Sweep 1 Flashcards
YOu want simultaneous contact in
centric and paracentric occlusion. There is smooth contact throughout the jaw movement.
Ability to reproduce CR is a major factor in
choosing cuspal angulation
Lingualized occlusion
max lingual cuspal dominance
Monoplane occlusion
flat
flat plane can be better if CR is hard to attain specifically.
For 30 deg teeth, set to
30, 0 deg teeth set to 0.
You want —– mm space between buccal cusps in lingualized occlusion
1mm
Curve of spee obtained by eleveting
2nd molar by 1.5mm
Monoplane - overjet
1.5-2mm - gives illusion of vertical overlap
Adjustment sequence
Check denture base with pressure-indicating paste
Check denture borders/peripheries with PIP
Occlusal Adjustment
Check Esthetics & Phonetics Polish
Home care instructions
Recall/Follow-up
Maxillary labial frenum:
the most common frenum to become irritated from denture overextension
PIP/Sorensen’s Paste Removal
Gauze, cotton rolls Alcohol-impregnated gauze
• Nothickposterior border - thins
toward soft palate
Prior to obtaining the new centric relation record…
Place two cotton rolls on the first molar denture teeth and have the patient close on these cotton rolls for 5 minutes. This allows optimal denture adaptation and seating the PPS area.
Techniques for recording a new centric relation (CR)
• Ask the patient to “take their jaw back and relax and close very slowly”
• “Curl your tongue tongue all the way back on the roof of your mouth and close
slowly.”
• Keep hands on mandible to ensure no translation during setting
• Hold position until set 1-2 min
VDO:
2-4mmbetween
lipclosureanddenture
teeth touching
• Usephoneticstesttocheckfor
interocclusal distance (count 60s-70s/sibilants [s,sh,j,ch,z]
• No contact of the opposing denture teeth during
speech!
During the production of the Sibilant sounds:
a) The anterior and posterior teeth should not touch
b) Incisors should approach an end to end relationship c) There should be no hissing or air loss
VDO
If decrease is <2 mm a
new interocclusal record must be made at
centric relation at the newly proposed VDO.
To make room for recording material, posterior teeth must be
removed from one arch (usually maxillary).
Posterior Palatal Seal
A raised acrylic resin area at the posterior border of the maxillary denture that enhances retention & maintains the peripheral seal by compensating for:
1) polymerization shrinkage
2) minor denture base functional movements
Post insertion CD problems generally occur in one (or more) of four (4) general categories:
Fit / pressure-related problems
Size / extension-related problems
Occlusion related problems
Random / other
Cheek biting
■ Solution:
increase horizontal overlap by reducing buccal surface of offending mandibular tooth - provides an escape for buccal mucosa
Soreness of the Mucosa at the Periphery of the Denture
Overextension of denture borders
Reduce, round, polish
Soreness of the Mucosa at the Periphery of the Denture
■ Sharp peripheral borders
Round and polish
Soreness of the Mucosa at the Periphery of the Denture
■ Impingement on frenulum
relieve and polish
Cheek, Lip and Tongue Biting
Inadequate horizontal overlap
Round lower buccal cusps or reset teeth
Cheek, Lip and Tongue Biting
■ Insufficient vertical dimension
Remake denture
Cheek, Lip and Tongue Biting
■ Teeth placed too far lingually
Move teeth buccally/remake denture
Cheek, Lip and Tongue Biting
■ Insufficient room posteriorly
between tuberosity and retromolar pad
Reduce acrylic thickness; use metal base if insufficient restorative space; consider surgery
Soreness of Specialized Mucosa of the Tongue
Etiology:Tongue biting due to low occlusal plane, impingement on tongue space
■ Solution: reset teeth/remake denture
Soreness on Residual Ridge or Palate (generalized)
Etio: occlusal discrepency
■ Solution: Remount dentures on articulator and equilibrate & refine occlusion
Soreness on Residual Ridge or Palate (generalized)
Etio: Excessive VDO
Solution: Reduce posterior teeth via selective grinding, replace teeth in one arch at correct
VDO, or remake dentures
Soreness on Residual Ridge or Palate (generalized)
Etiology: Bruxing
Solution
Educate patient
■Remove dentures to allow oral soft tissues to rest
Soreness on Residual Ridge or Palate (generalized
Thin mucosa over bony exostosis and tori
Relieve denture and/or refer to oral surgery
Soreness on Residual Ridge or Palate (generalized
Discomfort upon insertion or removal of denture past undercuts
Use PIP to locate and relieve area of denture that interferes/binds
Soreness on Residual Ridge or Palate (generalized
■ Deflective occlusal contacts that cause soreness under lingual and labial flange of mandibular denture
Remount dentures on articulator and correct occlusion
DifficultyinSwallowing
Overextension of DL flange of mandibular denture
Reduce using PIP (pt should place tongue to the opposite side of mouth to check for overextension)
DifficultyinSwallowing
■ Overextension in posterior of maxillary denture
Locate using PIP, relieve and polish
Difficulty in Swallowing
Etio: Excessive VDO
Solution: Correct VDO by
Resetting teeth/remake
Dislodgement
Overextension- any tissue under tension will dislodge denture
Use PIP to identify specific area for reduction
Dislodgement
■ Underextension- causes loss of peripheral seal
Add green stick compound or PVS to border and/or posterior palatal seal; if this corrects the problem, reline denture
Dislodgement
Inadequate posterior palatal seal
Correct posterior palatal seal area with acrylic/reline
Dislodgement
■ Teeth placed too far buccally or occlusal plane too high
Reposition teeth
Dislodgement■ Occlusal errors
Remount/equilibrate occlusion
Dislodgement
■ Atypical tongue position
Educate pt to keep tip of tongue forward
Speech Difficulties ■ Whistling:
■
■ Solution: add wax in area to correct,
modify denture accordingly
• Lisping or slushy speech-
anterior teeth set too far forward, or insufficient IOD
Speech Difficulties “Noisy” Denture Teeth
- Inadequate IOD/Excessive VDO
- Loose dentures
- Patient with poor NMC/Lack of motor skills
Gagging
Thick posterior border of maxillary denture & lingual flanges
Over-extended posterior denture border Loose dentures
Poor occlusion Psychogenic factors Inadequate vertical dimension
In the canine premolar area there should be a
gentle concave contour of the denture base extending from the palatal surface of these teeth to the horizontal shelf of the palate. (“s” sounds)
Cap cope drag
bottom to top
Land areas should be approximately the
height of the drag
Stone is covered with seperator but care taken not to
get on teeth (inhibits bond to acrylic)
Packing the mold
Acrylic resin dough is made by mixing powder and liquid in proper amounts (similar to Jet and Trim). The dough is placed over the teeth of the cast.
Skeletal classification with least interocclusal distance =
Class III.
Sibilant sounds:
mand travels downward and forward. Greatest in class II. IO = 5 mm with sibilant sounds. This tells you that: VDO is insufficient.
Three piece flask system consists of:
Drag, Cope, Cap
Best predictors for success:
lateral throat form, tongue position.
—— really all you’ve got for denture retention.
Surface tension
PIP End game -
no pressure points, no brush strokes.
EFSB
esthetics, function, structure, biology
——- is the starting point for an esthetic evaluation.
Facial midline
Facebow important if
changing Vertical dimension
Majority of the studies show that the
line joining the ——– with the —— of the nose is more often parallel to the occlusal plane
inferior portion of the tragus
ala
Mandibular resorption occurs at a rate of —-times faster than the maxilla
4x
Maxilla resorbs
inward, mandible resorbs downward and outwards
No alveolar ridge resorption:
Lip support:
Facial Support:
cervical 1/3 of the anterior teeth
alveolar process
Moderate/Severe resorption
Lip support:
teeth and the prosthesis
—- of the population had a difference of 3-4 mm between the Rest position and VDO
87%
With the lips at rest, a youthful appearance of an unworn dentition will display between
2 and 4 mm of the central incisors
When the Patient smiles the smile curve should fall within ——– of the distance between the upper and lower lip.
50-80%
RED Proportion
The central incisor, lateral incisor and canine have a constant proportion B/A = C/B
Overdentures -
usually associated with implants. Also keeping two tooth roots in the mouth to preserve ridge. Normally root canal must be done. You also need enough tooth coming through tissue to be cleansable. This other variant is not as common. By the time you do root canals, crown lenghtening (occasionally gold copings on top to prevent decay), you could just buy an implant and be done with it.
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
o 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
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
