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BDS2 CLINICAL Prosthodontics > RPD CLINICAL - CLINICAL STAGES > Flashcards

RPD CLINICAL - CLINICAL STAGES Flashcards

1
Q

what are the clinical stages of RPD

A 
visit 1 - assessment and primary impressions 
visit 2 - master impressions
visit 3 - framework trial
visit 4 - tooth trial
visit 5 - delivery (fit)
visit 6 - review
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2
Q

what happens in visit 1

A

assessment

primary impressions

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3
Q

what does assessment consist of

A

history and examination

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4
Q

what does the history consist of

A

denture history
dental history
medical
social/personal history

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5
Q

why do we take a denture history

A

it is important to get the patients opinion of any current denture as if an RPD has been worn with reasonable satisfaction it is advisable to reproduce the denture design.

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6
Q

why do we take a dental history

A

recent extractions may indicate the presence of active caries or periodontal disease that needs to be addressed by preventative aspects of the treatment plan

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7
Q

when taking dental history why is it important to find out when extractions took place

A

the most rapid phase of bone resorption occurs during the few months following the tooth loss – dentures constructed around the time of extractions therefore soon lose their fit

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8
Q

why do we take a medical history

A

to accomodate any conditions e.g diabetes

lso, the practice of oral and denture hygiene may be compromised by a reduced ability

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9
Q

why do we take a social/personal history

A

determines patient motivation

smoking habit should be noted

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10
Q

what does the examination consist of

A

extra oral

intra oral

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11
Q

what happens in an extra oral assessment

A

assess the facial form and symmetry. Study the jaw’s opening and closing movements alongside palpation of the TMJ and muscles of mastication. This information derived from these observations is helpful in the assessment of the health of the masticatory system.

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12
Q

what happens in an intra oral assessment

A

look for the standard of oral hygiene, begin detailed examination of soft tissues (mucosa of the lips, cheeks, tongue, palate and floor of the mouth). Note edentulous spaces and distribution and alignment of remaining teeth. The form of the residual ridges and the compressibility of the investing soft tissues in the edentulous areas should be assessed visually and by palpation (incompressible areas may have to be avoided by denture margins). Assess current restorations and health of periodontal tissues.

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13
Q

what are the two types of impression trays

A

edentate and dentate

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14
Q

what is the difference between dentate and edentate trays

A

dentate trays have a greater depth than edentate

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15
Q

how should the size of tray be selected

A

so that the teeth sit centrally within the trough of the tray and if possible there should be a space of about 4mm between the flange of the tray and the buccal and labial surfaces of the teeth

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16
Q

what impression material should be selected when there is no free end saddle

A

alginate

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17
Q

what impression material should be selected when there is a free end saddle

A

alginate and impression compound

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18
Q

describe how the impressions tray is modified for a free end saddle

A

dead space is filled with impression compound

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19
Q

why should any impression compound contacting the teeth be cut away

A

it prevents accurate reinsertion of the impressions ray and will eliminate space around the teeth necessary for a sufficient thickness of alginate used to complete the preliminary impressions

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20
Q

how do you border mould for the lingual border

A

it is achieved by the patient first pushing the tongue to contact the upper lip and then thrusting the tongue into each corner of the mouth in turn.

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21
Q

how is buccal and labial moulding achieved

A

moulding for both the maxillary and mandibular impressions, it is achieved by supporting the tray with one hand while manipulating the cheeks and lips with the other

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22
Q

when you have taken the impression how is it assessed

A

 Those sulcus areas which will be related to the denture borders
 The edentulous area
 The teeth

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23
Q

how should impressions be treated

A

they should be rinsed and disinfected

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24
Q

how is the impression prevented from drying

A

by covering it with a damp napkin and placing it in a plastic bag

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25
Q

what should the lab instructions be sent with the primary impressions

A
  1. Details of the patient and the dental practice
  2. Confirmation that the clinical items have been disinfected
  3. Date of the next appointment
  4. A request for the study cast to be surveyed if required
  5. Request for wax occlusal rims where necessary, if mounting of the study casts on an articulator required to assist in the RPD design stage
  6. Specification of material and design of the individual impression trays
  7. Size and location of ay stops to be performed on the tray
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26
Q

what is the normal bite

A

the intercuspal position

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27
Q

when can casts be hand articulated

A

when it is obvious where the teeth meet

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28
Q

what is not needed when the casts can be hand articulated

A

you do not need a primary record block and do not need to record the occlusion
you can get the casts mounted on the articulator with a wax wafer or nothing at all

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29
Q

how can the interocclusal record be done in visit 1

A

using a wax wafer

The wax is warmed and the patient bites on it.

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30
Q

why should you see the teeth meeting in a wax wafer

A

you will create a space.

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31
Q

when can a cast not be hand articulated

A

when there is a free end saddle

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32
Q

what is required if the cast cannot be hand articulated

A

record the occlusion using a primary record block and ask the technician to mount the primary cast using you registration

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33
Q

how is the master impression material decided

A

undercuts - requires more elastic material

34
Q

what is the lab instruction for a hand articulated

A

pour primary cast

special tray with spacer (1-2 sheets of wax depending on master impression material with handles/fingers rest)

35
Q

what is the lab instruction for non-hand articulated

A

pour primary cast
special tray with spacer (1-2 sheets of wax depending on master impression material with handles/fingers rest)
construct primary record block for preliminary jaw registration - base can be wax, shellac or light cure acrylic

36
Q

how does the accuracy of the material effect the spacing of the special tray

A

more accurate, less space

37
Q

what do you want done in terms fo the design of the denture before visit 2

A

 Survey to decide the path of insertion
 Survey to decide undercuts ect so you know where to put clasps
 Do you need to modify the teeth to produce rest seats, guide planes and undercuts
 Draw the design on the lab work card and get it signed of by a clinician

38
Q

what happens in visit 2

A

master impressions are obtained

39
Q

why do we take a master impression

A

The production of a cast sufficiently accurate for the construction of an RPD frequently necessitates the use of an individual tray. Such a tray enables an accurate impression to be made of the functional depth and width of the sulci in those areas that will be related to the denture border and to components such as gingivally approaching clasps, connecting bars and plates.

40
Q

what can you do when trying in special trays

A

you can trim the peripheries if overextended and modify the peripheries with greenstick and fit surface for free end edentulous saddles

41
Q

what are the impression materials at the GDH

A

poly vinyl siloxane
polyether
alginate
impression compound

42
Q

what is poly vinyl siloxane

A

o Brand name = extrude
o Medium body
o Be careful how much material you put in as it could be swallowed, and it is not biodegradable
o Dimensionally stable

43
Q

what is polyether

A

o Brand name = impregum
o It is very rigid – do not use with undercuts
o Also be careful with patients who have periodontal disease as you do not want it to get stuck
o Dimensionally stable

44
Q

what is alginate

A

o Well mixed
o Poured up as soon as possible
o Good if undercuts are present
o Be careful for air blows – it can compromise the accuracy

45
Q

what are the instructions for the technician after visit 2 if you want cobalt chrome

A

pour model in improved stone
construct chrome framework per design
clear design signed by clinical

REMEMBER TO PREPARE OCCLUSAL RESTS/GUIDE PLANES BEFORE TAKING IMPRESSION

46
Q

what are the instructions for the technician after visit 2 if you want acrylic

A

pour model in stone

construct record block with shellac base

47
Q

what does visit 3 consist of

A

framework trial

recording occlusion

48
Q

why should the framework trail be done without the addition of wax rims or artificial teeth

A

if the casting does not fit into place at once, the presence of wax hinders the search for interferences and additionally if the cast needs adjustment with stones, the heat generated may melt the wax and if the casting needs adjustment with stones the heat generated may melt the wax

49
Q

what questions do we need to ask when doing a trial fit on the cast

A

 Does it fit the cast?
 Does it seat correctly in the mouth?
 Is the cast damaged?
 Is the framework interfering with the occlusion

50
Q

how can we adjust the framework at chair side

A

(wearing appropriate mask for chrome adjustments) and using adam’s pliers for clasps

51
Q

why do we need to record occlusion

A

 To help design the denture
 To help the technician set up the teeth
 To ensure the denture is stable and is not dislodged in function
 Patient comfort
 Ensuring loading forces applied correctly to teeth

52
Q

what are the two approaches when it comes to occlusion

A

conformist

reorganized

53
Q

what is the conformist approach

A

this is when we keep the occlusion the same as it currently is. We need to know the position of the teeth in relation to each other.

54
Q

what is the reorganized approach

A

this is when we alter the occlusion either because of tooth wear or there is not enough teeth to meet

55
Q

what is the aim of visit 3

A

establish the inter-occlusal relationship to articulate the casts, occlusal vertical dimension and the tooth shade and mould.

56
Q

what extended edentulous spaces do we want to establish

A

 Buccal/labial contours of wax record block
 Lip support
 Incisal plane
 Posterior plane

57
Q

what are you aiming to inform the technician in visit 3

A

You are aiming to inform the technician where you want the artificial teeth to be positioned, their shade and mould, together with information on how the teeth occlude.

58
Q

what do we use for definitive occlusal registration

A

wax occlusal rims

they are made on casts from the master impression

59
Q

what do we need to do if there are no index teeth

A

we need to measure the occlusal vertical dimension (OVD) and the freeway space (FWS).

60
Q

how do we measure OVD and FWS

A

Willis bite gauge measure the vertical dimension – the first is when the patient is biting together and the second is when the patient is at rest. Sitting at rest the patient should have at least 2/3mm between their teeth at rest. The difference is called the freeway space. It is more important in complete dentures as in RPD the patient has teeth and we try to conform to that.

61
Q

what can be used to find the initial starting point for the oVD

A

old dentures

62
Q

why do we need to trim the wax blocks

A

Trim the blocks – when you try the blocks in they will be bulky. It has to stay in place. Any overextension of the peripheries will drop/displace. Too much lip support and it will drop. You use a wax knife and hot plate/spatula to make adjustments. Adjust the upper rim first. You may need to adjust the rim labially/buccally.

63
Q

why do we need to check the wax occlusal rims

A

The wax occlusal rims may be placed on temporary bases of shellac or acrylic resin or on the definitive cast metal frameworks. These must be tried in the mouth and their stability checked. If the stability is poor, yet the baseplate fits the cast accurately, consideration must be given to the possibility that the problem is due to an inaccurate impression. If this is confirmed the working impression must be retaken. The retention of the occlusal rim must be sufficient to maintain then rim in position during subsequent recording procedures.

64
Q

when prescribing the position of anterior teeth what do we need to do

A
  1. Make sure index teeth (teeth that already bite together) in occlusion
  2. Mark centerline
  3. Correct incisal plane
  4. Correct antero-posterior position
65
Q

what are the reference points for positioning of anterior teeth

A 
	Teeth present 
	Dento-facial midline
	Inter-pupillary line
	Ala-tragus line
	Curvature of lower lip
	Smile line
	Gingival margins of existing anterior teeth
	Previous dentures
66
Q

how should you select shade

A

think about existing teeth, previous denture and patient preference

67
Q

how should you select mould

A

you need to compare to existing teeth, previous denture and also measure

68
Q

what should you say to the technician after visit 3 for the record block on the framework

A

construct wax record blocks on framework (additional visit required)

69
Q

what should you say to the technician after visit 3 for the tooth trial

A

articulate casts for registration

set teeth for wax trial (shade and mould provided)

70
Q

what is visit 4

A

tooth trial

71
Q

what do we check in visit 4

A 
We need to check:
	Framework fit
	Occlusion
	Aesthetics 
	Extension
72
Q

what is the lab instruction after visit 4

A

please take to finish in acrylic (if happy)

73
Q

what is visit 5

A

delivery

74
Q

what happens when the denture is made in acrylic

A

You do get small dimensional changes when you make the denture in acrylic – sometimes the fit will improve

75
Q

what is the first thing you do in visit 5

A

First look at the dentures on the articulator

76
Q

what do you look at in the denture on the articulator

A

 Check design again is as requested
 Examine denture for roughness/blebs – run fingers over acrylic to check for roughness
 Check it seats properly
 Look at the undercuts and if there are clasps there – are they engaging it? Are they staying in or are they easy to remove? Are any teeth on the cast broken?
 Is the pin on the table?
 Does the occlusion look correct

77
Q

what do you check when the denture is in the patients mouth (visit 5)

A

 Stability – does it rock?
 Support – are rests/flanges seating accurately
 Retention – adjust clasps with adams pliers
 Aesthetics – carry out above checks first, last thing you do is show the patient

78
Q

what do you look at when checking the occlusion in the patients mouth

A

 Do the teeth meet in the prescribed occlusal scheme per the wax up? Check with articulating paper for heavy/early deflective contacts
 Is something propping open the bite? Small change adjust with acrylic bur chairside. Large change may require removal of teeth and reset in wax.

79
Q

what are the instruction given to patient based on

A 
	Insertion/removal
	Coping with new dentures
	Pain
	Denture cleansing
	Speech
	Eating 
	Refer to clinic patient information leaflet
80
Q

what is visit 6

A

The review

Here we take a history, do an examination and make any adjustments

BDS2 CLINICAL Prosthodontics (13 decks)

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