1
Q
What are complete dentures usually made of?
A
PMMA (acrylic)
2
Q
How long should an acrylic denture last?
A
5 years
3
Q
What can be used as an alternative to an acrylic complete denture if a patient is allergic to acrylic?
A
Nylon
4
Q
How long does a Nylon denture last?
A
18 months
5
Q
What are effects of edentulism?
A
- loss of masticatory function
- speech
- aesthetics
- self esteem
- quality of life
- general health effects
6
Q
In more detail what are some of facial changes that occur in edentulous patients?
A
- no lip support so lips collapse inwards
- reduced facial height
7
Q
According the Cawood and Howell classification describe the 6 stages of post-extraction ridge resorption?
A
stage 1 - before extraction stage
stage 2 - after extraction stage
stage 3 - high well rounded ridge
stage 4 - Knife edge shaped ridge
Stage 5 - low well rounded ridge
Stage 6 - depressed bone level
8
Q
What can effect the rate of resorption of the ridge post - extraction of teeth?
A
- dependent on pre extraction state of the teeth and alveolar bone
9
Q
What are some of the causes for rendering a patient edentulous?
A
- Caries
- Periodontal disease
- failing dentitions
- appearance
- tooth wear
- occlusal collapse (often caused by failing dentitions)
- occlusal collapse
10
Q
What are Medical factors that can increase caries risk?
A
Xerostomia
Sjogren’s syndrome
Radiation caries
Developmental disorders
Disability
Dementia
Addiction
11
Q
What factors can increase the risk of periodontal disease?
A
Susceptibility
Disability
Dementia
Medical factors
Social history
12
Q
What can cause tooth wear?
A
attrition
abrasion
erosion
lack of posterior support
supervised neglect
13
Q
What can cause failing dentitions?
A
- overambitious treatment
- cycles of replacement
- human, social and medical factors
14
Q
What can cause occlusal collapse?
A
often secondary to other reason eg perio caries and tooth wear
15
Q
What are the two methods of complete denture construction?
A
- conventional dentures
- replica dentures
16
Q
When would you use conventional construction of complete dentures?
A
- if patient has never had dentures
- previous dentures are poor
- if you want to make major changes
- easier to correct faults
17
Q
When would you use the replica method when constructing complete dentures?
A
- if patient happy with current dentures (dentures just worn)
18
Q
What is the aim of a primary impression?
A
to accurately record clinical relevant landmarks without excessive tissue distortion
19
Q
What is lab stage 1 in construction of complete dentures?
A
- casts poured in dental stone
- special trays made
20
Q
What is the primary support areas on a complete upper denture?
A
hard palate
21
Q
what is the secondary support areas on a complete upper denture?
A
ridge crest
22
Q
which part of a complete upper denture is non- contributing to support?
A
denture border
23
Q
where does there need to be relief areas on the upper denture?
A
midline suture and incisive papillae
24
Q
Where is the primary support areas on lower dentures?
A
buccal shelf and retromolar pad
25
where is the secondary support areas on the lower dentures?
ridge crest and genial tubercles
26
Where on a lower denture might there need to be relief areas?
- prominent genial tubercles
- prominent mental tubercles
- lingual ridge incline and mylohyoid ridge
27
which part of a lower denture is non-contributing to support?
labial ridge incline
28
What materials can be used to modify primary impression trays?
- red ribbon wax, greenstick, putty and red composition
- can reduce tray extension with acrylic bur
29
What areas on a stock tray commonly have to be altered?
- reduction for buccal, labial and lingual frenulum
- reduction for mandibular tori
- palatal reduction (extending to far posteriorly)
30
What are the limitations of stock trays?
- trays not made to measure
- peripheral extensions often over or under extended
- limited sizes available
31
When would you maybe uses red composition without alginate when taking an impression?
- for primary impressions in a patient with a bad gag-reflex
- much shorter setting time
32
ideally what should be the distance between stock tray flange and denture bearing areas?
4mm
33
Describe the clinical procedure of primary impression taking?
- explain procedure to patient
- select stock trays you think will be most suitable
- asses the tray visually in the mouth by manipulating lips cheeks and tongue
- change tray size if need be or make modifications using acrylic bur or red wax if needed
- once happy apply adhesive to tray and wax
- mix alginate and load tray
-seat loaded tray in mouth
- border mould muscle while alginate is setting (cheeks and lips)
- stick tongue out for lowers to get correct sulcus depth
- once set remove tray with sharp sudden movement
34
What material is used to make special trays?
VLC resin PMMA (acrylic)
35
What is used as a spacer when making special trays?
modelling wax
36
How thick a spacer do you need when your using alginate or silicone elastomers/ polysuphides to take master impressions?
3mm
37
when would you have no spacer when moulding special trays?
if the impression material to be used was going to be silicone elastomers or ZOE paste
38
What are the advantages of special trays?
- accurate peripheral extensions
- uniform thickness of impression material
-reduce amount of material needed = less discomfort for patient
- records denture bearing areas more accurately
39
What factors make complete denture retention and stability difficult?
- reduced saliva
- CoCr dentures don't adapt as well as PMMA
- incomplete palate (cleft palate)
- atrophic ridge
- fibrous ridge
- movement of soft tissues
- gag reflex (cant extend denture far enough)
-
40
What is adhesion?
the physical attraction of dissimilar molecules to each other
- saliva and mucous membrane
- saliva and denture base
41
What is cohesion?
the physical attraction between similar molecules
- salivary flow
42
What is a post dam seal?
A groove cut along the posterior palatal margin of the maxillary denture which produces a ridge on the finished denture to create a posterior seal to aid in retention
43
How would you achieve optimal retention and stability via the fitting (basal) surfaces of the denture?
- good palatal extension
- post dam seal (maxillary)
- good base shape (adaption to mucosa)
- good extension into the retromylohyoid fossa (mandibular)
- labial and bilateral soft tissue undercuts
44
How would you achieve optimum retention and stability via the occlusal surfaces?
- occlusal plane and level
- tooth position on arch in relation to ridge, tongue and oral musculature
- balanced occlusion
- good tongue control
45
How would you achieve optimal retention and stability via the polished surfaces of the denture?
- good contour of buccal, lingual and palatal shapes
- can take 7s out in lower to give tongue more space
46
What two things can be added to the mucosal surface to aid in denture retention and stability?
- denture adhesives
- implants (titanium)
47
during anterior tooth selection what 3 factors do you need to take into account that will effect the patient?
- appearance
- function
- speech
48
What dental factors may influence the choice of artificial teeth and gums?
- previous dentures
- ageing
- size of facial skeleton and skeletal class
- physiological pigmentation
- dentists perception
49
What patient factors may influence the choice of artificial teeth and gums?
- influence of others
- lifestyle, relationships and goals
- smileorexia
- phycological factors
- perception of aging
- self-esteem
50
What materials can be used for artificial teeth?
- acrylic (always unless allergic)
- porcelain
- composite resin based
- combination
51
What factors can influence shade selection of artificial teeth?
- colour washout
- illuminant metameric failure
- observer metameric failure
- technical errors
- patient photographs
- family members
- patient preference
52
What is the Leon Williams classification?
- Classified faces into square, tapering and oval
- Inverted shape of the face corresponded to the shape of the maxillary central incisor
53
What measurements are given on a teeth mould guide?
- width of the 6 anterior teeth
- width of central incisor
- length of central incisor
54
once you have selected the mould of your upper anterior teeth what guide tells you what mould you should use for your lower anterior and posterior teeth?
senator articulation table
55
What additions can you add to your denture during tooth setting which may give your denture a more natural look?
- characterisation
- imbrication
- diastema
- rotation
- straight
- natural
- recession
56
What instructions do you need on your lab card for a tooth trial?
- name
- shade
- mould
- setting
- any additional instruction for technician
57
What 5 things do you need to consider when modifying record blocs?
LIMBO
- lip support
- incisive level
- midline
- buccal corridors
- occlusal plane
also make sure you have FWS
58
When setting teeth where should the tip of the central incisor lie in relation to the incisive papilla?
5.5mm anterior
59
What is the golden rule for anterior tooth position during try in phase?
- let patient see appearance and gain approval
- take note of approval before progressing to next phase
60
How do you select and position posterior teeth?
- size
- width
- number and length
- position
- occlusal surfaces
61
What factors may influence your choice of posterior teeth?
- neuromuscular control
- ridge
- reproducibility of occlusal position
62
What determines the width of lower posterior teeth?
width of ridge
- avoid lingual overhangs teeth need to sit directly on ridge
63
What effects length and number of posterior teeth?
- length of ridge
- sufficient tongue room
- can remove 7s if not enough space or a premolar if you just need a bit more space
64
How does the positioning of upper and lower artificial teeth differ?
- upper teeth are placed slightly buccal to the ridge without compromising oral seal
- lower teeth are placed on the crest of the ridge to ensure stability
65
How do you know if your occlusal plane is sufficient?
- use a fox's bite gauge and make sure it is parallel to the ala tragus line
66
What angulation is used on the occlusal surfaces of artificial teeth?
- usually hybrid 12degrees
67
when would flat non-cusped occlusal surfaces be the choice for posterior artificial teeth?
- usually used when difficulty in getting a reproducible jaw relationship
68
What do you want to look at on your complete denture at trial stage before your patient arrives?
- correct lab work and patient
- damage
- is it what you asked for (design and shades)
- is it stable on casts
- is it smooth
- is the border extensions shaped to the depth and width of the functional sulcus
- is the wax well adapted
- check occlusion
- are the teeth in the midline with each other
- is the pin on the table
- is the overbite and overjet as expected
- are there even contact points
- are lower teeth set over the crest
- are upper teeth set buccal to the ridge
- is it the correct number and shade of teeth
- has a post dam been cut
69
What are the denture try in checks you would want to do?
- check retention and stability
- check base extensions
- LIMBO checks
- position of teeth compared to soft tissue
- vertical dimension FWS
- even contact in occlusion (RCP)
- speech
- aesthetics
70
What is an he indications for a underextended or over extended denture base?
1. overextension of peripheries - denture will drop when you manipulate tissues
2. under extension - denture will drop when you hold tissues away
3. too much lip support and the denture will drop
71
When do you know if the teeth are in the correct place when assessing denture during try in?
- teeth should be in the neutral zone
- not getting dislodged by tongue or cheeks
72
How do you know if you have the correct vertical dimension during the denture try in?
- measure OVD - RVD = FWS
- if sufficient FWS then vertical dimension is fine
73
How would you test if patients speech is adequate during denture try in?
- test fricative sounds
- count from 60-70, days of the week etc
- look for f and v sounds (incisors and lower lip contact)
- not too much whistling on s sounds
- teeth should be slightly apart during speech
74
How do you decide if the aesthetics of the denture is adequate during try in stage?
- give patient a mirror and allow them to decide ( give them time )
- ask if there happy with the fit, look and speech
- reassure that gums will not be as red in final denture
75
What is the problem if teeth are making contact during speech?
- insufficient FWS
- OVD needs to be reduced
76
What is the problem if there is significant whistling sounds during "s" sounds?
- too much air escaping
- OVD needs to be increased or change anterior tooth position if Class 2
77
During try in stage if the midline wasn't correct how would you fix it at chairside?
- remove central incisor and lateral incisor of the side you want to move the midline towards
- reset central incisors at the desired midline and send to lab to reset rest of teeth and re try
78
If there is a major over or under extension of the flange during try in stage what would you do?
- go back to master impression stage
79
If there is a minor over or under extension during the try in stage what can you do?
over extension -modify wax and mark on master cast maximum extent of flange and send to lab with specific instructions of or insertion
under extension - 1. wash impression in try in (closed mouth technique) and send to lab for casting/mounting then do a re try 2. proceed to insertion stage but do not insert at that stage but instead reline denture
80
In relation to adjusting the occlusal surfaces of artificial teeth what is the BULL rules?
only adjust the Buccal upper (palatal surface of buccal cusp) and lingual lower (buccal surface of lingual cusp) when altering
81
What 3 extra things are added to the try in checklist during the final insertion stage?
- discomfort
- removal and insertion of the denture
- wear and care instructions
82
What small alterations involving base extension retention and stability may you have to do at the final insertion stage?
- may need to adjust to compensate for labial fraenum
- retching (may need to adjust palate extension)
83
What can be used to mark on the denture where muscle attachments are rubbing?
pressure indicated paste
84
At the insertion stage which can you adjust slightly out of LIMBO?
lip support- minor labial flange reduction only
85
Can you change the position of teeth to soft tissue at insertion stage?
- can reduce excess/ reshape lingual sulci only
86
Cn you alter occlusal contacts at the denture insertion stage?
minor occlusal adjustments are often needed at this stage
- altered by selective grinding
87
In clinic during the insertion stage if the was major discrepancies in occlusal contacts how would you fix it?
1. remove lower wax teeth is upper teeth are acceptable
2. replace with wax rim
3. re record the registration (remember FWS)
4. prescribe another wax re try in
5. give both dentures to lab
6. the lab will mount on articular and reset lower teeth to upper
88
Can you change speech or aesthetics of denture at insertion stage?
no but reassure patient a lisp is normal until they get used to it
- manage expectations
89
Where are the common areas of discomfort during denture insertion which may need to be altred?
- tuberosity
- anterior labial flange
- tori
- areas of poor support ( mylohyoid ridge, knife edge ridge, flabby ridge)
90
How can you identify what area of the denture is causing a patient discomfort?
- discomfort history ( ask patient where)
- pressure indicating paste
91
How would you teach your patient on insertion and removal of their denture?
- insert lowers before uppers
- demonstrate how to do it using a mirror
- check patient can manage to do it themselves
92
What are the wear instructions you would give your patient on delivery of there denture?
manage expectations - remind patient it may take a while to adjust
perseverance - some discomfort is normal , speech may lisp, eating may be difficult, may get comments on aesthetics
wear as much as possible but take out at night
if problematic wear denture a day before review appointment so can see where the problem is
93
What are the care instruction you would give your patient to maintain there denture?
- brush denture daily with non-abrasive cleaner
- soak dentures daily in denture cleaner to remove plaque and disinfect
- leave dentures out at night to relieve pain and prevent infection
- insure your mouth remains healthy with regular dental appointments
94
What do you do with your lab card on completion of the denture?
- tick accepted or declined in the patient statement
- give 3rd copy of lab card to patient
- 2nd copy in patient notes
- original copy with "finished" goes back to lab with casts and trays
95
When would you get your denture patient back for a review appointment?
1-2 weeks after insertion
96
What would you check at the patients review appointment?
- patient complaints etc
- aesthetics and speech
- function
- recheck occlusion (FWS)
- any other problems
- examination (redness/ hyperplasia/ ulceration)
97
If patient has redness/ ulceration/ hyperplasia at review appointment what would you do?
- get history
- place pressure indicating past on denture at site
- adjust
- recheck
- if major adjustments/polished surfaces/sharp edges adjusted get dentures polished
98
What are the causes of poor denture hygiene?
- old worn dentures
- sleeping with dentures in
- xerostomia
- poor manual dexterity
- inability to self care
- lack of knowledge
- poor diet
- ill fitting dentures
- poor neuromuscular control
99
What is found in the debris on dentures?
- plaque - biofilm
- calculus
- food
100
What makes up the pellicle layer of debris on the dentures?
salivary proteins and bacterial products
101
what makes up the oral debris on dentures?
- mucin
- food
- desquamated epithelial cells
- bacterial and fungi
102
What bacteria in the mouth can cause halitosis (bad breath)?
- fusobacteria
- produces sulphur products
103
What bacteria can be found in the debris on dentures?
- s. aureus
- E. Coli
- Alpha streptococci
- spirochaetes
- fusobacteria
104
What fungi can be found in the debris on dentures?
Candida - acidic environment under PMMA favours candida
105
What are the effects of poor denture hygiene?
- caries
- periodontal disease
- halitosis
- pain
- denture stomatitis
106
What are the signs of denture stomatitis?
- red, pain and swelling under denture
- bad breath
- red sore commissure
107
What cause denture stomatitis?
- caused by accumulation of candida under denture
108
How would you treat denture stomatitis?
- Denture OHI
- get patient to take denture out at night
- antifungal (clotrimazole)
109
What is Aspiration Pneumonia?
- aspiration of food, reflux and oral bacteria into the lower respiratory tract (common in older patients)
110
What are the different methods of mechanically cleaning the denture?
- ultrasonic
- soft brush and soap
- microwave (no longer than 20s and no metal)
111
Why is important that the denture is mechanically cleaned before chemically cleaned?
- removes obvious debris
- chemically cleaning is ineffective unless debris has been removed first
112
What are the ideal properties of denture cleaners?
- cheep
- easy to use
- effective removal of biofilm mass
- effective stain removal
- non - toxic
- bactericidal and fungicidal
- harmless to denture components
113
What are the different types of chemical denture cleaners you can get?
- alkaline peroxides
- alkaline hypochlorite
- enzymes
- abrasive cleaners
- acids
114
Alkaline peroxide denture cleaner:
- steradent 3mins
- comes in tablet or powder form and creates bubbles when combined with water
- active ingredient is sodium perborate
- effervescent
- does not effectively remove calculus or dark staining
115
Alkaline hypochlorite's denture cleaners:
Example: Milton
- very effective antibacterial/ antifungal
- may corrode metal
- short soak (10mins) if metal component
- dont use on soft linings
116
Acid denture cleaners:
Example: Denclen
- good at dissolving calculus and staining
- citric acid
- vinegar
- don not use for soft linings or metal based dentures
117
Enzymes denture cleaners;
Example: polident
- expensive
- proteolytic enzymes
- dextranase, protease and mutanase
-
118
Abrasive denture cleaners:
Example: Dentu-Creme
- stain removal
- damage to denture
- less effective antimicrobial activity
- adjunctive chemical soak still needed
119
What are the negatives of chemical denture cleaners?
- manufacturers instructions
- damage
- bleaching
- allergies
- thermoplastic appliances
120
What effect can acid cleaners have on metal in dentures?
- tarnishing
- galvanic reactions
121
What are 2 good cleaning routines for metal based dentures?
1. soak in effervescent alkaline peroxide cleaners such as steradent for max 15mins at night
2. soak in alkaline hypochlorite cleaners eg milton for max 10mins at night
- soak in water over night
122
What is a good chemical cleaner and routine for cleaning soft denture linings?
- soak in effervescent alkaline peroxide cleaners such as steradent for max 15mins (cold water)
- avoid hard toothbrushes
- soak in cold water over night
123
How would you provide a patient with denture car instructions?
- Give them a GDH caring for your denture leaflet
- discuss verbally
- individualise for specific patient circumstance (type of denture)
- record keeping
124
What specific instructions would you give patients on brushing there denture daily?
- rinse after every meal
- brush using a soft toothbrush, soap and water
- don't use toothpaste (scratch acrylic)
- do it over a basin of cold water to prevent breakage if dropped
125
What advice would you give to your patient on soaking there dentures daily?
- soak denture for 20mins each evening in an alkaline peroxide or alkaline hypochlorite cleanser
- less soaking time if metal base/components or soft linings
- soak over night in water
126
What advice would you give your patients about taking there dentures out at night?
- helps relive soreness and prevents infection
- very important in those at risk of denture stomatitis and elderly people
- soaking over night will help prevent stomatitis and aspiration pneumonia
127
Why would you instruct denture patient to maintain regular visits with their dentist?
- check for ill fitting/worn dentures
- check mucosal health and advise/manage
- check changes in social/medical circumstances
- maintain health of present teeth if they have any
128
What are some of the advantages of an immediate partial denture?
- speech
- function
- reduces/prevents drifting of remaining teeth
- appearance improved
- self esteem
- allows for post extraction heeling
- prevents collapse of facial musculature
- ridge form preservation
- promotes health
129
What are the disadvantages of an immediate partial denture?
- temporary prothesis due to ridge resorption
- poor adaption due to large amount of ridge resorption after extraction
- early extraction during denture making process due to pain and swelling
- managing patient expectations
- ongoing maintenance needed eg relines
- increased costs and patient visits
- limitations on improving aesthetics at try in
- undercut problems as there is no bone resorption at time of extraction
130
What can cause increased complexity of prosthetic stages when making an immediate partial denture?
Impressions - poor fitting stock trays, loose teeth, mispositioned teeth, hard to get denture bearing area
Occlusion - index teeth may be present and useful for OVD but drifted, tilted, over erupted teeth cause issues in recording occlusion
Design - limited to simple acrylic plate
Try in - limited to those teeth already missing but can still check extension, OVD, occlusion and shade
Insertion - correct teeth on denture, traumatic extractions can make insertion difficult
131
What are the contraindications to giving someone an immediate partial denture?
- some ORN?MRONJ areas
- pre chemo/ radiotherapy
- denture not required as there is no major aesthetic of functional deficit
- some pathological issues (eg large cyst)
- major fractures eg mandible of maxilla
- lack of patient consent
- dementia
132
What is the clinical process for preparing or an immediate denture?
- Examination and Assessment (radiographs if required)
- Medical History
- plan for extractions
- take primary impressions
- design acrylic plate
- take master impressions
- jaw reg
- try in plate (wont have teeth that still have to be extracted)
- check correct teeth are on immediate denture before extraction
- insertion of immediate partial denture
- adjust as needed with acrylic bur
133
What instructions do you need to give the lab after the try in of the immediate partial denture?
- teeth to be extracted (mark on master casts)
- arrangement/overbite (mark on cast teeth new incisal level)
- shade/mould
- material
- date required for insertion
134
If your patient is thinking about implants in the future what may you place in the socket after extraction?
- pack with bone (bio oss)
135
What is the initial aftercare of immediate dentures?
- keep dentures in for 24 hours after appointment
- review patient day after or as close to that as possible
- remove denture and examine mouth for healthy clots or any areas of inflammation
- after 24hrs advise warm saline mouthwash and patient to remove denture after mealtimes to rinse mouth and clean denture
- use soft toothbrush, soap and water
136
How often would you arrange review appointment with patient after fitting them with an immediate partial denture?
- review after 1-2 weeks and do any further adjustments
- review after 1 month and assess adaptation (consider a temporary reline)
- may need repeat review appointments and temporary relines, soft or definitive relines
- usually replace with RPD after 6month- 1 year depending on bone resorption
137
How would you do a chairside reline?
- Place reline material directly on fitting surface of denture and moulded in the mouth
- can be used in localised areas
138
when would you do a one stage immediate denture?
- when replacing 1 or 2 anterior teeth e.g trauma, abscess or root fracture
139
What are the clinical stages of making a one stage immediate denture?
- take upper and lower impressions
- high quality interocclusal record required to confirm occlusion
- choose shade
- prescription to lab should include design, which teeth have to be extracted and date of extraction
- extraction and insertion on next visit
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