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Test 2 Flashcards

1
Q

What is the purpose of festooning?

A

Reproduction of proper gingival contours, esthetics and proper support and contour of lips and cheeks. Provides improved tolerance and comfort and facilitates stability and control.

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2
Q

What does proper contouring and development of the maxillary cuspid eminences help provide?

A

Helps to displace the corners of the mouth and the lip away from the biting zone.

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3
Q

What is the desired shape of the interdental papilla. Why?

A

Flat or slightly convex to provide a more natural appearance and to avoid food impaction.

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4
Q

Why should the lingual contour of the mandibular denture be concave and have a slight gingival roll?

A

To prevent tongue biting and to anchor the denture teeth within the acrylic resin.

The lingual concavity facilitates stability and contrpl of the denture by having the tongue press against the concave lingual surface

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5
Q

What prevents the mandibular denture from being displaced laterally?

A

The buccinator.

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6
Q

What happens during the wax try-in appointment?

A

Verify the CR mounting, evaluate esthetics and phonetics, verify appropriate VDO, posterior palatal seal, have patient sign the record for approval.

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7
Q

Where should the incisal edges contact for ideal phonetics?

A

On the wet-dry line.

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8
Q

How do you verify adequate interocclusal space?

A

By checking the vertical dimension. VDR-VDO=2-4 mm. Closest speaking space is 1-1.5 mm.

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9
Q

What is the purpose of the posterior palatal seal?

A

To enhance retention and preserve peripheral seal by creating positive contact with the tissues at the posterior border of the denture to offset the effect of polymerization shrinkage.

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10
Q

How do you locate the posterior palatal seal?

A

Locate the pterygomaxillary notch with the mouth mirror. Slide in posterior direction along the crest of the tuberosity until the mirror steps up into notch. Mark notches with indelible ink stick. Locate the fovea palatinae. Have the pt say “ah” to locate the vibrating line. Posterior palatal seal should end at or just beyond (within 1 mm) of the vibrating line. A class III soft palate requires you to be very precise. Can transfer at impression stage.

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11
Q

How do you carve the posterior palatal seal?

A

Carve seal/bead with discoid cleiod or #8 round bur on slow speed handpiece. The shape will resemble a butterfly. It should extend through notches to the buccal side, unless there exists rigid pterygomandibular raphe. it will be processed as a positive “bead seal” onto the palatal portion of the denture base.

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12
Q

When is the posterior palatal seal placed?

A

Prior to sealing the dentures down onto master casts.

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13
Q

Steps of Denture Processing

A
  1. Lubricate flasks.
  2. Apply separator to Master Cast.
  3. First investment.
  4. Check that denture teeth are below flask top.
  5. Remove excess stone investment creating the land area.
  6. Let the first investment set and apply separator to the first investment.
  7. Second investment of denture.
  8. Expose cusp tips and incisal edges through stone investment.
  9. Let set and apply separator to second investment.
  10. 3rd and last investment.
  11. Place lid on flask and remove excess.
  12. Boil out tank.
  13. Wax melted and flask separated.
  14. Removal of wax residue.
  15. Placement of diatorics for mechanical retention.
  16. Apply separator to investment around the teeth and in the master cast.
  17. Pack with denture acrylic over teeth.
  18. Place separating plastic and prepare for trial pack.
  19. Trial pack.
  20. Separate flask parts.
  21. Remove excess flash.
  22. Refit flask halves together for further packing.
  23. Final packing.
  24. Place flask in a spring clamp to secure it for processing.
  25. Processing tank.
  26. Separate by tapping removal ring.
  27. Tap investment assembly out of flask.
  28. Remove cast and denture from investment mold.
  29. remount.
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14
Q

What is the water temperature of the boil out tank?

A

212

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15
Q

What problems are caused when you use excess monomer when mixing denture acrylic?

A

May cause porosity, mix according to directions.

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16
Q

What pressure is trial packing at?

A

1000-1500 psi.

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17
Q

What is the final packing pressure at?

A

L199: 3500 psi

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18
Q

Slow water bath processing

A

9 hours at 165 degrees F. Commonly used in Denver with no correction for altitude.

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19
Q

Rapid water bath processing

A

1.5 hours at 165 degrees F. 30 min at 212 degrees F.

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20
Q

What is the purpose of the water bath?

A

To prevent porosity. L199 acrylic polymerization is very exothermic. The 165 degree water bath removes heat and prevents boiling of the monomer which could cause porosity.

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21
Q

What is the purpose of the lab remount?

A

To correct errors in occlusion that have occurred during processing. (wax distortion, acrylic shrinkage, packing pressure, changes in investment)
To return dentures to the correct vertical dimension of occlusion. (pin on plate)
To restore CR.

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22
Q

What should the incisal pin be set at?

A

zero, or the number it was when you were setting your dentures. The amount that the pin is open is due to processing error.

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23
Q

What are the steps for occlusal adjustment?

A
  1. Restore VDO (pin on the plate at your recorded VDO)
  2. Refine and equalize CR contacts.
  3. Refine working and balancing occlusion.
  4. Correct protrusive occlusion.
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24
Q

What is the objective of the adjustment?

A

Restore the VDO to the level achieved with the trial denture and develop as many occlusal contacts as possible in CR.

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25
What are the acronyms used to adjust interferences during excursive movements with out affecting the centric stops?
BU-LL: Buccal Upper and Lingual Lower MU-DL: Mesial Upper and Distal Lower.
26
What are the steps for preparation of denture delivery?
Fabricate maxillary remount index. Removal of processed dentures from master casts. Polish/refine dentures. Mound MX CD using remount index.
27
When is the MX remount index made in clinic?
After the wax try in and prior to sending the denture to lab for processing.
28
What is the purpose of the remount jig?
To preserve the facebow transfer.
29
What is the proper thickness of the palate?
2 mm.
30
What happens during the delivery of dentures?
Adjust the denture bases (internal adaptation). Adjust denture borders/extensions. Make new CR record. Remount MN CD. Adjust occlusion on articulator. Patient education. Appointment for 24 hour post delivery check.
31
What happens prior to delivery appointment?
Ask patient to leave the old dentures out of the mouth for 12-24 hours before the delivery appt for undistorted tissues. Keep dentures in water before the delivery appointment for expansion. Inspect denture intaglio, polished surface, boarder extensions thickness.
32
PIP
Pressure indicating paste used to detect adaptation discrepancies.
33
When is PIP spray used?
In patients with xerostomia in order to prevent the PIP from sticking to the mucosa.
34
Zinc Oxide paste
A type of PIP.
35
How do you disclose internal adaptation discrepancies?
Dry internal surface of dentures, apply PIP sparingly using disposable PIP brush to the entire intaglio surface. Place in patient's mouth trying not to prematurely touch the internal surface. Apply finger pressure only. Remove carefully taking care to not disturb PIP markings. Inspect for pink acrylic show through or pressure areas. Adjust areas of show through on horizontal areas first. Vertical areas of show through may be to rubbing on insertion or removal.
36
What areas of show through should you adjust first?
Horizontal. Vertical may be due to rubbing on insertion and/or removal.
37
Disturbed vs undisturbed brush lines.
Disturbed: Tissue contact. Undisturbed: No tissue contact.
38
What area do you need to pay particular attention to in the MN denture?
Mylohyoid ridge region.
39
When do you know you are complete with the PIP procedure?
When brush marks are obliterated and there are no areas of tissue displacement noted. Areas of gross pressure are eliminated.
40
What material is used in adjusting extensions?
Disclosing wax or PIP.
41
What are the steps for adjusting extensions with disclosing wax?
Dry denture extensions. Apply DW to border and warm for 5 seconds on water bath or carefully insert denture and wait for wax to reach body temp where it will flow. Mold the borders of selected area. Remove and inspect for show through. Repeat.
42
What is an important area to ensure proper extensions on the MX CD?
Lateral to the tuberosity. Check for interference from coronoid process.
43
What is the purpose of the clinical remount?
To correct for the fact that adjusted denture bases seat more accurately than record bases. To correct for errors made in the fabrication of previous CR records (inaccurate CR, incorrect transfer of interocclusal records). To correct for unaddressed processing errors. To finalize the occlusion to achieve a bilaterally balanced gliding occlusion.
44
How do you make the CR record?
Allow dentures to settle into tissues while biting gently on cotton rolls placed on posterior teeth for at least 3-5 min to deprogram the occlusion. Make the CR record using aluwax or exabite.
45
What are limitations of dentures?
Incising difficult, especially fibrous foods. Biting into apples and corn is no bueno. 2-3 denture adjustments are normal after delivery.
46
Why do you want to remove the dentures at night?
You want the tissues to rest.
47
Why do you want to avoid adhesive pads?
They potentially change the occlusion.
48
What are the most likely causes to the complaint: The denture is too long.
MX: DB flange of CD is too thick and interfering with the coronoid process. MN: Intaglio surface of the mid to posterior-lingual flange are causing the mylohyoid muscle fibers to be restricted.
49
Most likely cause: I can't swallow.
Bead is too deep and sharp in the posterior palatal seal area.
50
Most likely cause to "my mouth is sore"
Check the PIP pattern. Canine eminence. other heavy seated areas. Frenum areas. Anterior MX frenum is most common
51
Most likely cause to pain
Mental nerve branch of the inferior alveolar nerve. Patients with severe resorption of the alveolar ridge may have an exposed mental nerve at the foramen. Pressure here causes severe pain.
52
"this lower denture doesn't fit!"
Encouragement, practice, patience, tongue position.
53
"my mouth is sore everywhere"
Open VDO. Inaccurate CR. Lack of occlusal balance. Occlusal interferences. Always recheck occlusion. Clinical remount may be indicated.
54
What is a common problem for poor phonetics?
Excessive thickness of the MX palatal portion. Position of the Mx anterior teeth. Need time to adapt. VDO.
55
Causes of Gagging.
Excessive palate thickness. Posterior border not beveled to the tissue. Palatal extension too long. Lack of tongue space from teeth being set too far lingually.
56
Causes of Cheek biting
Lack of sufficient posterior horizontal overlap. To fix, narrow the offending MN tooth from the buccal cusp.
57
Causes of burning sensation
Area of the mental foramen in the severely resorbed MN causes excessive pressure on the neurovascular bundle. Area of the incisive papilla due to the excessive pressure of the neurovascular bundle.
58
What is an immediate denture?
A dental prostheses inserted immediately following the removal of the remaining teeth. May replace one, several or all teeth.
59
How does CU do immediate dentures?
Posterior teeth are removed 6-8 weeks prior to immediate CD fabrication. Rationale is that the healion required in the primary stress bearing areas to provide a positive posterior seat for the CD. 2 opposing bicuspids may be saved to assist in VDO determination.
60
Conventional vs. Interim Immediate dentures.
Conventional: The definitive prosthesis. Refit or reline as required. Tissue conditioners. Interim: Limited period of time. New prosthesis planned after healing period of 9-12 months.
61
Advantages as a bandage
Controls bleeding, protects the blood clot, reduces contamination, protects against trauma, promotes healing.
62
Advantages with patient adaptation
Forced adaptation. No retraining of oral structures after a prolonged healing period, i.e. tongue. Less time for patient to accomadate to edentulism.
63
Advantages with aesthetics and function.
Esthetic changes are simple. Minimal disturbance of lip, face support. Resume job activities quickly. Patients more likely to continue wearing dentures. Learn to function through the surgical healing process, participates in social activities.
64
Advantages with natural teeth.
Aide in VDO, tooth position, size, shape.
65
Disadvantages of immediate dentures
Loss of natural teeth and stimulation. Forces of dentures are applied while bone and tissues are healing. Will shape bone to accommodate forces. Require more adjustments. Greater initial ridge resorption and shrinkage. Unhealed tissues resorb faster than healed. In the wax try-in you can verify CRR and posterior arrangement only, no anterior wax try in. You can't verify esthetics and phonetics until insertion. More expensive.
66
Informed consent
Limitations of prostheses. Possible complications of surgery. Time, effort and expense. Need for continued care such as reline and remake.
67
What are the steps of the immediate dentures?
1. primary impressions 2. Final impressions: One tray or sectional tray. 3. Jaw relation records using posterior wax rims. 4. Wax try-in/CR verification of posterior teeth. 5. Surgery and delivery of immediate CDs. All steps except clinical remount. 6. Post-op follow up. 25 hours. 7. Clinical remount is 10-14 days post insertion.
68
Preliminary impressions
Irreversible hydrocolloid. Special trays are available with only anterior teeth. Contour/extend with wax.
69
Final Impressions
Border mold edentulous area with custom tray. Use the selective pressure technique usually with polysulfide (RBI) because existing teeth may be mobile and periodontally involved and of potential tissue undercuts labial of the MX and MN. You need full vestibular extensions, same as conventional dentures.
70
Sectional Tray Technique
Labial flange of tray is removed and a two-stage impression is made. You border mold sectional tray and make RB or PVS posterior impression. Secondary alginate impression is used to capture the anterior segment. Reassemble outside of the mouth.
71
What are the three ways to trim a cast?
Spatial modeling, standard and Jerbi.
72
Surgical Stents
Used as a trial denture to precheck fit of final CD. Areas of blanching require more surgical reduction or will require denture border adjustment.
73
When is the stent fabricated?
The lab fabricates the stent on the master cast at CD boil out stage.
74
When do you do the clinical remount??
10-14 days! IT IS MANDATORY.

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