RPD clinical sequence Flashcards
What are the important information points to get from the patient interview?
Presenting complain + history of PC
Med Hx
Dent Hx
Pt expectation
What should be achieved from the complete oral exam?
TMJ + Occlusion
Vitality of critical teeth
Perio assessment of abutments
Assessment of soft tissues
Study models on articulator
What are the steps to producing an RPD?
In the clinic the upper and lower preliminary impressions are taken.
In the lab the impressions are used to produce the upper and lower cast
RPD survey and design is conducted in lab. Identify which teeth need survey crowns
Mouth preparation for RPD is then conducted in the clinic
Another final impression is taken in clinic
Master model is produced to create the final denture.
How should bite registration be achieved CR or MIP?
If the confirmative approach is used (for RPDs often the case) then in MIP
If the reorganizing approach is used (If increasing vertical dimension is needed) then in CR
How is the anterior bite registration achieved?
Using a leaf gauge
When is a leaf gauge best to use?
When the patient doesn’t have any tenderness in MoM or TMJ issues
What is used when a leaf gauge is contraindicated?
An anterior jig + occlusal splint
How is bite registration determined in patients with edentulous anterior teeth in one arch?
Base and rim as well as external soft tissue can be used to determine the bite registration.
Base of the nose to base of chin - freeway space
What should be sent to the lab for production of an acrylic partial denture?
Master model
Lab prescription
What should be sent to the lab for Co-Cr partial denture?
Master model
Study model with framework design
Lab prescription
What is used for the final impression?
A special tray and an elastomeric impression material
How is an acrylic partial denture made from the master model?
Mount models on articulator
Tooth setting
Denture try in
Processing
Insertion
How is a CoCr partial denture made from the master model?
Duplicate master model
Survey blocks out the undercuts
Cast Co-Cr framework
Framework try in
Mounting of master model on the articulator
Tooth setting
Denture try in
Denture processing
Insertion
How can final impression be used to create a denture?
It can be scanned directly (not at ohcwa) and then:
Digital designing of the acrylic denture -> Milling of the acrylic partial denture
Digital designing of the Co-Cr framework -> 3D printing of the bridgework (wax or castable resin)
What can be scanned to produce a final denture?
Master model can be scanned directly
Impression can be scanned directly
Why is the master model duplicated?
1 of them will be used for blocking out undercuts and designing the framework whereas the other one is used for processing the denture
How is the frameowkr assessed outside of the model?
Assess cast framework outside of the model:
Check for defects on the tissue side of the framework
Check for abraded areas on the master cast
Assess smoothness of the framework
Check for adequate thickness
How is the framework assessed on the master model?
Verify that the framework follows the design created
Check seating of the framework on the master model
Check for proper adaptation and placement of clasps
Check for ease of framework removal
What are the steps to assessing framework for try in?
Assess cast framework outside of the model
Assess cast framework on the model
Assess framework in the mouth
How can the framework be assessed in the mouth?
Seating the framework in the mouth: IT MUST BE PASSIVE SEATING
Fully seated on the rest seats with clasps in the correct position
Retention and stability (denture should not rock)
Relationship with soft tissue (ensure correct distance from framework to mouth)
Assess occlusion (use shim stock)
How is framework adjusted during try in?
Dye is applied to the internal surface of the framework. Then framework is applied to the tooth, this then tells us where there is interference to be reduced using a cylindrical carbide bur
What structure should never be reduced when trying in a framework?
Do not touch the terminal 1/3rd of the retention arm with the bur that point should always touch the teeth.
How is occlusion assessed in class 1, 2s or extensive class 4s?
Use a base and rim with bite registration material on top
What is the altered cast technique?
It is used for class 1 and 2s in the mandible (maxilla is supported by hard palate so no need).
After try in of framework, framework is then returned to the master cast and a baseplate is created which acts as a custom tray above the acrylic base, border molding around the free end saddle is conducted light body impression material is added.
