the trial placement Flashcards
this stage becomes a critical phase of complete denture care in evaluating this relationship
wax trial
significant appt for successful complete denture
trial placement
mutual satisfaction is needed before dentures are processed and change is difficult
-BOTH pt and dentist can see and evaluate
trial placement
subsequent steps convert dentures to acrylic resin which limits the possibility of
further correction
preliminary arrangement of denture teeth that has been prepared for placement into the patient’s mouth to evaluate esthetics and maxillomandibular relationships
trial denture
process of placing a trial denture into the patient’s mouth for evaulation
trial placement
clinical evaluation of trial denture. Why?
- _____ are crude approximations of positions of artifical teeth. contours are______
- ___ and ___ of teeth selected are based on anatomic averages
wax occlusion rims
arbitrary
shape and size
use what inside the trial bases
denture adhesive powder
(wet inside)
trial dentures clinical evaluatiion:
1
2
3
4
5
6
7
- OVD
- CO
- midline, vertical and horizontal overlap
- occlusal plane (horizontal)
- buccal corridor (natural dark space)
- phonetics
- overal esthetics (s sound)
-numerous methods suggested but all are unscientific
-should assess using a combination of methods for more accuracy
assessing OVD
normal 2-4 mm space between teeth when mandible in rest position
2-4 mm space= IOD (interocclusal distance)
PRP= IOD + OVD
stretch-relax method
(OVD assessment)
-dot on nose and chin
-open wide and hold for 20 seconds
-slowly close until lips first touch
measure distance between dots
-after 10-15 more seconds, close until teeth touch. measure dots again
swallow-relax method
(OVD assessment)
-patient is asked to swallow, then relax. teeth contact while swallowing, then separate upon relaxing
-note: teeth should not be in contact at PRP
closest speaking space
(OVD assessment)
rapid speech of sibilant sounds (S, CH)
“sixty six, san francisco, Kansas City Chiefs”
-should be NO contact of max and mand teeth when speaking
S SOUNDS
must verify that the casts are mounted correctly on the articulator
centric occlusion
make new interocclusal record in mouth and check it on the articulator
remember: either record base can move on soft tissue and the resulting occlusion may seem acceptable when its not
REMOUNT CASE IF NEEDED
trial placement- verify centric relation mounting
centric position contacts:
- check with articulating paper
- stabilize the mandibular denture
- new centric relation record
- minimal amount of recording medium
-teeth interdigitate perfectly
-NO SPACE AROUND THE CUSPS
-condylar ball should contact fossae wall
if either criteria not met, remake record
accurate mounting
-mandibular cast removed from mounting ring
-mounting plaster ground thinner
-cast remounted, using the new record
second record using to confirm inaccurate mounting
_____ determined by esthetics/phonetics
anterior
1-2mm incisor teeth visible
resting upper lip (level of occlusal plane anterior)
displays most of teeth length, but. minimal amount of denture base
smiling
_______should have positive contact with lower lip when fricative sounds (F V, very funny) are made
maxillary incisors
should be slightly visible at lower lip
mand incisors
mandibular molars at height
2/3 up RM pads
occlusal plane posterior.
plane should be ____ below dorsal surface of resting tongue (below commisure of mouth
2-3 mm below
occlusal plane posterior should be _____ the two residual ridges and usually bisects the _____ between the ridges
parallel
space
occlusal plane:
max posterior teeth parallel ____
ala-tragus plane (campers plane)
max posterior teeth (should/should not) appear to descend posteriorly
should not
easier to assess - teeth have replaced bulky rims
crowded tongue space can adversely affect this
phonetics
phonetics:
- S, CH- OVD
- F, V -incisors hit wet/dry line
- sibilant sounds
- fricative sounds
-F, V, fifty-five
-ask patient to count from 50 to 60
- maxillary incisal edges should just touch the posterior 1/3 of the lower lip
fricative sounds
speech- 5 components
1. lungs:
2. vocal chords:
3. pharynx, mouth, nasal cavity
4. mandible, tongue, lips, soft and hard palate, alveolar ridge and teeth convert sound into meaningful speech
5. a learned activity
- respiration
- phonation
- resonance
- articulation
- neurologic integration
if teeth touch when speaking ______ sounds, occ vert. dimension is too far open
s sound
if speaking space is excessive (more than 3 mm, then:
OVD is likely overclosed
if patient whistles on sibilant sounds:
contour of anterior palate may be too narrow
if patient lisps on sibilant sounds:
anterior palate may be too broad
S
Z
T
CH
SH
sixty-six
mississippi
sibilant sounds
incisors should approach end to end relationship
sibilant sounds
-non-uniform OVERJET of anterior teeth
-diastemas betwen teeth
-palatal contours
-diamond-shaped openings between incisors
lisping
posterior tooth position:
mediolaterally centered over denture-bearing area
-records condylar inclination of patient
-is used to adjust articulator condylar angles
-is for BALANCED OCCLUSION SCHEMES ONLY.
protrusive record
protrusive record is made ~ ___mm protruded
6
this affects phonetics, comfort, and retention
-should not be slightly convex in shape
(dont make bulky)
denture base contours
with denture base contours,
ensure that the denture base is not:
unduly thick or thin
with denture base contours,
excess bulk will:
(feel between index and thumb)
base that is too thin will:
(should not be able to see through)
excess bulk will: impair comfort
base that is too thin will: be weakened
