1
Q
What is removable prosthodontics?
A
It is a speciality in dentistry which focuses on replacing mssing teeth with removable prosthesis.
Gum and teeth will be replaced.
2
Q
What are some of the common consequences of tooth loss?
A
- Bone resorption - can lead to high frenum/muscle attachment
- Overreruption of opposing tooth
- Medially/distally drifting/tilting of adjacent tooth/teeth
- Occlusal disharmony affecting function
- Change in speech and aesthetic
- General affects on general health as well as quality of lfie
3
Q
What are some of the way we can classified removable dentures?
A
- Based on location of missing teeth - partial vs comlete
- Based on materials - acrylic, valplast, crhome
- Based on support - tissue or tooth or combined
- Construction methods - immediate vs conventional
4
Q
Do all patients with missing teeth need dentures?
A
No
5
Q
What are the aims of a removable dentures?
A
Restore:
- Aesthetics
- Function
- Speech
- Preserving remaining soft and hard tissues
6
Q
What are indications for a removable dentures?
A
- Replacing single or multiple missing teeth
- Temporary space maintenance in congenital missing teeth
- Obturation of hard palate after removal or oral cancer
7
Q
What are contraindications for partial dentures?
A
- Lack of suitable abutmnet teeth
- Rampant caries
- Severe periodontal diseases
- Poor oral hygiene
- Patients who cannot tolerate dentures
- Patient who recently received head and neck radiation treatment
8
Q
What are the options for patient that have missing teeth? Be very general?
A
- Removable prosthodontics
- Implants
- Fixed prosthodontics
- Do nothing
9
Q
What should we consider before making a denture for a patient?
A
- Patient oral hygiene
- Existing oral health conditions: caries, perio, pathologies, salivary flow and quality
- GIngivae and abutment tooth/teeth
- Gagging issues patient might have
- Patient’s perception
10
Q
What codes are there for dentures?
A
- Codes starting with 7
- Denture reline
- Denture repair
11
Q
How many appointments do you need for a general denture?
A
- Denture consult + primary impressions
- Secondary impressions
- Bite registration + shade mould selection
- Denture try on
- Denture insert
- Review denture
12
Q
What will the patient feel when they get a new denture?
A
- Excessive saliva
- Change in speech
- Feeling of bulkiness
- Food might get stuck under denture
- Denture moves to some extend
- Remove denture to clean
- Might have a sore spot or ulcer
- Might have a high spot
13
Q
How do they care for their denture?
A
- Remove dentures and clean after meals
- Brush dentures as brushing your teeth
- Brush and remove dentures at night and keep in denture container
14
Q
What is the difference between an overlay and overdenture?
A
Overlay - the denture sits around the tooth
Overdenture - the chrome part of the denture sits on top of teeth
15
Q
What are the standard steps for a chrome denture construction?
A
- Denture consult + primary impressions
- Secondary impressions
- Frame try in + bite registration + shade mould selection
- Trial denture - aka wax
- Denture insert
- Review denture
16
Q
What are the standard appointments for a valplast denture contruction?
A
- Consult, alginate impressions, bite reg, shade selection adn mould
- Dentur try in
- Denture insert
- Review
17
Q
What do you do in the consultation appoitmnet?
A
- Take all histories
- Do a specialised limited exam - extra oral exam, intraoral exam, occlucal exam
- Take alginate impressions
18
Q
What is the purpose of alginate impression?
A
To make a study cast and fabrication of a special trays - preforated (for secondary alginate) vs non perforated (for rubber based material)
19
Q
What do you write in a lab prescription after completing primary impression with alginate?
A
- Please pour up alginate impressions for study models
- Please construct a CCA special tray for upper or lower arch
20
Q
What is an occlusal stop?
A
It stops the tray from touching the teeth. Similarly - the gingival stopper will stop at the gingival thus making your impression better
21
Q
What materials could you use for secondary impressions?
A
- PVS
- PE
- Alginate
22
Q
What to do if the patient has no teeth and you still need a bite registration?
A
Record centric relation
23
Q
What are the indications for temporary denture? How many appointment does a construction require?
A
As an interim denture or immediate partial denture
Usually 3 appointments:
- Denture consult, alginate impression + shade selection
- denture try in
- Denture insert (after extractions)
+
Review
(Can’t be chrome or varplast)
24
Q
What is edentulism?
A
It is the state of being edentulous, without natural teeth
25
What is edentulous?
It means "without teeth". It could be partial or complete
26
What are some of the reasons for tooth loss?
1. Decay and periodontal disease
2. Trauma
3. Orthodontic extractions
4. Congenital missing teeth
5. Impacted teeth
6. Pathologies
7. Radiation therapy to treat head and neck cancers
27
What are the Kennedy's classifications of partial edentulous arch?
Class I - bilaterla edentulous areas located posterior to the remaining natural teeth
Class II - A unilateral edentulous area located posterior to the remaning natural teeth
Class III - A unilateral edentulous area with natural teeth remaining both anterior and posteror
Class IV - A single, bilaterla edentulous crossing mid line
28
What are the 3 main categories of changes following tooth loss?
1. Morphological changes - extra and intra oral changes
2. Neuromuscular changes
3. Functional changes
29
What are some of the extra oral changes that occur due to tooth loss?
1. FLat philtrum and deep nasolabial grooves
2. Hollow cheeks
3. Decreased columella-philtrum angle
4. Narrowing of the lips
5. Decrease face height
6. Commissures drop
7. Lost support for facial muscle
8. Reduced facial height
30
What are some of the intra-oral changes that occur due to tooth loss?
1. High frenal attachment due to bone loss
2. Bone resorption
3. Traumatised neuromascular structure under denture
4. Atrophic mucosa - can cause pain due to proximity of the denture to the nerves
5. Class III skeleton relationship will develop eventually
6. Decrease in occlusal vertical dimension
31
What are some of the occlucal changes that occurs due to tooth loss?
1. Occlusal disturbances
2. Lost of occlusal vertical dimension
3. Increase in parafunctional habits
32
What are psychological changes following tooth loss?
1. Emotional effects of tooth loss
2. May increase stress levels
3. Social-disability
33
What are the impacts of tooth loss on oral health and general health?
1. Reduce in quality of life
Oral otcomes:
1. Risk factor for impaired mastication
2. oral mucosa lesions
General health:
1. Unhealthy diet due to impaired mastication
2. Sleep disordered breathing
34
What are current and future treatment options for edentulism?
1. Prevention of edentulism - MAIN STRATEGY - think about biopsychosocial approach
2. Monitor alveolar ridge resorption
3. Monitor oral mucosa health and screening oral mucosa lesions
4. Rem. Pros.
5. Consider implant retained overdenture or implat supported overdenture where appropriate
35
What is complete denture retention?
Complete denture retention is the resistance to displacement of the denture base away from the ridge. It provides psychologic comfort to the patient.
36
What is denture stability?
Stability is the resistance to horizontal and rotational forces. Stability has been cited as the most significant property in providing for physiologic comfort.
37
What is denture support?
Support is the resistance to vertical movement of the denture base towards the ridge.
38
What are some of the important aspect of the denture that promote retention?
1. Proper contour and design of polish surface - harmonising with function of tongue, lips and cheeks
2. Contour and thickness
3. Smoothness
39
What are some of the aspect that de-promote denture retention?
1. Overextension of denture base
2. Overcontour of polished surface
40
What is the neutral zone?
It is a virtual potential denture space with a dynamic equilibrium forces of the tongue, cheeks and lips.
If denture seats in a neutral zone - denture is more retentive.
41
What are some of the physical factors affecting retention?
1. Adhesion
2. Cohesion
3. Surface tension created at the meniscus of the denture border
4. Gravity ( think better for lower and worse for upper)
5. Atmospheric pressure
42
How to maximise denture retention by managing physical factors?
Good primary and secondary impressions - good accuracy, tissue contact and adequate periphery seal - remember special tray needs to have near perfect coverage and cover all hard tissues such as the tuberosities
43
What are some of the biological factors affecting retention?
1. Height of bone ridge
2. Shape and width of bone
3. Muscle attachment
4. Neuromuscular control - muscle movement diseases such as Huntington's disease may cause some problems
44
What are some of the other method of providing retention for complete denture?
1. Adequare extension and shape of the falanges of the denture
2. Adequare saliva to provide adhesion, cohesion and surface tension - water can be used before insert
3. Mechanical - overdentures using implants or root stumps
45
How you tell a contact is high?
A ring shape with hollow middle - means contact is too high.
If it does not follow that round shape - it is not too high
46
What are some of the factors that affect stability?
1. Firm keratinised tissue
2. Ridge height
3. Ridge contour
4. Ridge stability
5. Intimate base adaptation
6. Adequate extension
7. Occlusal harmony
8. Neuromuscular control
47
What is the primary support areas for the dentures?
Upper - primary support area is the hard palate
Lower - retromolar area and buccal shell
48
How to increase stability and support of a denture?
1. Maximise denture base extension
2. Bilateral balancing occlusion
3. Setting up teeth on the bone ridge
4. Consider mono-occlusion (no cusps) for small bone ridges
49
What provides retention, stability and support in partial dentures?
1. Clasp units
2. Major connectors
3. Intra/extra coronal attachments
4. Implant locator attachment
5. Locator attachment on root
6. Survey crown
50
What are some of the other methods of achieving retention acrylic dentures?
1. Clasps
2. Acrylic dental papilla - soft tissue support
51
What are the ideal properties for impression materials?
1. Accuracy
2. Elastic recovery
3. Dimensional stability
4. Viscosity that allows a flow into minute details
5. Flexibility
6. Workability
7. Patient comfort
52
How do we separate impression materials?
1. Based on properties of the set material - rigid, water based gel, alstomers?
2. Based on hydrphylic and hydrophobic properties
53
What is the example of water based gel material?
1. Alginate - irreversible hydrocolloid
2. Arga-arga - reversible hydrocolloid
54
What is the examples of elastomers?
1. Polysulfide - no longer used
2. Polyether (PE) in impregum - very rigid
3. Silicone (Polyvinyl Siloxane) (PVS) or putty
55
What can you use the copper wax for?
You can use copper wax for bite registration
56
What can you use modelling (red) wax for?
Wax rim or was bite registration
57
When would you use Zinc Oxide Eugenol (ZOE) in rem pros?
Only use in edentulous patient because it is very very very rigid.
Please apply vasaline to patient face because it may burn the patient
58
Why to do with alginate impression after you taken them?
After taking the impressions make sure you wrap it in a damp towel!
59
What are the alginates that are available at the ADH?
1. Halas Alginate - very dimensional stable
2. Kromopan Alginate - EXTREMLY DIMENSIONALLY STABLE WOW
60
What can you use alginate for in rem pros?
1. Primary impression
2. Secondary impression - for mobile teeth
3. Valplast denture impressions
4. Obturator of cleft palate
61
Why don't we use polysulfieds anymore?
1. Long setting time
2. Smells real bad
62
Where do you use light body and heavy body?
Light body - gingival sulcus
Heavy body - everywhere else and to push the light body
DONT USE WITH LATEX
63
What do we use PVS for in rem pros?
1. Seondary impressions for all impression
2. Wash impressions for reline
3. Impressions for obturators for cleft palate
64
What can you use exabite for?
Bite registration
65
What are some of the applications for Coe-soft and Coe-comfort in rem pros?
1. Impressions for reline
2. Impression for obturators of cleft palate
3. Functional/neautral zone impressions
4. Temporary reline
5. Tissue condition impression
66
What are some of the aspects to consider when selecting impression materials?
1. Biocompatibility
2. Accuracy
3. Elastic recovery
4. Hydrophilic or hydrophobic properties
5. Working time and setting time
6. Tear strength
7. Dimensional stability
8. Ease of use and delivery system
9. Cost
67
What are components of the dentures?
1. Denture base
2. Denture teeth
Denture connectors:
3. Major connect
4. Minor connector
5. Clasp unit
68
What materials can be used for a denture base?
1. Polymethyle methacrylate (PMMA) and it's modifications- also know as acrylic
2. Rubber reinforced Lucitone 199 - a type of acrylic that is specifically used at ADH
3. Polyamides like Valplast - good for aesthetics for short saddles
4. Formlabs denture resin
69
What materials can be used for a denture teeth?
1. Polymethyle methacrylate (PMMA) and it's modifications - also know as acrylic
2. Formlabs denture resin
3. Sleeve crown (cobalt/chrome)
4. Porcelain teeth
70
What is the purpose of taking a radiograph with the denture in?
It can be done in order to preplan an implant procedure to replace the missing tooth or to provide mechanical retention for a denture.
71
What can you used fibre reinforced resin for in rem pros?
To connect a denture that split in the middle. But it still need to be berried below with a layer of acrylic
72
What material could be used for clasp units in rem pros?
1. Vaplast
2. Cobal chrome
73
What are the advantages of using resin teeth in dentures?
1. Chemical bond to acrylic resin
2. Achievable articulation
3. Strong but not as strong as porcelain
4. Abrasion resistant
74
What are the disadvantages of porcelain teeth for rem pros?
1. They can not be adjusted or need glaze after occlusal adjustment
2. They cause significant wear to opposing teeth
3. They are quite brittle and easy crack or chip
75
What is the purpose of a metal overlay or crown in the case of overdenture/overlay?
To increase the occlusal vertical dimension and is only reallu used for posterior teeth?
76
What material can you use for denture frame?
1. Cobalt chrome - Remanium+ is used at ADH
2. Titanium - for patient alergic to cobal chrome or other materials
3. HPPE frame
77
What is the centric relation?
It is the retruted contact position. It is the maxillo-mandibular relationship independent of tooth contact. This CAN BE RECORDED IN EDENTULOUS PATIENT. You can ensure that the patient is in centric relation by asking them to go through repeated movement of protrusion and retrusion in order to arrive at the centric relation.
78
What is centric occlusion?
It is the intercuspation position. It is the occlusion of opposing teeth when the mandible is in centric relation. This may or may not coincide with maximum intercuspal position
79
What is centric postion?
It is position of the mandible when the jaws are in centric relation
80
What is balanced static occlusion?
It is a balanced occlusion
81
What us balanced dynamic occlusion?
It is a balanced articulation
82
What is occlusion?
Verb - It is the act or process of closure or of being closed or shut off.
Noun - It is also the static relationship between the incising or masticating surface of the maxillary or mandibular teeth or tooth analogues
83
What is an occlusal surface?
It is a surface of a posterior tooth or occlusion rim that is inteded to make contact with an opposing occlusal surface
84
What is the occlusal plane?
It is the average plane established by the incisal and occlusal surfaces of the teeth
85
What is posselt's envelope of motion?
The posselt's envelope of motion looks at the following aspects of incisor potion through the movement of the mandible?
1. Intercuspal position (ICP) aka cnetric occlusion
2. Retruted contact position (RCP) aka centric relation
3. Edge-to-edge articulation (E)
4. Maximal opening without condylar translation of the condyle (rotation only)(R)
5. Maximal mandibular opening with translation of condyle (T)
6. Protrusion (Pr)
86
What is centric relation?
It is the maxillo-mandibular relationship independent of tooth contact
87
What is centric position? What is important about it?
It is the position of the mandible when the jaws are in centric relation. This is a reproducible position
88
What are clinical applications of centric relationship
When you have a full denture:
During bite registration you need to take an impression of the centric relation
While in try in and insert you need to assess the centric occlusion
When you have a partial denture:
During bite registration you need to take an impression of the centric occlusion
While in try in and insert you need to look at centric occlusion or maximal intercuspal position
89
What is the natural rest position?
It is the occlusal vertical dimension + 2-4 mm
90
What determines the OVD?
OVD is determined by the contact between natural teeth. If there is no natural teeth - please estimate OVD by subtracting from natural resting position
91
What are the 3 types of occlusion?
1. Balanced occlusion - the best type of occlusion - when is a balanced intercuspal position on anterior and posterior teeth - best of denture stability and create pressure to retain the bridge.
2. Monoplane occlusion
3. Lingualised occlusion - the elimination of buccal cusp contact - may be used if the patient has a modified occlusion due to skeletal and other reasons
92
What are the Hanau's Quint factors affecting occlusal balance?
1. Incisal guidance - greater incisal guidance results in greater posterior teeth separation
2. Condylar inclination - steeper condylar inclination results in greater tooth separating during protrusive movemenet
3. Occlusal plane inclination - greater occlusal plant inclination results in greater tooth separation during protrusive movememnt
4. Compensating curve - lower cruve of Spee results in greater separation duing protrusive movement
5. Cuspal inclination/ cusp height - greater separation results in greater cusp height
93
What is the curve of monson?
Combination of Curve of Spee and Surve of Wilson
94
What is the significance of compensating curves in rem pros?
It is to compensate for the path of mandibular movement from centric to eccentric occlusion
95
What is the working side and what is balancing side?
Working side - the mandible moves towards it during chewing - usually the same side as the food is - will have a contact
Balancing side - oppsite to the working side
In natural occlusion 0 the teeth contact on the working side but do not contact on the balancing side
96
What are the Gysi's and French's concepts of occlusion?
Gysi's concept:
Cusped teeth with inclination of 33 degrees and occlusion on working side and no occlusion on balancing side
French's concept:
Teeht are at 5-10 inclination and during mastication, balancing side has slight contact for stability
97
What are the steps to recording occlusion in removable complete dentures?
1. Horizontal dimension - record centric relation
2. Vertical dimension - estimate new OVD by taking 2-4mm away from resting vertical dimension
3. If patient previous Angle's Molar classification was II or III - try to set up complete denture for Class I
98
What are some of the desired properties of denture occlusion?
1. Effieicient function
2. Minimal contact areas
3. Bilateral balanced occlusion
4. Balancing on working side and no interference on balancing side
5. Anterior clearance during masticatory function
6. Cusp height, condylar guidance based on ridge height - if ridgr is low, the teeth might have to be anatomy free
99
What are the difference between natural and artificial occlusion?
1. Natural teeth retained by periodontal tissue - denture teeth are not
2. Natural teeth move independently - denture teeth move as a unit
3. Malocclusion in natural dentition may not cause any symptoms for yeras - in denture teeth there will be an immediate response
4. In natural teeth, second molar is one of the power points of mastication - in denture teeth this may cause a shifting of the denture base
5. Bilateral balance during excusrion is rare in natural teeth - in dentured teeth it is required for stabilisation of denture base
6. Proprioceptors guide neuromuscular control during function, meaning mandible return to centric occlusion - if any interference occurs in dentured teeth, denture base shift and may be dislodged
100
What is the clinical significance of curve of Spee and Curve of Wilson in dentures?
1. Curve of Spee os designed to permite protrusive disocclusion of the posterior teeth by combination of anterior and condylar guidance
2. Curve of Wilson permits lateral mandibular excursion free from posterior interference
101
What are some of the factors that affect denture aesthetcs?
1. Facial height and shape
2. Soft tissue support
3. Smile line
4. Facial and dental symmetry
5. Shade and mould
6. Crown height
7. Anterior zone width
8. Gingival display of upper incisors
9. Buccal corridor ration
10. Last vissible tooth while smiling
102
What can compromise competent lip seal?
1. Excessive occlusal vertical dimension
2. Excessive overjet or proclination of upper anterior teeth
3. Excessive upper incisal length
103
What is the lip line?
It is the imaginary line that is drawn at the inferior border of the upper lip and extend mesio-distally
104
What is the smile line?
It is the vertical tooth display in smiling or elevation of the upper lip when smiling in relation to upper incisors. Average smile line is around 77-100% height of maxillary teeth and interdental pappillae
105
What is a smile arc?
Imaginary line along upper anterior edges and the superior border of the lower lip
106
Where does the facial symmetry line lye?
The maxillary midline, mandibular and the filtrum but mandibular midline could be sacrificed
107
What is the ideal buccal corridor ratio?
it is 1:1.618 of the length of the corresponding smile zone side aka the length of the canine + second incisor + first incisor
108
When would you select no-anotomical teeth for a denture?
For partial: If anatonical teeth have been severley worn
For full: If the alveolar ridges are poor and there is uncoordinated jaw movements
BDS 3 Sem 2
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