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BDS4 > Restorative - Pros > Flashcards

Restorative - Pros Flashcards

1
Q

Partial Dentures-
1. Define support, retention, stability and indirect retention

A
  • Support- resistance to occlusal directed load e.g. rest seats
  • Retention- resistance to vertical disapclement forces e.g. mechanical- clasps/guide planes, muscular, physical e.g. cohesion/adhesion
  • Stability- resistance to horizontal displacement forces
  • Indirect retention- resistance to rotation displacement forces- provided by supporting components e.g. rest (prevent disto-vertical rotational disapclement of a saddle, ideally 90° to axis of rotation and on opposite side of the axis to the displacing force
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2
Q
  1. Define Kennedy Classification ll Modification 1?
A
  • Unilateral free end saddle with one bounded saddle
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3
Q
  1. What is the system of design used for designing partial dentures?
A
  • Outline saddles
  • Support
  • Retention
  • Bracing (reciprication)
  • Connectors
  • Review design
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4
Q
  1. Give 2 maxillary and mandibular connectors with advantages and disadvantages?
A
  • Maxillary Full Coverage Plate- ADV- can be made thin in cross section (0.5mm) and still maintain rigidity, can be made to avoid gingival margins so easily cleansable, provides support across palate from free end saddle, few edges that the patient might find uncomfortable, DISADV- mucosal coverage prevents natural sensation from the palate
  • Maxillary anterior Posterior Bar/Ring- ADV- little coverage of mucosal tissue which allows natural sensation, wide relief of gingival margins to allow to be easily cleansable, DISADV- number of edges patient might find uncomfortable, requires great cross sectional thickness which patient can find annoying, posterior bar offers less support to the free end saddle across the palate
  • Lingual bar- ADV- Less mucosal coverage and gingival margins left clear which makes the denture more cleansable, DISADV- Must be made thick in cross section to maintain rigidity which can make them hard to tolerate
  • Lingual plate- ADV- thin in cross section so generally well tolerated, DISADV- Cover the gingival margins making the difficult to clean and acting as a possible food and plaque trap
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5
Q
  1. What measurement are required for a lingual bar?
A
  • 8mm- 4mm height of bar, 3mm from the gingival margin, 1mm from bar to functional sulcus of floor of mouth

7mm

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6
Q

RPI-
1. What is an RPI?

A
  • Stress relieving clasp system
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7
Q
  1. What does RPI stand for?
A
  • Res on mesial surface
  • Proximal plate on distal surface
  • Gingivally approaching I-bar clasp
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8
Q
  1. What is the mechanism of action of an RPI?
A
  • As the saddle sinks into the denture-bearing mucosa during function there is rotation about the mesial rest which acts as an axis or rotation
  • The proximal plate and I bar clasp rotate downwards and mesially (respectively) around the axis of rotation
  • This causes them to disengage from the tooth/undercuts thus avoiding potentially traumatic torque
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9
Q

You are shown a cast with an upper Co/Cr framework in place.
1. List methods of tooth borne support? (3)

A
  • Occlusal rests
  • Cingulum rests
  • Incisal rests
  • Full coverage (onlay) rests
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10
Q
  1. Where should the extension of the Co/Cr denture base extend to?
A
  • 2mm in front of the palatine fovea (vibrating line)
  • If it is a full palatal strap
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11
Q
  1. There is a rest set on 12- what is it for? (1)
A
  • What may anterior rest seats provide? Indirect retention
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12
Q
  1. There is a rest seat on the 16- what is it for? (1)
A
  • What may posterior rest seats provide? Bracing (reciprocation) and support
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13
Q
  1. What type of clasp is the clasp on 24? (1)
A
  • What are the options for clasps on premolar- Gingivally approaching I bar clasp
  • If you were to use an occlusally approaching clasp would have to be gold
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14
Q
  1. What type of clasp if the clasp on 16? (1)
A
  • What are the options for clasp on molars?- Occlusally approaching clasp- single arm clasp, circumferential clasp, ring clasp
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15
Q
  1. Why is the framework not extending to 11 and 23? What is the benefit of this?
A
  • Less mucosal coverage
  • Easier for the patient to clean
  • Less bulky/irritation so more comfortable for the patient to wear
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16
Q

Complete Dentures-
1. Give 3 differences between old and new denture images on an image? (3)

A
  • Increased vertical dimension (tooth wear on old denture)
  • Flange extension
  • Tooth shade
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17
Q
  1. What is the name of the method used for producing a new denture of the same specifications?
A
  • Replica technique
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18
Q
  1. What are two other methods of adjusting the fit of a loose denture? (2)
A
  • Relines with soft or hard lining
  • Rebase
  • Remake
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19
Q
  1. What do you need to check at try in stage? (3)
A
  • Before patient comes in- Check correct denture and as prescribed, fit on the models, trail bases are smooth and rounded with no sharp angles
  • Extension- hold tissue away from denture and see if it drops (sign of overextension), should extend right into functional sulcus (pull back lip to check), check ip support by pushing on it
  • Retention (resistance to vertical displacement)
  • Stability (resistance to horizontal movement)- check for rocking
  • Support
  • Occlusion- satisfactory and even occlusal contacts with appropriate OB and OJ
  • Incisal and occlusal plane orientation
  • OVD
  • Midline- coincident?
  • Lip support
  • Incisal level and tooth show
  • Position of teeth as requested/desired
  • Shade and mould of teeth as requested/desired
  • Appearance acceptable to patient
  • No tooth contact during speech (increase inter-occlusal tooth if so)
  • Patient’s overall thoughts

  • LIMBO, OVD, retention, support, stability, aesthetics and occlusion
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20
Q
  1. What is the definition of retention? (1)
A
  • Resistance of a denture to vertical disapclement
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21
Q
  1. What is the definitive of stability? (1)
A
  • Resistance of a denture to horizontal displacement
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22
Q
  1. Give 3 ways that an upper denture is retained?
A
  • Retentive effect of surrounding musculature on non-fitting surface of the denture
  • Extension in the depth of the functional buccal sulcus (helps achieve border/peripheral seal)
  • Incorporation of a post dam positions
  • Adhesion and cohesion (effect of saliva underneath the palatal aspect of the denture)- the effect of this is enhanced by an accurate fit of the denture base to the mucosa
  • Clasps
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23
Q
  1. How can you check retention clinically?
A
  • Grabbing central incisors and trying to pull vertically downwards
  • Pull back lips/cheek to see if denture drops out on functional movement
  • Asking patient to speak with dentures in
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24
Q
  1. Biometric guidance for setting upper and lower teeth? (How should you set the teeth to best aid stability) (2)
A
  • Aim to place teeth in pre-extraction sites
  • Maxillary teeth placed buccal to the ridge to promote lower denture stability
  • Mandibular teeth placed over the ridge so that the palatal cusps of the upper occlude with the fossa of the lowers and the forces are appropriately directed
  • Position lower teeth over the ridge also reduced tongue restoration
  • Want the teeth to be set in the neutral zone
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25
Q
  1. How do you restore freeway space in very worn dentures?
A
  • Occlusal pivots
  • Restore occlusal surface with auto-polymerising acrylic resin (provisional)
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26
Q
  1. Other than remaking them how can you improve the retention of dentures?
A
  • Reline
  • Rebase
  • Move to implant retained
  • Precision attachments
27
Q
  1. What problems can an incorrect OVD give?
A
  • TMJD aggravation
  • Clicking of teeth when eating
  • Angular cheilitis
  • Pain in mandibular muscles
  • Occlusal trauma
28
Q
  1. Where should you post dam be on upper denture?
A
  • Hamular notch to hamular notch along the vibrating line (junction between the hard and soft palate- compressible tissue) which is located 1-2mm anterior to the palatine fovea
29
Q
  1. Where should distal extension of lower complete denture be?
A
  • 2/3 onto retromolar pad
30
Q
  1. Why is the buccal shelf used for support?
A
  • Is it relatively un-resorbable as the bone is very dense
31
Q
  1. What anatomical features are used to help set the incisors?
A
  • Patients facial asymmetry and philtrum as midline of phase- centreline between 2 central incisors
  • Labial frenum
  • 1-2mm incisal edge show when the lips are at rest
  • Teeth set 1cm anterior of the incisive papilla
32
Q
  1. What 4 things make up shade
A
  • Value
  • Chroma
  • Hue
  • Translucency
33
Q
  1. Write a prescription for special trays for upper and lower complete dentures?
A
  • Please our impression and construct upper and lower special trays in light cured acrylic
  • Upper tray- 2mm wax spacer
  • Lower tray- 1mm wax spacer
  • Include intra-oral stub handles and finger rests
34
Q

Immediate Dentures-
1. What are the advantages of immediate dentures?

A
  • Allows patient to have dentures as soon as extraction si carried our meaning they maintain their aesthetics which has a less effect on their physiological health
  • Maintains muscle tone
  • Maintains soft tissue and prevents soft tissue collapse
  • Can reduce post-operative extraction pain and infection as the socket is protected from the surrounding oral environment
35
Q
  1. What are the disadvantages? Immediate denture
A
  • Resorption over time makes the fit poor and the denture less retentive and stable
  • Will require reline/rebase or remake within 3-6 months as a result of alveoli ridge resorption
  • Can be sore around the extraction site during tissue swelling
  • Can be difficult sitting after surgical extraction
36
Q

An 85-year old lady attends you practice for the first time. She is complaining of generalised pain underneath her lower complete denture on the left side. She is also edentulous in the maxillary arch and successfully wear a complete upper denture. She gives a history of the denture becoming progressively looser during the last 2 years. On examination you suspect that the cause of the pain may be related to an unerupted sound second premolars tooth that is now partially visible?
1. Describe two common radiographic views used to assess the position of the tooth? (4)

A
  • OPT and occlusal or periapical radiograph
  • Use parallax technique (slob rule- if tooth moves with beam it is lingually placed and if it moves opposite to the beam it is buccal)
37
Q
  1. Given that the mandibular denture bearing area is very resorbed and the patient has osteoporosis. What possible complications could arise if extraction of this tooth was attempted? (4)
A
  • If patient is taken bisphosphonates for osteoporosis then risk of medication related osteonecrosis of the jaw (MRONJ)
  • Risk of fracture of the mandible (as atrophic)
  • Regular risk of extraction- pain, swelling, bruising, bleeding, infection, dry socket
  • Risk of nerve damage to mental nerve due to tooth position
  • Increased risk of infection as patient elderly as possibly immunosuppressed
38
Q
  1. You decide, after discussion with the oral surgeon that the tooth should remain in situ. Outline your approach to the design of a replacement lower denture that would be stable and comfortable in function. (12 marks)
A
  • Ensure denture is retentive, has sufficient support and stability
  • Ensure occlusal is sufficient- appropriate OVD, FWS
  • Ensure teeth set in neutral zone
  • Tooth shade and shape to patient preference
  • Ensure denture is extended appropriately and doesn’t impinge on frenulum attachment or into neutral zone
  • Consider placing a relief in the region of the 2nd premolar
  • Consider using a soft lining material under the area of the premolar
39
Q

Two impression trays are shown- one with greenstick on posterior saddles, one with the impression taking in alginate. 1. What denture stage is this? (1)

A
  • Master impression
40
Q
  1. Name the impression materials used on the diagram and explain what they are used for? (4) Alginate and greenstick.
A
  • Alginate- used for impression to capture the anatomy and surface details of the denture bearing tissue
  • Greenstick- used to modify trays by 1) creating stops to ensure that there is sufficient room preserved for the impression material 2) accurately modifying the posterior borders of the tray to help achieve good posterior seal and displace tissue in the area of the functional sulcus to ensure a functional impression is taken which helps ensure extension of denture is appropriate (functional movement of denture is possible)
41
Q
  1. Name any two constituents of the impression materials used? (2)
A
  • Alginate- calcium sulphate, salt of alginic acid (e.g. sodium alginate), trisodium phosphate, filler
  • Greenstick- carnauba wax, talc, stearic acid
42
Q
  1. What is the implication of taking an impression in impression compound?
A
  • Non-elastic material which allows disapclement of the tissue- used for primary impression
  • Must not use this where there are large undercuts
  • Generally poor surface detail so not used in primary impression
43
Q

Ridge Classifications-
1. What is Alwood and Howell’s classification of a ridge?

A
  • 1- Dentate
  • 2- Post extraction
  • 3- Broad
  • 4- Knife-edge
  • V- Flat
  • VI- Submerged
44
Q
  1. What is a knife edges ridge?
A
  • Caused by rapid resorption of lingual and buccal alveolar bone
  • Lingual/buccal bone resorbs much more rapidly after tooth loss than the height diminishes as a result of increase active osteoclastic bone resorption in the labial/buccal and lingual /palatal area
  • The typical presentation includes hard thin bone (significant width reduction) with thickened soft tissue to replace the lost bone closing
45
Q
  1. Name 3 reasons for a knife-edge ridge?
A
  • Immediate dentures
  • Periodontal disease before extraction
  • Traumatic surgery for extraction
46
Q
  1. How is a knife-edged ridge maintained (managed) for a complete denture?
A
  • Soft lining material place on fitting surface
  • Surgical removal of sharp bony defects if painful
  • If there is a specific sore area, reliefs can be put on the denture to relieve pressure on the given area
47
Q
  1. How is a knife-edged ridge maintained (managed) for a complete denture?
A
  • Soft lining material place on fitting surface
  • Surgical removal of sharp bony defects if painful
  • If there is a specific sore area, reliefs can be put on the denture to relieve pressure on the given area
48
Q
  1. What is the difference between a soft lining material and a tissue conditioner?
A
  • A soft lining material may be used on health mucosa simply as as a cushion/shock absorber in a reline or to aid in comfort of a denture in the case of an atrophic/knife-edge ridges
  • A tissue conditioner is used in unhealthy/ulcerated/inflamed mucosa to aid healing- it also dissipated forces but is a more short-term option
49
Q
  1. What is a functional impression?
A
  • Tissue conditioner is used
  • The material is applied and the patient wears the denture and impression in function for approximately 2hrs
  • They then return the impression and it is sent to the lab for a reline
50
Q

Denture Stomatitis-
1. What is the aetiology of denture stomatitis?

A
  • Poor dental hygiene- wearing dentures over night and not cleaning dentures
  • Trauma from ill-fitting dentures
  • May be exacerbated by immunocompromisation- diabetes, HIV etc., corticosteroid therapy- e.g. asthma inhaler, broad spectrum antibiotics therapy, nutritional deficiency, high carbohydrate diet and xerostomia
51
Q
  1. How is denture stomatitis manged?
A
  • Clean palate daily
  • Give denture hygiene advice including cleaning (clean with soft brush and warm soapy water or non-abrasive water and leave to soak in denture solution as per manufacturer instruction (usually 10-15 minutes twice daily)) and leaving out at night
  • Soak dentures in CHX mouthwash twice daily for 15 minutes and consider use of CHX mouthwash to clean mouth twice daily
  • Encouraged patient to leave dentures out as often as possible till inflammation resolved
  • Improve fitting surface of the denture- may consider providing new denture or rebasing denture in the long run but initial use of a tissue conditioner on the denture will help to reduce inflammation of the tissue in order to take accurate impression for new denture or denture rebase
  • Manage any other contributing factors e.g. referral to GP is suspected underlying medical condition, encourage rinsing after steroid inhaler use etc.
  • If this condition persisted, appropriate antifungal treatment- miconazole oromucosal gel (20mg/g- apply pea sized amount to fitting surface 4x daily after food for 7 days to lesions have healed (80g tube))- first line as both anti-bacterial and anti-fungal activity (some available with hydrocortisone)
52
Q
  1. What microbes are usually involved in denture stomatitis?
A
  • Candida albicans
  • Staphylococcus aureus
53
Q
  1. Give 4 virulence factors of candida albicans?
A
  • Adhesins
  • Hydrolytic enzymes- phospholipase, haemolysin, proteinase
  • Switching mechanisms
  • Germ tube formation
  • Extracellular enzymes
  • Acidic metabolites
54
Q
  1. Name 5 medicines you could use to treat denture stomatitis?
A
  • Topical- miconazole, nystatin, chlorhexidine
  • Systemic- fluconazole, itraconazole
55
Q
  1. You decide you need to make a new denture? What can you do in the short term for the patient’s current denture?
A
  • Tissue conditioner
  • Reline
  • Rebase
56
Q
  1. What local factors may contribute to denture stomatitis? (3)
A
  • Poor OH
  • Wearing denture at night
  • Trauma from poorly fitting denture
  • Smoking
  • Xerostoma
  • Inhaler
57
Q
  1. If the patient takes inhaler what will be seen on the occlusal surface and what could you do in the short term?
A
  • Erosion due to acidity of inhaler
  • Rinse mouth out after use of inhaler
  • Place fluoride varnish to protect occlusal surfaces
58
Q

Combination Syndrome- 1. What problem can occur with a complete upper denture occluding with a partial lower denture?

A
  • Combination syndrome which results in a flabby upper ridge
59
Q
  1. Why does a flabby ridge occur in combination syndrome?
A
  • Forces directed at upper anterior region where the upper denture displaces
  • This results in excessive and rapid bone loss of the maxillary anterior ridge which is replaced by excess fibrous tissue (makes impression taking difficult)
60
Q

How is combination syndrome flabby ridge managed.

A
  • Ensure take a mucostatic impression so the tissue are recorded at rest
  • Option 1- Use a 2-stage impression technique by taking an original impression in medium bodied silicone then cutting out the impression material in the area of the flabby ridge and take a second impression of this area using a light bodied impression material
  • Option 2- use window technique where relief holes are cut in the special tray to allow outflow of the impression materials so that the tissues are left undisplaced (NB. Use low viscosity impression material for this)
61
Q

Replica Denture-
1. Describe the process of making a replica denture?

A
  • Explain to the patient the process and why replica dentures would be favourable and gain consent for this
  • Clean and sterilise the patient’s dentures
  • Modify existing dentures if required for any areas of under extension
  • For each denture you need 2 large dentate stock trays and adhesive
  • Place adhesive on inner surface of one try and the outer surface of the other tray
  • Mix and place lab putty on inner surface of one try and seat the denture occlusal surface down
  • Mould the putty to 2mm off the edge of the denture
  • Place vaseline around the putty and 3 locating notches to aid removal and replacement
  • Place lab putty on fit surface of denture
  • Place 2nd tray outer (adhesive) surface down, hold together and leave to set
  • Remove, clean dentures and return to patient
  • Send to laboratory with lab prescription care requesting wax copies for replica dentures
  • Use wax copied as master impression and modify as needed
  • Use a light bodied impression material to record an impression
  • Complete jaw registration at the same visit
  • Continue as normal dentures from here
62
Q

Label

A
63
Q

Label

A

BDS4 (24 decks)

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