1
Q
EXTRAORAL OBSERVATIONS (6)
A
- Appearance
- Bearing and manner
- Gait (manner of walking)
- Facial color, sweating
- Any obvious swelling or disproportion of face
- Wearing eyeglasses, hearing aids
2
Q
From the hairline, to the levels of the condyle, to the angles of the jaw, the sides of the face are straight and parallel.
A
A. The SQUARE Face
3
Q
Is widest at the hairline and narrowest at the angles of the jaw. The lines on the sides of the face converge in towards the jaw.
A
B. The TAPERING Face
4
Q
Is widest through the center at the level of the condyles. It curves upward and downward to form an oval outline
A
C. The OVOID Face
5
Q
From the hairline down to the condyles, the sides of the head are parallel.
From the condyles down to the angle of the mandible along the sides of the face, the outline tapers to the angle of the jaw.
A
D. The SQUARE Tapering Face
6
Q
FRONTAL FACE FORM CLASSIFICATION (OUTLINE OF THE FACE)
A
According to House & Loop, Frush, Fisher & Williams:
a. Square
b. Tapering
c. Ovoid
d. Square Tapering
7
Q
LATERAL FACE FORM CLASSIFICATION
A
ACCORDING TO ANGLE
* Class I – Straight form
* Class II – Retrognathic
* Class III – Prognathic
8
Q
- Examined by viewing patients from the side.
A
FACIAL PROFILE
9
Q
- Profile is obtained by joining two reference lines:
A
o Line joining the nasion (X) and the deepest point in the curvature of the upper lip (A) subnasion
o Line joining point (A) and the most anterior point of the chin (B) (pogonion)
10
Q
two lines nearly form a straight line.
A
- Class I – Straight form -
11
Q
lines form convexity towards tissues.
A
- Class II – Retrognathic
12
Q
lines form an angle with concavity towards tissues.
A
- Class III – Prognathic
13
Q
LIPS CLASSIFICATION (5)
A
- Lip Length ( long, medium, short)
- Lip Thickness (thin or thick)
- Lip mobility
o Class I normal
o Class II reduced mobility
o Class III paralysis - Smile or Lip line (High lip line, low lip line, normal)
- Lip support (adequate or inadequate)
14
Q
- Ability to perform various mandibular movements.
A
Neuromuscular Coordination Classification
15
Q
Neuromuscular Coordination Classification (3)
A
o Class I – excellent
o Class II – fair
o Class III - poor
16
Q
TMJ (3)
A
- Pain or difficulty in mouth opening
- Uncoordinated jerky movements
- Tenderness, clicking or crepitus.
17
Q
Mucous Membrane (4)
A
- Color
- Firmness
- Painful area
- Thickness
18
Q
What is cheek essential for?
A
- Essential for peripheral seal due to placement of tissues over the buccal flanges of the denture
19
Q
- Commonly seen lesions on Cheek
A
- Lichen planus
- Submucosal fibrosis
- White lesions
- Malignancies
20
Q
Tongue size (4)
A
Ø Class I = Complete visualization of the soft palate.
Ø Class II = Complete visualization of the uvula.
Ø Class III = Visualization of only the base of the uvula.
Ø Class IV = Soft palate is not visible at all.
21
Q
can affect the prognosis of the mandibular denture.
A
Floor of the Mouth
22
Q
- Near or at level of the ridge crest
A
Floor of the Mouth
23
Q
- Hyperactive floor
A
Floor of the Mouth
24
Q
- Ridge resorption so great that the floor of the mouth ___________________
A
in the sublingual gland and mylohyoid region spill onto the ridge.
25
o Denture insertion and removal difficult and painful.
Maxillary Tuberosity
Undercut (unilateral or bilateral)
26
o Back end of occlusal plane may be placed too low.
o Not enough space to set all molars.
Maxillary Tuberosity
Enlarged
27
o Most favorable for retention & stability
* Class I – U shaped
28
o Not very favorable
o Slight movement will break seal and cause loss of retention
o Associated with tapered arch
* Class II – V shaped
29
o Not very favorable
o Poor resistance to lateral forces
* Class III – Flat or Shallow vault
30
Determines the extent of additional area available for retention as well as the width of the posterior palatal seal area.
Hard Palate Classification
31
almost horizontal to the hard palate
* Class I
32
slope about 45 degrees from the hard palate
* Class II
33
slope about 70 degrees from the hard palate
* Class III
34
Arch Size (3)
* Class I – Large
* Class II - Average
* Class III – Small
35
Arch Form (3)
* Class I - Square
* Class II - Tapered
* Class III - Ovoid
36
Arch Relationship Classification (2)
Anterior
* Class I
* Class II
* Class III
Posterior
* Class I
* Class II
* Class III
37
Interarch Space (3)
* Class I – Normal
o 16- 20 mm. adequate for the accommodation of artificial teeth.
* Class II – Excessive
o Associated with highly resorbed ridge.
* Class III – Insufficient
o Setting difficult, each tooth might be ground to fit space - Associated with large ridge.
38
Residual Ridge Classification (4)
* Class I
o Residual bone height of >21mm measured at the least vertical height of the mandible
o Class I maxillomandibular relationship
* Class II
o Residual bone height of 16-20mm Class I maxillomandibular relationship
* Class III
o Residual bone height of 11-15mm
o Class I, II, III maxillomandibular relationship
* Class IV
o Residual bone height of <10mm
o Class I, II, III maxillomandibular relationship
39
Saliva
Consistency (3)
* Thin serous (favorable for denture retention)
* Thick mucus (tends to displace denture)
* Mixed (contains both)
40
Saliva
Amount (3)
* Class I - Normal (ideal for denture retention)
* Class II - Excessive (makes construction difficult & messy)
* Class III – Reduced/ Xerostomia (reduced retention, increase tissue soreness)
41
Procedures intended to improve the denture bearing surfaces of the mandible and maxilla
PREPROSTHETIC PROCEDURES
42
NON-SURGICAL METHODS
1. Rest for the Denture Supporting Tissues
2. Occlusal Correction of the Old Prosthesis
3. Good Nutrition
4. Conditioning of Patient’s Musculature
43
* Removal of denture for extended period
* Use of temporary soft liner (for several days)
* Regular finger or toothbrush of denture bearing mucosa, especially the edematous and enlarged.
1. Rest for the Denture Supporting Tissues
44
* To restore vertical dimension using interim resilient lining material
* Correction of the extent of the tissue coverage
2. Occlusal Correction of the Old Prosthesis
45
* Eat a variety of food
* Build diet around complex carbohydrates: fruits, vegetables, whole grains and cereals
* Eat at least five servings of fruits and vegetables daily
* Select fish, poultry, lean meat, or dried peas and beans every day
* Obtain adequate calcium
* Limit intake of bakery products high in fat and simple sugars
* Limit intake of process foods high in sodium and fat
* Consume 8 glasses of water daily
3. Good Nutrition
46
* Use of jaw exercises can permit relaxation of the muscles of mastication and strengthen their coordination.
4. Conditioning of Patient’s Musculature
47
. Stretch relax exercises
open wide, relax
move to the left, relax
move to the right, relax
move forward, relax
* do it 4x in each, 4 sessions a day
48
Any surgical procedure performed on a patient aiming to optimize the existing anatomic conditions of the maxillary or mandibular alveolar ridges for successful prosthetic rehabilitation
SURGICAL METHODS
49
Surgical procedures included are:
1) Improve the bony foundation.
2) Improve the soft tissue foundation.
3) Improve ridge relationship.
4) Implant procedures.
50
Classification: SURGICAL METHODS
1. Related to the development of a retentive denture.
2. Related to the provision of a stable denture.
3. Those which will allow the establishment of a correct vertical dimension.
51
- Prevent proper extension of the denture base
- Border seal cannot be made
- Soreness can occur due to thin tissues
- Fracture of the denture base
Torus Mandibularis
52
- Affect denture stability
- May cause sore spot
- Interfere with tongue function
- Affects post-damming
- May fracture denture
Torus Palatinus
53
Indications for Removal of Torus (4)
1. Extremely large torus that prevents the formation of an adequately extended and stable denture
2. Traps food debris due to undercuts causing chronic inflammatory conditions
3. Torus that extends past the junction of the hard and soft palate (prevents formation of posterior palatal seal)
4. Patient concern (cancerophobia)
54
- An exostosis (bone prominence) on the buccal surface (cheek side) of the alveolar ridge of the maxilla or mandible.
Alveolar Exostosis
55
- Creates discomfort causing displacement.
Genial Tubercle
56
- Present in extreme mandibular resorption, causing pain.
Pressure in Mental Foramen
57
Common Procedures to Improve Bony Foundation
P Simple Alveoloplasty
P Intraseptal Alveoloplasty
P Maxillary Tuberosity Reduction
P Buccal Exostosis and Excessive Undercut Removal
P Maxillary Tuberosity Reduction (osseous)
P Genial Tubercle Reduction
P Maxillary Tori Reduction
58
- Interfere with optimal seating of the denture.
- Affects denture stability.
Hyperplastic ridge
59
- Interfere with optimal seating of the denture.
Epulis fissuratum
60
- Harbors micro-organisms
- Removal using electrosurgery or microbrasion
Papillomatosis
61
- Encroachment or obliteration of interarch space
Pendulous fibrous maxillary tuberosities
62
- Difficult to obtain ideal extension
- Affects peripheral seal
Frenular Attachment (Close to the Ridge Crest)
63
Common Procedures to Improve Soft Tissue Foundation
P Soft tissue plasty/recontouring
P Soft tissue reductions
P Soft tissue excisions
P Soft tissue repositioning
P Soft tissue grafting
64
,* Increases the vertical extension of the denture flanges.
* Reposition muscle attachment from crest of the ridge.
Vestibuloplasty
65
* Places considerable stress and unfavorable leverages on the basal seat
Discrepancies in Jaw Size
66
* Increase bulk of the ridge
Ridge Augmentation
67
Procedures to Improve Ridge Relationship (4)
P Maxillary advancement procedures
P Maxillary retrusion procedures
P Mandibular advancement procedures
P Mandibular retrusion procedures
