The Trial Placement Flashcards
clinical evaluation of the wax trial denture
a complete denture is a mechanical object, much of which is fabricated outside the dental operatory. this mechanical object must function in a harmonious relationship between the mechanical and the biologic. the wax trial denture stage becomes a critical phase of complete denture care in evaluating this relationship
Trial Placement (4)
– a significant appointment for successful complete denture
treatment
– both patient and dentist can see and evaluate what has been
created
Mutual satisfaction is needed before dentures are processed and
change is difficult.
Accept —Modify —or start over
dentist should approach the appointment with the attitude that
errors max exist in all areas
subsequent steps convert dentures to acrylic resin which limits
the possibility of further correction
trial denture
a preliminary arrangement of denture teeth that has been prepared for placement into the patients mouth to evaluate esthetics and maxillomandibular relationships
trial placement
the process of placing a trial denture into the patients mouth for evaluation
wax occlusion rims are crude approximations of positions of artificial teeth. contours are —
arbitrary
shapes and sizes of teeth selected are based on the anatomic —
averages
dont overlook problems (3)
difficult/impossible to change after processing
may require removal, resetting, and reprocessing
procedures more costly and time consuming
Use denture — — inside the trial bases
adhesive powder
trial dentures clinical evaluation (7)
OVD centric occlusion midline, vertical and horizontal overlap occlusal plane buccal corridor phonetics overall esthetics
OVD
the distance measured between 2 points when the occluding members are in contact
assessing occlusal vertical dimension (3)
numerous methods suggested
all methods are quite unscientific
should asses using a combo of methods for more accuracy
OVD assessment
PRP (size)
2-4 mm space between teeth when the mandible is in PRP
OVD assessment
stretch-relax method (4)
dot on nose and chin. open wide and hold for 20 s
slowly close until lips touch. measure distance between dots
after 10-15 more s, close unit teeth touch. measure dots again
difference in measurements is interocclusal distance (2-4 mm average)
OVD assessment
Swallow relax method (2)
patient is asked to swallow, then relax. teeth contact while swallowing, then separate upon relaxing
note: teeth should not be in contact at PRP
OVD assessment
closest speaking space (2)
rapid speech of sibilant sounds (sixty six, san Fransisco, Kansas City chiefs, etc)
should be no contact of max and mand teeth when speaking
centric position contacts (4)
check with articulating paper
stabilize the mandibular denture
new centric relation record
minimal amount of recording medium
accurate mounting (3)
teeth interdigitate perfectly (no space around the cusps)
condylar ball should contact fossa wall
if either criteria not met, remake record
second record used to confirm inaccurate mounting (3)
mandibular cast removed from mounting ring
mounting plaster ground thinner
caster remounted, using the new record
level of occlusal plane
anterior (3)
anterior determined by esthetics/phonetics
resting upper lip: 1-2 mm incisor teeth visible
smiling: displays most of teeth length, but minimal amount of denture base
occlusal plane/phonetics (2)
maxillary incisors should have positive contact with lower lip when fricative sounds are made
mandibular incisors should be slightly visible at the lower lip
fricative sounds
F, V, very funny
occlusal plane
posterior (3)
mandibular molars at height 2/3 up RM pads
plane should be 2-3 mm below dorsal surface of resting tongue
plane should parallel the two residual ridges and (usually) bisects the space between the ridges
occlusal plane:
max posterior teeth generally parallel
max posterior teeth should not appear to descend
ala-tragus plane (campers plane)
posteriorly
phonestics (2)
easier to asses (teeth have replaced bulky rims)
crowded tongue space can adversely affect phonetics
sibilant sounds
S, CH- OVD
fricative sounds
F, V- incisors hit wet/dry line of lip
fricative sounds (3)
F, V, fifty five
ask patient to count from 50 to 60
max incisal edges would just touch the posterior 1/3 of lower lip
speech- 5 components
respiration- lungs
phonation- vocal chords
resonance- pharynx, mouth, nasal cavity
articulation- mandible, tongue, lips, soft and hard palates, alveolar ridge and teeth convert sound into meaningful speech
neurologic integration- a learned activity
phonetics- sibilants (2)
If teeth touch when speaking s sounds, OVD is too far open
if speaking space is excessive- more than approx 3 mm OVD, likely overclosed
phonetics tests
if patient whistles on sibilant sounds
if patient lisps on sibilant sounds
contour of anterior palate may be too narrow
anterior palate may be too broad
lisping (4)
non-uniform overjet of the anterior teeth
diastema between teeth
palatal contours
diamond- shaped openings between incisors
Esthetics/Appearance
Midline centered on
superior 2/3 of face and head.
Visualize from 3 ft away.
Esthetics/Appearance
Incisal plane parallels
interpupillary line
Esthetics/AppearanceStand back and evaluate overall appearance –the various
(5)
harmonies of tooth size, form, position, arrangement, shade.
Posterior tooth positions
— centered over denture-bearing area
Mediolaterally
checklist (4)
CR verified with recording medium VD verified (2-3 mm between lip closure and teeth touching, phonetics tests, lips appear and feel unstrained) tooth form, arrangement and shade verified phonetics verified (S, F, M)
protrusive record (4)
records condylar inclinations of patient
used to adjust articulator condylar angles
record is made approx 6 mm protruded
is for balanced occlusion schemes only. is not needs for non balanced schemes
denture base contours affects (3)
phonestics
comfort
retention
denture base contours should not be
slightly convex in shape
excess bulk will impair
comfort
feel between index finger and thumb
base that is thin will be
weakened
should not be able to see through
lab prescription
request (3)
processing, finishing and polishing
lab remount of the dentures
adj of occlusion to compensate for processing changes
