Sweep 1 Flashcards
These are just from the lectures - they pretty much are the slides that I didn’t know put into flashcards.
The fact that I have so damn many cards is why I can’t have nice things…
set the remaining
maxillary anterior teeth on
a clear glass or plastic
slab is positioned on the mandibular record base to represent the plane of occlusion.
Cuspids need
distal inclination from perpendicular with incisal edge touching occlusal plane.
Note how the cervical and incisal edges of the cuspid are aligned
vertically (yellow line).
The facial surface of the cuspid however, is canted
inward and appears “toed
in” (red line) due to the prominence of the cervical area of the tooth (yellow arrow).
When viewed facially, only the ———– plane of the canine should be visible
mesial
Wedesiretominimizethe forces applied to the mandibular and maxillary
-Horizontal and vertical overlap
anterior ridges in centric occlusion. - no contact.
Horizontal and vertical overlap: also done to allow for
Createtheappropriate relationship of the maxillary and mandibular anterior teeth during the production of sibilant speech sounds.
For most patients, labial surface of mand incisor should be roughly perpendicular to
occlusal plane.
Class II patients mandible travels
further anteriorly - need more horizontal overlap
The the cervical of the mand. canines are in the
towed out position.
The the cervical of the mand. canines are in the
towed out position.
When measuring patient’s existing dentures:
– Select best match to shape & size (height, width) of central incisor
– Measure circumference of the six
maxillary anterior teeth
– Use mould guide to select
corresponding mandibular anterior and posterior moulds
Measuring existing dentures exact direction
Measure distal of canines to mesial of central incisor. -Measure mesial of 1st PM to distal of 2nd M
Anterior Tooth Placement considerations
-Pattern of maxillary ridge resorption
• Average values
• Phonetics
• Smile line- follow contour of lower lip
Average Values: Anteroposterior position
On average, the distance from the center of the incisive papillae to the labial surface of the central incisor is 8-10 mm.
Average Values:
Midline & Canine Cusp Tips
The incisive papilla can also be used to help locate midline of dental arch.
A line drawn passing in the posterior extent of the papilla will define where cusp tips of canines should be placed
Between the anterior-posterior line and papilla line, it will look like a cross.
Phonetic Determination
• Labiodental Sounds “F” & “V” sounds aid in the correct anterior- posterior positioning of the central incisors.
The upper lip contacts the
the wet-dry line of the lower lip during speech production of “f” and “v” sounds.
Phonetic malpositioning:
F sounds like V or vice versa.
Center of posterior residual ridge:
Maxillary lingual cusps should be centered over this line
• Ensures denture stability
• Reduces fulcruming forces during
function
Mand anterior teeth should not
be placed beyond the center of the vestibule
• Positioned beyond this point will result in denture instability and undesirable cantilever forces.
Severe arch discrepancies (Class II and Class III-reverse articulation)
•Poor residual ridges (flabby ridges)
both can indicate
for non-anatomic teeth.
Posterior Tooth Selection - match size and shade to
anteriors.
Posterior teeth - select
Select by determining distance from distal
of canine to ascending ramus
Posterior teeth should
• Should approximate cervico-incisal height of anteriors selected
• B-L width of teeth can affect
tongue space
MAXILLARY blockout areas
-labial surfaces of anterior ridge •Frenum areas •Rugae •Lateral areas of tuberosities •Redundant tissue areas
Mandible blcokout areas
- Retromylohyoid fossa
- Frenum areas
- Facial surface of anterior ridge
- Buccal and lingual regions of residual ridge
As viewed from the lateral perspective the wax rim should project
anteriorly to just beyond the outer edge of the land of the cast
Wax rim Lingual contours must not
impinge on the tongue space
The occlusal portion of the wax rim should have the following thicknes
a) Molar region - 8 mm
b) Premolar region - 6 mm
c) Anterior region - 3 mm
Max width of occlusion wax:
Anteirorly 22mm, posteriorly 8mm from deepest part. - roughly 12mm of wax over triad. 15 degree tilt anterior, 45 degree tilt over posterior.
The rim should be
centered over the crest of the ridge to maximize STABILITY
Mand width of occlusion wax:
18mm, up to 2/3rds height of RMP. 15degree tilt over anteiror.
Amount of max wax showing -
women - 1-3mm, men 0-1 mm.
Use dental adhesive if
tray is slightly loose (can’t do phonetic tests otherwise)
Ideal nasolabial angle
95deg, with vermillion border showing.
Lip length 10-20mm
incisal display - 3-4mm
Lip length 20-25 mm
2mm
Lip length 26-30mm
1mm
Lip length - 30 or greatermm
0
• Edge of rim touches
“wet-dry” junction of lower lip when ‘F’ or ‘V’ sounds
Anterior portion of rim must be parallel to
inter pupillary line - mesiolateral dimension
Transfer midline scribed on maxillary rim to the
mandibular rim
- 1-2 mm horizontal overlap b/w maxillary wax rim and mandibular wax rim
• Patient is instructed to: (VDR)
-“gently bring their lips together, and softly hum”
• “gently lick lips and swallow”
These actions bring the elevator and depressor muscles in equilibrium and the condyles in a neutral, unstrained position.
Determining VDR using Phonetics
say “mmmmm, emma”
IN VDR, there should bve
2-4mm space between both rims.
Establishing ovd
‘Closest Speaking Space’
• Measure difference between VDO & VDO • Sibilant sounds (“s”, “z”, sh”, ch”)
Wax rims: occlusion, you want
even contact along rims in centric position
CR
def: maxillomandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective discs with the complex in the anterior-superior position against the shaped of the articular eminencies
CR is
independent of tooth contact
When mounting on articulator,
Increase incisal pin +2 to compensate for thickness of centric record
Lateral displacement and rotation during function
stability
Vertical displacement
retention
vertical placement
support
Draping of the cheeks over the buccal flanges
is essential for peripheral seal. Loss of muscle tonicity & overlapping is common
Retromolar pad helps
Create peripheral seal
Finger stops on mand. impression trays should be
20mm by 10mm
Maxillary Impression Borders action 1
Action: Ask the patient to create suction around a finger and the impression tray handle.
Effect: Labial and Buccal Frena, Labial & Buccal Vestibule
Maxillary Impression Borders action 2
Action: Ask the patient to create suction around a finger, pucker or pooch their lips and produce a maximal smile line
Effect: Labial and Buccal Frena, Labial & Buccal Vestibule
Maxillary Impression Borders action 3
Action: Ask the patient to open their mouth wide and then move their mandible side to side to stretch the pterygomandibular raphe and allow the coronoid processes to shape the impression
Maxillary Impression Borders action 4
Action: Pinch the patient’s nostrils closed and ask the patient to attempt to blow air through their nose. Make sure that the tongue is held down using a mouth mirror. Mark the hard-soft palate junction. OR**
Have the patient pronounce the word “aah” or cough to locate the vibrating line so it can be marked, thereby
identifying the area between the vibrating line and hard palate- soft palate junction
Mandibular Impression Borders: actions 1-3
Action #1: Ask the patient to create suction around a finger and
the impression tray handle
Action #2: Pucker or pooch their lips and produce a maximal smile line
Action #3: Pronounce the word “Christmas” and the letters “Q” and “U” & pull the lower lip and cheek superiorly over the
impression tray
Effect: Labial, Buccal and Lingual frena, Lip musculature, Buccinator and Masseter muscle
Mand impression borders action 4
Action: Place a finger on the top of each side of the
impression tray and ask the patient to close the mandible against resistance using one second intervals of applied force
Mand impression borders action 5
Action: Ask the patient to raise their tongue to the roof of
the mouth, then anterior to vermilion border, and then to the corners of their mouth. Ask patient to swallow (if possible)
Class III s sound
no retrusion afterward - teeth stay incisor-incisor.
• Angle Class II patients:
posteriors have similar to class I but anteriors are set with more overbite to match skeletal reality
o Angle Class II Div I: may need
setup with the same generous overbite/overjet relationship to restore their facial form, dental esthetics and speech
Angle class II Div II:
with prominent maxilla and generous overbite with a minimal overjet and shortened dental arch will need same as div I setup
• Inclination of anterior teeth are vertical or retruded to best match
mandibular incisors
• Angle Class III combo of prominent long mandible with small retruded maxillae setup
entirely different: mandibular incisors incline lingually and distally back from the larger mandible to meet upper teeth which incline outward from small and retruded upper arch
o Set anteriors end-to-end with very light occlusion
o Due to flaring of max incisors, they put too much tension on upper lip musculature and might need to crossbite the posteriors with max buccal cusps positioned lingual to mandibular teeth and enhanced lateral occlusal curvature (Wilson) to accommodate small maxilla/large mandible
o Anteriors are also placed crossbite or underbite
The Lingual Look Test
• Test to check if teeth fully touch in the lingual/palatal area
o Check on articulator
o Common to have to lift mandibular lingual cusps up and pull max lingual cusps down to achieve desired max lingual cusp to mand central fossae occlusal contacts
Completing the Wax-Up For the Try-in Appointment
• Tooth set up works best with minimum amt of wax
• Overlooked wax that is not cleaned off will screw everything up
• After bases are fitting fully and accurately, add gingival contours
o Flow molten wax in slight excess to build up secondary gingival and mucosal contours
o Teeth above gingiva need to be clean and free of all wax in order to be held securely and accurately during processing but avoid groove that will trap calculus
o Finish contours with clean lab toothbrush
o Polish with cold soapy gauze
