RMTL Flashcards
Explain the shortened dental arch concept
-not replacing posterior teeth (molars beyond the premolars)
-aka premolar dental arch and premolarised occlusion
-theoretically this may cause TMD, occlusal, TSL, function and aesthetic problems. Loss of OVD. Dentoalveolar compensation (raised gingival margins)
-But evidence shows these problems are not actually common
-It is a simplified approach which can maintain adequate function at minimal cost, and bilateral free end saddle dentures are hard for patients to adapt to, never mind normal dentures.
Indications and contraindications for a shortened dental arch
-Indications: good long-term prognosis of anterior and premolar teeth (no perio, caries, endo concerns) Cost issues. Never had a denture before so likely to not adapt well to it, especially with bilateral free end saddles
-Conta-indications: severe class II or III dents-alveolar malrelationship, parafunction, TMD, advanced tooth wear, advanced perio disease, patient <40 years old
Difference between transitional, temporary, provisional, trainer dentures
-Transitional= used between edentulous and edentulous States, slowly getting them used to denture as teeth have poor prognosis. Can make additions, Not permanent.
-Provisional/ temporary= Short term to allow healing of bone, either made for after extraction, or before bridge/ implant
-Trainer= if odd occlusion (disorganised, dysfunction), trial dentures to test pt tolerance
Advantages and disadvantages of transitional partial dentures
(slowly adding teeth to existing denture when pt going from edentulous to edentulous)
-Pros= simple, untraumatic, maintains function, appearance occlusal stability, use of info given by remaining teeth, helping pts adapt to dentures, can make immediate additions
-Cons= prolonged treatment, difficulty constructing a functional denture, aesthetics can be poor (mismatch of colour of added acrylic), areas of weakness where additions have been made
What type of denture will you make for a young patient with severe hypodntia
short term provisional partial dentures that is re-made as the patient grows.
Pros using trainer dentures
-can test if someone can adapt and tolerate dentures
- no tooth prep is required so completely reversible
- useful for difficult tooth wear cases/ disorganised occlusion/ dysfunction.
-Diagnostic tool: complete over closure so want to re-establish occlusion and check aesthetics and new OVD
What is the typical design for transitional/ temporary/ trainer dentures
Usually:
-all acrylic as easy to make additions and modify
-only mucosal support
-broad extension of denture base
-ensure gingival clearance
How are transitional/ temporary/ trainer dentures retentive
tight contact points
muscular control
Can add clasps
Flanges
What are the clinical stages of provisional/ temporary/immediate dentures
Preliminary impressions (as or partial dentures)
Reg if no natural contacts
Survey and design
Tooth mods if required
Major impression (as for partial dentures)
Definitive registration
Try-in
Lab replace teeth to be extracted
insert after extraction
What are the stages of transitional dentures when extracting a tooth and needing to make immediate additions
Immediate additions= adding tooth to denture prior to extraction. Done within 1 day
-primary impression with denture in, and opposing dentition
-Denture stays in impression so patient will be left without it for a morning
-Lab form –draw design, circle ‘immediate’, teeth to be replaced, pocket depths, shade, flanged or open faced
-Lab pours the impression. Gingival margins marked, long axis of tooth marked, height measured. Wax matrix made to show the occlusal surfaces.
-Teeth size selected
-Teeth removed and socket prepped – tungsten carbide bur, carver. Considering the pocket depths provided. Keep the gingival margin in tact
-Add wax over the area and add the teeth
-Remove wax (matrix made to keep tooth in position), roughen old acrylic for better chemical bond, add self cure acrylic, pressure cooker, trim and polish
-Inserted in the afternoon after extraction
What is an immediate denture
-a provisional denture made before extraction then immediately placed after
Importance of a full flange for immediate dentures
-improves retention
-protects the socket
How to overcome undercut in anterior ridge form when making immediate dentures
-Alter path of insertion
-Remove the undercut (alveolectomy)
-Don’t put acrylic in that region= open faced without flange which look good initially but over time resorption creates a gap
-Part flange= does not go into full sulcus, but aesthetics and food trapping a problem
Advantages and disadvantages of immediate dentures
-Pros: Quick fix, Patient never without ‘teeth’
-Cons: Design based on ‘prediction’ of ridge form, Rapid resorption after extraction (so replacement denture or rebase needed)
numerous appoitnments for additions etc. needed after, challenging for dentist
Indications and contraindications for immediate dentures
-Acute failing dentition (pain/sepsis)
-urgency (e.g. pre- radiotherapy)
-medical indication /convenience for patient
Contraindications:
-diabetes, haemophilia, post radiotherapy (risk of MRONJ)
-multiple peri-apical/ periodontal abscesses (>3), considerable oral surgery required
-poor pt compliance, unable to manage
-very elderly
-If many teeth need extracted
=Transitional may be better
Aftercare and review appointments after immediate denture insert
-Bite on gauze and give usual post op instructions
-Kept in for 24 hours otherwise tissues will swell and will be difficult to get back in
-24 hour review appointment - examination, remove denture, saline rinse, check clots, make any adjustments using pressure cream, patient instructions regarding removal and cleaning
-1 week review - any further adjustments
-1 month review - may need rebase
Due to rapid remodelling, poor adaption of immediate denture occurs overt time. What are the solutions
Tissue won’t fully heal for a while so need a temporary solution to improve adaption.
-Temporary reline on fitting surface chair side (hard or soft lining). May need many replacements.
-Once initial remodelling has stopped (after 3-6 months) then do a Lab reline/rebase. Impression is needed, often only in localized area
Why long term recall and maintenance is required for immediate dentures
-remodelling causes poor adaption over time so need to reline
-Monitor occlusal wear, occlusal discrepancies, fractures, loss of denture teeth
-Maintain oral health
- early detection and treatment of pathology (caries, candida)
Difference between rebase and reline
-Reline- adding additional material onto fitting surface to improve adaptation.
-Rebase- same thing, but strip away fitting surface AND base and replace with new base. Because otherwise would be too bulky palatally and feel bulky for the tongue.
-Rebase for upper, don’t rebase lower dentures
-Indications= loss of fit and adaptation due to rapid resorption during first 9 months, but everything else about the denture is fine
Clinical and lab stage of reline/ rebase
-Clinic: Ease undercuts and gently roughen the fit surface. Denture used as a tray to take a wash impression of the fit surface - closed mouth technique using ZOE/ kellys paste/ light bodied silicone to get thin film so don’t increase bulk or affect the occlusal position
-Laboratory: Cast made. Registration recorded. Denture separated from the model and matrix and all impression material is removed.
- If upper denture, centre of palate trimmed away otherwise reline would be too bulky =rebase
-Denture is relocated to the model and matrix to the correct occlusion and vertical dimension. Wax is then added to the space previously occupied by impression material.
-Denture then ‘flasked’ and new acrylic packed into the reline area once the wax has been boiled away, Polymerised, de-flasked, trimmed polished
Indications for using soft lining materials
-short term trauma management (acute inflammation, soreness, ulceration)
-temporarily improving adaptation of denture during rapid resorption period
-alleviate pressure on knife edge alveolar ridge or pronounced torus palatinus
-denture induced stomatitis
-utilise undercut areas to improve retention
-reducing load to underlying tissues
-persistent soreness
-obturators (fits into defects eg. after tumour removal)
