the oral cavity?
A
It changes the shape, muscles are very strong and can exert a huge force when they are active, this can result in the displacement of dentures both upper and lower.
25
How is interfacial surface tension created?
When there is a thin layer of fluid present between two parallel planes of rigid material.
26
Why must the material of the denture allow for it to get wet?
The ability of the denture material to allow fluid to wet the rigid material, allows for the creation of interfacial surface tension.
27
The pure water on the acrylic material will cause droplets of water on the material and will not form an interfacial surface tension, what must be created first?
A pellicle layer must be created first and this is created by saliva, saliva would coat the acrylic denture. Once the acrylic is coated, the acrylic can be wetted much better.
28
Saliva consists of two components, what are they?
Mucous and serous fluid.
29
Serous (watery saliva) has a greater ability to create interfacial surface tension than thick mucous saliva, true or false?
True.
30
What is interfacial viscous tension?
The force holding two parallel plates together that is due to the viscosity of the interposed liquid (saliva).
31
Viscosity refers to the resistance to flow, what does low viscosity mean?
Low viscosity means that it is easy to flow.
32
What would cause the viscous tension to increase?
As the viscosity of the liquid decreases
33
Viscous force falls rapidly as the thickness of the liquid increases or decreases?
Increases
34
What is required for the optimum adaptation between denture and mucosa?
Need good quality saliva (salivary film).
35
Interfacial viscous tension is more critical to maxillary or mandibular dentures?
Maxillary
36
What Is the definition of adhesion in relation to dentures?
The physical attraction of unlike molecules for each other.
37
What is the adhesion relationship in dentures?
Saliva – mucous membrane and saliva – denture base
38
How do you maximise adhesion in dentures?
The bigger the area that is covered by denture, the bigger the adhesive force can be.
39
What is cohesion?
The physical attraction between similar molecules (salivary film)
40
Atmospheric pressure is present in the importance of a border seal, seals are only really achievable in maxillary or mandibular
MAXILALRY
41
To achieve optimum retention and stability with complete dentures we need to consider the three surfaces of the dentures, what are these surfaces?
1. Fitting (basal) surfaces
2. Polished surfaces
3. Occlusal surfaces
42
Loss of alveolar bone height is greater in the mandible or maxilla?
Mandible
43
What is the primary supporting tissue for dentures?
Basal bone of the maxilla or the mandible
44
What is the secondary supporting tissue?
1. Soft tissue
2. Rugae
3. Tuberosity
45
Where should the post dam be ideally be placed?
Near the palatine fovea
46
For lower partial dentures, if the patient has a very resorbed alveolar ridge, which fitting surface area can be utilised to help keep the denture in place?
Retro mylohyoid fossa (lingual pouch)
47
Having a path of insertion that is not straight will make the denture more?
Retentive
48
What is an atrophic ridge?
It is the no presence or minimal alveolar bone.
49
Why are the teeth placed on a denture placed in the neutral zone?
The neutral zone is in relation to the tongue and oral musculature.
50
Why should the posterior teeth in the mandibular dentures be straight?
This prevents lingual overhangs, which make the denture unstable.
51
Natural teeth can cause trauma to the opposing edentulous ridge, what can this trauma lead to?
Resorption of the ridge
52
Trauma to the maxillary denture bearing area by opposing teeth, can result in alveolar resorption and replaced with what?
A fibrous tissue replacement known as a flabby ridge.
53
What does this image show?
A fibrous ridge
54
When taking an impression for edentulous patient who has a fibrous ridge, should you take the impression under load or at rest and why?
Who should take the impression at rest, because when the patient is at rest and wearing his denture it will stay in better
55
When taking an impression it is vitally important that an impression is fully extended but not?
Overextended
56
If a patient is wearing a full upper denture, and only has lower anterior teeth present, what complication can it cause to the denture?
It would allow for the posterior aspect of the denture to tip down.
57
if a patient had a full upper denture, and was wearing this lower partial denture, it would indicate that they had lower anterior teeth present. Why is it so important to have this lower denture design?
The free end saddle will allow for the stability of the maxillary denture from tipping.
58
This image shows the over eruption of the upper teeth, due to the over eruption it has not left enough space for the dentures. What is the management for the over erupted teeth?
Extraction
59
What is relining?
Relining is resurfacing the tissue side of a denture with a new material to fill the space that exits between the original denture contour and the altered tissue contour.
60
what is rebasing?
Replacing the entire denture base material of an existing denture
61
relines fall in to three categories, what are they?
1. Temporary
2. Soft
3. Permanent
62
Temporary relines are used for how long?
Few weeks maybe longer.
63
When would you use temporary relines?
1. Tissue conditioning – with grossly ill-fitting dentures
2. Post immediate dentures
3. After implant surgery
64
Why can’t soft relines last long functionally, and what problems can this cause?
the soft relines have plasticizer present in the material which give it that plasticity and flexibility structure, over time the plasticizer bleaches and results in the material to harden. Losing function and harbouring more bacteria.
65
How is molloplast B cured?
By heat
66
How is coe-soft cured?
It is a self-cured acrylic
67
Before taking an impression for a reline, what must be removed from the current denture?
Undercuts
68
What type of impression is taken when doing relines?
Wash impressions
69
How would you do a simple repair for a midline fracture of a complete denture?
If fractured pieces can be located together, disinfect & send to lab (no impression needed), cast poured, fractured area removed, new acrylic processed.
70
How would you do a repair with a piece of denture missing?
Impression taken with fractured denture in mouth, disinfected, cast poured and new acrylic processed into defect.
71
Cyanoacrylate glue is known as?
Super glue
72
Additions on partial dentures fall in to three categories they are?
1. Immediate addition
2. Post-immediate addition
3. Retention
73
When a tooth is lost after denture construction such as having an extraction, when would this addition be added?
Immediately
74
When would a post-immediate addition take place?
When a tooth is lost after denture construction & at a later date a tooth added, allowing for the soft tissue to heal for two or three weeks.
75
What is an overdenture?
Any removeable dental prosthesis that covers and rests on one more remaining natural teeth, the roots of natural teeth, and/or dental implants.
76
What are the advantages of overdentures?
1. Correction of occlusion and aesthetics
2. Support
3. Tooth wear management
4. Preservation of ridge form
5. Proprioception
6. Denture retention
7. Can be used with precision attachments
8. MRONJ & radiotherapy patients – avoids extractions
9. Psychological benefits
10. Useful in elderly patients
11. Eases transition to edentulism
77
What are the disadvantages of overdentures?
1. Need for good oral health
2. Increased caries/periodontal problems
3. Care homes
4. Denture fracture
5. Discomfort fracture
6. Discomfort/infection
7. Medical history
8. Potentially more traumatic extractions
78
What is a dental implant?
A dental implant is an artificial tooth root that is surgically anchored into the jaw to hold a replacement tooth or teeth or a denture in place. The benefit of using implants is that they don’t rely on neighbouring teeth for support.
79
When placing a implant into bone, there will be no periodontal ligament to support it, however implant materials are accepted by the bone as part of itself rather than a foreign body, what is the term given for this?
Osteointegration.
80
Where does the abutment sit on a dental implant?
Between the implant screw and the crown.
81
Which landmark does the abutment sit on?
The gum, known as the peri implant mucosa
82
Why do you not have periodontitis with implants?
You cannot have periodontitis because there are no periodontal ligaments present, you however will develop periimplantitis
83
An implant that can restore multiple teeth is called a?
implant bridge
84
An implant that can secure a denture firmly is called a?
implant overdenture
85
What is the implant treatment sequence?
1. Plan and consent
2. Place
3. Uncover and connect abutments
4. Restorative procedures
5. Restore
6. Monitor and maintain
86
What are the risks associated with implants?
1. Minor surgical risks – pain, bruising, swelling
2. Major surgical risks
3. Paraesthesia
4. Perforation into nasal cavities or maxillary antrum
5. Failure to integrate
6. Late failure
7. Bruxism and implants
8. Peri-implants
9. Peri-implantitis
10. Failure of superstructure & components
87
What are the four stages of placement of an implant?
1. Raise flap
2. Place implant
3. Place cover screw
4. Suture
88
Once you have placed the implant and sutured over it, how long should you weight for osteointegration to occur?
3 months
89
What are the prosthetic stages for a single tooth?
1. Uncover implant
2. Place abutment
3. Take impression with coping
4. Choose colour
5. Place temp
6. Cast impression with lab dummy
90
What are the common post implant treatment complication?
1. Peri-implant mucositis
2. Peri-implantitis
3. Loose/fractured components
4. Late implant failure
91
What is peri-implant mucositis?
Peri-implant mucositis is defined as inflammation of the peri-implant mucosa with no evidence of crestal bone loss. The tissue will appear red and swollen and may bleed on gentle probing.
92
What is peri-implantitis?
Peri-implantitis is defined as infection with suppuration and inflammation of the soft tissue surrounding an implant, with clinically significant loss of peri-implant crestal bone after the adaptive phase. The tissues will appear red and swollen, may bleed on gentle probing and there will be suppuration.
93
If there are signs of peri-implantitis what must you do with a radiograph?
Carry out a radiographic examination to evaluate peri-implant bone levels compared with the baseline radiograph.
94
UK medical device manufactures must be registered with the?
Medicines and Healthcare products regulatory Agency (MHRA) under the terms of the medical devices.
95
All custom-made dental devices such as crowns, bridges, dentures, implant prosthesis, orthodontic appliances are classed as?
Medical devices
96
Since the beginning of April 2021 all the NHS and university teaching laboratories have been registered as what?
The manufacturer
97
What must laboratories produce, which must be offered to the patient by the clinician?
Statement of manufacture
98
What are the advantages of a statement of manufacture?
1. Include quality control
2. Use of materials for device
3. Used as teaching model for future devices
99
If a statement of manufacture was declined by the patient, what should be done?
It should be written in the notes that it was declined.
100
When did the new prosthodontics forms begin?
30/08/2022
101
What does the new form have?
1. A section for patient identification
2. A design section
3. A treatment plan/special instructions section
4. Room for 5 stages on one form
5. A4 sheet so different from size of current form
6. Carbon copy (yellow)
102
On the five stages form who is the prescriber?
You the student
103
After you have done the occlusion, the next stage will be 2nd imps. So you are going to need special trays, you need to specify the material for the 2nd imp tray which is usually what?
Light cure material.
104
How much spacing do you need for the alginate in the 2nd imps?
3mm
105
What must you have done before taking the 2nd impression?
Designed the denture.
106
A cobalt-chrome framework often requires an extra week between visits, how long?
Usually, 3 weeks rather than 2.
107
