Study sets, textbooks, questions
Upgrade to remove ads
Removable Pros Exam I - 8400
Terms in this set (143)
What does tooth loss result in?
- Ridge resorption, changes in intraoral structures, decreased chewing function, psycho-social effects, loss of facial support
Why is there residual ridge resorption after tooth loss & with dentures?
- Tension on bone by the PDL w/ a tooth causes bone deposition/apposition
- Compression from a denture base causes bone resorption
Describe the pattern of ridge resorption in the maxilla and mandible. Which resorbs faster?
- Maxilla: loss of bone from the buccal leading to vertical bone loss
- Mandible: loss of bone in BL direction, vertical height is lost (4x higher than maxilla)
What is the result of bone resorption following extractions?
- Compromised denture stability
- Pseudo Class III jaw relation
- Compromised retention due to easy breaking of peripheral
The retromolar pad is a major site of mandibular support for the denture. This site typically remodels following tooth extraction and denture use. Mandibular bone resorbs slower when opposing natural dentition.
- False: it is relatively unchanging
- False: it resorbs much faster when opposing the natural maxillary dentition
The posterior palatal seal is located at the junction of the hard and soft palate. A Class III Soft Palate (House) classification is the most ideal for a denture.
- False: it is located posterior to this at the vibrating line
- False: Class III drops at a 70 degree angle from the hard palate with only 0-3mm of space for the PPS; Class I is the most favorable
What anatomic structure limits the length and thickness of the labial flange extension of the mandibular denture?
- The mentalis muscle
Following years of resorption, the mental foramen changes location. Describe its change. What changes must be made in the denture to accomodate for this?
- With bone resorption, the mental foramen comes to sit on top of the mandibular bone
- Denture must be relieved in this area to prevent nerve compression & pain
What forms the muscular floor of the mouth? What is the Retromylohyoid Area Throat Form Classification? Which type of tongues are unfavorable?
- Mylohyoid muscle
- Describes the length of lingual flange the patient will tolerate, with Class I being the longest and Class III the shortest
- Retruded tongues
Diabetes causes thinning of the keratinized epithelium and results in an impaired tolerance of dentures. Angular cheilitis is secondary to chronic candidiasis and may be due to gain of VDO.
- False: loss of VDO
What is Epulis Fissuratum?
- Inflammatory fibrous hyperplasia which begins as a traumatic ulcer secondary to an ill-fitting denture flange
What is Inflammatory Papillary Hyperplasia? Is this pre-malignant?
- Pebbly hyperplasia due to ill-fitting maxillary dentures and is sometimes complicated by chronic candidiasis
- Not premalignant
What is Combination Syndrome? How should you take an impression on these patients?
- Caused when edentulous maxilla is opposed by partially dentate mandible; maxillary denture tips anteriorly and compresses the pre-maxilla, leading to extreme resorption in this area
- Window technique
What tissue factors affect support in maxillary dentures? Mandibular dentures?
- Maxillary: keratinized tissue, alveolar ridge contours, palatal shelf & contour
- Mandibular: retromolar pad, alveolar ridge, keratinized mucosa, buccal shelf
What tissue factors affect stability in maxillary dentures? Mandibular dentures?
- Maxillary: ridge height, well-formed denture bearing tissues, tuberosities
- Mandibular: ridge height, FOM contour, tongue position, NM control
What tissue factors affect retention in maxillary dentures? Mandibular dentures?
- Maxillary: shape of palatal vault, drape of soft palate, quality & quantity of saliva, compressibility of PPS, well-shaped tuberosities, height of alveolar ridge
- Mandible: tongue position, FOM posture, NM control, peripheral seal, adhesion, cohesion
What is the House Psychological Classification of patients?
What trays should be used for Preliminary Impressions?
- For resorbed ridges: edentulous trays
- For some non-resorbed ridges: dentulous trays
What material is typically used for Preliminary impressions?
- Irreversible Hydrocolloid: such as Jeltrate or Accudent
On the diagnostic cast, why are undercuts blocked out?
- To allow for removal of the custom tray from the cast
- To allow space for impression material to flow into & capture
What are the non-elastic material choices for final impressions? Elastic materials? Elastomeric?
- Impression plaster, ZOE, Impression compound
- Agar, alginate
- PVS, polysulfide, polyether
ZOE impression materials (non-elastic) cannot be used under what conditions?
Cannot be used when
Impression compound materials (non-elastic) are generally used for ________________.
- Preliminary or "wash" impressions made with ZOE or hydrocolloids
- This material is thermoplastic
Describe the advantages of using agar. Is it reversible or irreversible?
- Excellent accuracy & excellent w/ undercuts
- Reversible hydrocolloid
What are the advantages and disadvantages of Alginate?
- Great accuracy, good with undercuts
- High viscosity, distortion of tissue, low tear strength
Compare and contrast PVS and Polysulfide by the following:
- Setting time
- Dimensional stability
- Setting time: PVS is fastest, polysulfide has longest working and setting time
- PVS is hydrophobic while polysulfide is less hydrophobic
- PVS has highest dimensional stability, polysulfide is moderate
Disposable plastic trays are preferred over metal trays. The tray itself captures the borders of the mouth.
- False: metal trays preferred (less distortion)
- False: the material in the tray captures borders
What types of Alginate materials are available in the clinic?
- Jeltrate: may not capture edentulous vestibules if unsupported
- Accugel system 1: edentulous vestibules
- Accugel system 2: partially edentulous or completely edentulous
What is the purpose of border molding? What materials can be used for this?
- To capture the extension and thickness of a patient's vestibules
- Modeling compound (cheapest) or putty (very expensive)
How should final impressions be seated? What should the patient do following seating of the tray?
- From front to back
- Make functional movements to capture the vestibule in function
What is the Selective Pressure impression technique?
- Pressure applied to the areas that are capable of withstanding the forces of occlusion
- Non-stress bearing areas are recorded with the least amount of pressure
Where are the Maxillary and Mandibular stress bearing areas for the selective pressure impression technique?
- Maxilla: residual ridges and palatal areas
- Mandible: buccal shelf and residual ridges if well preserved
_____ is needed for the best Support of a denture.
Improved stability is accomplished by registering the ______.
- Maximum coverage
- Undistorted tissues
______ of the final impression will give the first and most important step in teeth position and appearance of the denture
- Correct Border Thickness
What 2 materials are used in clinic to make custom trays?
- Fastray: autopolymerizing resin
- Triad: light cure material
List the following dimensions for the Master Cast:
- Thickness of the Base
- Land area
- Vestibule depth
- Base: 15-18 mm
- Land area: 3-4 mm
- Vestibule: 2-3 mm
List the following measurments for the wax rims:
- Maxillary anterior height
- Mandibular anterior height
- Maxillary & Mandibular anterior width
- Maxillary height: 22 mm
- Mandibular height: 18 mm
- Width: 5 mm
When determining the vertical dimension, the mandibular wax rim is placed in the mouth first. About 4-5mm of the wax rim should show below the upper lip.
- False: maxillary placed first
- False: 1-2mm in young people and none in older people
What factors are checked to determine whether or not to adjust the vertical dimension when trying in the wax rims?
Anterior length of the rim
: 1-2 mm showing for young person. No rim showing for older individual (50+)
: naso-labial angle should be 90° and symmetrical
: fricative sounds, edge of rim should touch the wet/dry line of lower lip
When establishing the Occlusal plane of the maxillary wax rim, the plane should be parallel to the ______ in the anterior and close to parallel with the ______ in the posterior. The occlusal plane will be located ______ mm below the parotid papillae.
- Inter-pupillary line
- Ala-tragus line (camper's line)
- 3 mm
How are the anterior and posterior portions of the maxillary wax rim inclined?
- Anterior: inclined toward the labial
- Posterior: inclined toward the lingual
The VDO is 2-4 mm Larger than the VDR. The maxillary wax rim is adjusted until the rims touch evenly at the VDO.
- False: 2-4 mm shorter
- False: mandibular rim adjusted
The inter-occlusal space, also called the "______" is ______ to _______ mm.
- Speaking space
- 0-2 mm
What is recorded by the Facebow record? What is recorded by the CR record (centric relation record)?
- Facebow: maxilla to the cranial base
- CR: maxilla to mandible at a musculoskeletal stable location
How is the CR record made?
- Make 3 non-parallel notches in the Mx wax rim
- Very thin layer of vaseline
- Cut away a few mm from the posterior Mn wax rim
- Place Regisil or warmed Alu wax in the space and have the patient bite together
What is accomplished at the JRR appointment?
- Wax rims adjusted to proper Occlusal plane
- VDO determined
- Midline/lateral ala marked for canine location
- Facebow transfer to mount the upper wax rim and master cast
- CR is registered
- Tooth shade taken
- Tooth mould chosen
What lines should be marked on Master cast before removing wax to set teeth?
- Line Parallel to the Occlusal plane w/ mm measurement
- Midline mark
- Canine lines if used
- MM measurement to High smile
Once the teeth are set the Plane should mimic the ______.
Vertical overlap of the anterior teeth should be ______ mm if balanced occlusions is not planned. If balanced occlusion is planned, _______ mm of vertical overlap may be placed.
- Lower lip
- 0 mm
- 1 mm
What are the major differences between Natural occlusion vs. Denture occlusion?
- Natural teeth touch and interlock while denture teeth have contact only in the posterior (no anterior contact)
- Lateral movements of natural teeth have group function on one side only (working side) w/o contact on the other side
- Lateral movements of denture teeth have posterior contact on both sides (BBO)
Bilateral balanced occlusion is common in natural dentition. Bilateral balanced occlusion is desired in denture dentition for base stability. Teeth should be trimmed prior to the record base to retain strength.
- False: are in natural dentition
- False: trim record base first
______ is the main determinant of the denture tooth position. Centralization of centric occlusal forces should be located over the _______.
- Functional anatomy
- Mandibular residual ridges
Define Monoplane Occlusion (neutrocentric concept).
- Concept of occlusion that assumes that the A-P plane of occlusion should be parallel to the denture foundation (not dictated by condylar inclination
- Plane of occlusion is
completely flat and level
What is Bilateral Balanced denture occlusion?
- Simultaneous contact of opposing upper and lower teeth in Centric relation w/ bilateral gliding contact to any eccentric position.
- Lingual cusps of Maxillary teeth firmly in contact with the central fossae of mandibular teeth (no buccal cusp contact in any movement)
- Also known as Lingualized occlusion
Maxillary anterior plane of tooth setup should mimic the _____________.
- Curvature of the lower lip
What are the 5 factors of Hanau's Quint? Which ones can be controlled by the dentist?
- Condylar inclination
- Occlusal plane inclination
How is the articulator adjusted for proper Lateral Movements?
- Lift the incisal table 'wings' so that in lateral movements the Canines will barely miss (done after try-ins and before processing)
When making the Protrusive record, the mandible must be protruded a minimum of ______ mm. The protrusive record is used to set the _______ so that the articulator can perform eccentric movements similar to the patient.
- 5-6 mm
- Condylar Inclinations
To check the VD of occlusion there should be ______ mm of space between the upper and lower when the patient is speaking.
- 0-2 mm
How is the Centric Relation Verification done?
- Denture adhesive holds the Upper denture in place.
- Alu wax or Regisil is placed on the Lower denture
- Patient closes until first contact
- The dentures are then placed back on the casts
- Casts are closed to confirm that they contact properly
- If they don't contact properly according to the CR verification, then the lower cast should be remounted and lower teeth reset in the wax
What are Flat Plane teeth indicated for? What are good patients for these?
- Full dentures, allowing for complete freedom in lateral excursions
- Patients without posterior teeth for a long time or patients with worn down, existing denture; also, patients with a non-repeatable CR or NM condition (Parkinson's)
What type of denture teeth are the most aesthetic in the posterior? Is this an important factor when choosing posterior teeth?
- Anatomic are most aesthetic
- Aesthetics is the least important factor
Where should the Posterior Palatal seal be placed?
- Vibrating line:junction of the movable and immovable tissues of the soft palate
- PPS is carved into the Master cast just anterior of the vibrating line
The deepest portion of the posterior palatal seal is at the midline. The posterior palatal seal is the posterior limit of the maxillary denture.
- False: deepest portion on either side of the midline
The denture base color should match what location in the patient's mouth?
- Inside of the Lip
What steps are done after the posterior try in but before it is sent to the lab for processing?
- Seal bases to the cast (flush with the land areas)
- Finalize occlusion
- Complete wax-up, festooning
- Facebow remount index (if needed)
What is the purpose of the Remount jig? When is the remount jig used?
- Used to remount the processed denture for occlusal adjustments: essentially recreates the facebow record
- Remount jig used immediately before un-mounting the final wax-up for processing (in case the master cast is destroyed upon removal from the flask)
What is the purpose of the Selective Grind-in?
- Correction of errors in occlusion that occur during processing
- Return dentures to correct VDO
- Restore centric and bilateral balanced occlusion
List the Steps for a clinical remount with a New Remount cast
- Complete adjustments of borders
- Capture new facebow record w/ Mx denture
- Obtain CR bite record with both Mx and Mn
- Fabricate remount casts w/ blockout inside denture and flanges on stone base
- Mount maxillary cast w/ facebow
- Mount mandibular cast w/ CR bite record
- Evaluate and adjust occlusion
With Neutrocentric occlusion, how are the teeth positioned?
- All teeth (except Mx lateral incisors and maybe canines) will be on the same plane
- No vertical overlap of anterior teeth
In lingualized occlusion, which part of the maxillary teeth will be in contact in centric?
- Lingual Cusp tips
How should the denture be polished when preparing for delivery of the denture?
- Bulk trimming before polishing
- Polish through progressively finer grits: acrylic bur to red stripe acrylic bur to rubber polishers to bristle brushes for papillae to pumice and Acryluster (high shine can be done after you see the patient)
List the denture placement sequence when delivering the denture to the patient.
- Adjust denture Base
- Adjust denture Borders
- Remount in CR
- Protrusive record
- Equilibrate in lateral excursion
- Patient education
- 24 hour follow-up
What is PIP used for? How is it used?
- Used to locate contact areas on the intaglio (tissue) surface of the denture base
- Stiff-bristled brush used to paint on the intaglio surface to create lines, place in patient's mouth, remove and check of smudge areas where lines disappear (too much contact here)
What is disclosing wax used for?
- Used to check denture borders
- Length of disclosing wax placed on borders of denture and placed in the mouth, border movements made, and check for thinned areas (burn through areas)
- Muscle contacts will produce the burn through
What home care instructions should be given to a denture patient?
- Remove denture every night
- Brush denture to remove food debris
- Store in water w/ deodorizing tablet
- Rinse and brush before morning placement
- Use adhesive sparingly
What is done at the 24 hour follow-up appointment?
- Patient wears denture for 24 hours continually before appointment
- Check for sore spots in patients mouth
- Check denture for pressure areas with PIP
- Check borders for over-extension
- Evaluate occlusion
What are the common sources of discomfort at the 24 hour follow-up appointment?
- Open VDO (generalized ridge soreness)
- Inaccurate CR record
- Lack of occlusal balance
- Poor denture base adaptation
- Inappropriate denture base extensions
Retention and stability may be compromised by what factors that you can control?
- Occlusal discrepancies
- Poor denture base adaptation
- Inadequate denture extensions
Retention and stability may be compromised by what factors that you cannot control?
- Resorption of the ridge
- Unfavorable floor of mouth position
- Retruded tongue
- Reduced salivary flow
- Poor neuromuscular control
What is the likely problem with the following issues after denture delivery?
- Problem w/ D, J, and G sounds
- Problem w/ F and V sounds
- Problem w/ Gagging
- Single sore spot on ridge
- D, J, G: Maxillary palatal portion too Thick
- F, V: Position of Maxillary anterior teeth
- Gagging: Palate too thick, too long, or no tongue space (teeth too far lingual)
- Single spot: malocclusion or dot of acrylic
What is the likely problem with the following issues after denture delivery?
- Burning sensation
- Tongue or cheek biting
- Fiery redness of all oral tissues
- Redness of denture area only
- TMJ pain
- Burning: pressure on nerve (palatine or mental nerves)
- Biting self: posterior teeth set edge-to-edge (needs overlap)
-Fiery redness: Allergey
-Redness of denture area: Bad fit, Candidiasis
-TMJ: VDO too small, Occlusal disharmony, Arhtritis, trauma
What is the likely problem with the following issues after denture delivery?
- Whistle on S sounds
- Lisp on S sounds
- Too much teeth show at rest
- Whistle: too narrow airspace in anterior palate
- Lisp: too broad airspace in anterior palate
- Teeth showing: VDO too great
What health/physical factors should be considered about the patient before making an immediate denture?
- Issues that affect healing: smoking & diabetes
- Pre-operative issues: comorbidities (CVA, MI, HTN) and issues for surgery
What mental factors should be considered about the patient before making an immediate denture?
- House classification: Exacting, Indifferent, Hysterical, Philosophical
- Emotional stabilty (can they handle the Tx)
How should you explain Immediate dentures to your patient?
- Don't fit as well (cause discomfort)
- Esthetics unpredictable
- May be impossible to insert immediate dentures on the first day
- If inserted the first day they should be worn for 24 hours without being removed by the patient
- Immediate dentures become loose within the first 1-2 years
What dental factors should be considered for Immediate dentures?
- Teeth: VDO, size, shape, # remaining, esthetic preference
- Periodontal support: expected gingival recession following exts, inter-arch space
______ mm of space is ideal for 1 prosthesis.
- 8-10 mm
What is an Interim immediate denture?
- Existing RPD that is converted into the immediate prosthesis
- Transitional use until a conventional denture can be made
The _______ teeth are usually necessary to maintain the vertical dimension. If the incisors desperately need removal along with the posterior teeth, an ______ would be appropriate
- Maxillary and mandibular canines
- Interim RPD w/ WW clasps on the Canines
What are the Indications for Conventional Immediate dentures?
- Patient presents with only anterior teeth, few posterior teeth, and no existing RPD
- Patient can function without posterior teeth during fabrication
- Patient can tolerate 2 extraction visits
What are the contraindications to Conventional immediate dentures?
- Patient cannot go without posterior teeth during fabrication
-Patient has a complex treatment plan on the opposing arch
- Patient needs excessive changes to the VDO
What are the indications for the Interim immediate denture?
- Multiple anterior teeth, and existing RPD
- Can't go without teeth while conventional denture is made
- Opposing arch has complex Tx plan
- Only 1 surgery visit
- Esthetically demanding patient
What are the contraindications for the Interim immediate denture?
- Financial factors: interim is a more expensive process (paying for 2 dentures: interim and conventional)
What are the main Advantages to the Immediate denture?
- Immediate denture acts as a bandage or splint following extractions; controls bleeding
- Protects against trauma
- Protects extraction sockets
- Protects against blood clot disruption
- Regain function faster
- Replace teeth immediately (esthetic)
What are the main disadvantages to the Immediate denture?
- Impression difficulty; fit not as good
- No wax try-in for the anterior teeth
- Unpredictable esthetics: may not be acceptable after delivery
What are the physical factors to consider when planning immediate dentures?
- Height of remaining bone support
- Presence of other pathological changes related to the roots
- Pattern of bone destruction
What orientation marks should be made on the mounted casts for an Immediate denture?
- Midline mark
- Correct occlusal plane
- Location of the Lip at Rest
- Location of the Lip at High Smile
What should be considered prior to Tori removal?
(what makes up the tori? how does that affect surgery?)
- Tori covered by thin soft tissue
- Tori made up of mostly cancellous bone w/ thin layer of cortical bone
- Regeneration of the cortical bone takes 8-24 weeks; however a minimum of 6 weeks is recommended
Under what circumstances can a Maxillary torus be covered by a denture?
- Small maxillary torus
- Doesn't extend to the vibrating line
What impressions are made for immediate dentures?
- Preliminary (alginate) for custom trays
- Final impressions: fabricate final denture and surgical guide
What are the objectives for complete denture impressions?
- Preservation of the ridge
- Stability: close adaptation to mucosa
The material of choice for the Preliminary impression for immediate dentures is ______. The custom tray that is made on the prliminary cast should be ______ mm thick
- 2-3 mm thick
What steps should be made when making the Custom tray for an immediate denture on the preliminary cast?
- Trim the cast to access vestibules
- Block out undercuts
- Cover entire denture bearing surface with 1 thickness of wax for the selective pressure technique
- Ensure the teeth are covered by sufficient wax to block out undercuts created by the teeth
What are the indications for the double or 2-piece custom Tray (combination tray)?
- Severely mobile teeth remaining
- Severe angulation or undercut in the anterior
- Combination syndrome patient (extremely mobile, flabby soft tissue)
What materials are used for Final impressions of Immediate dentures?
- Elastomeric materials
: newest, most expensive, very hydrophobic, highest dimensional stability
Polysulfide rubber base
: good detail, longest working and setting time, bad smell, high tear strength, less hydrophobic, moderate dimensional stability
- Polyether (not commonly used)
How is a Double custom tray made?
- Blockout undercuts and place 1 layer thickness of wax over denture bearing surface
- Window cut over the excessively mobile or severely angulated teeth
- 1st Tray trimmed Trimmed and index placed
- Resin placed over teeth protruding through the window and onto the index (2nd tray)
- 2nd tray is removed and trimmed.
What are the Advantages to the 2-piece impression trays?
- Ease of manipulation
- Less discomfort to the patient
- Reduce chair time
- 2 different impression material may be used if desired
- Easy to recover the cast from the impression assembly
What are the Disadvantages to the 2-piece custom trays?
- More lab work needed
- Not applicable for all clinical cases
How can the cast be removed from the impression material without breaking the master cast?
- Submerge the set stone cast with impression into Boiling water to soften the impression compound for easier removal
The master cast needs to be at least _____ mm at the thinnest portion to prevent breaking during processing.
- 15-18 mm (≈½ inch)
How is creating the base plate for Immediate dentures different than for conventional dentures?
- The Base plate for immediate dentures will have space for the existing teeth
- The base plate must not cover the occluding portion of the anterior teeth; may result in opening the VDO (natural teeth have to touch)
- The base plate will not wrap around the Labial portion (posterior portion)
The wax rims for Immediate dentures have similar height to the conventional dentures (22mm Mx, 18mm Mn). The base plate for immediate dentures need Adhesive to stay in place during JRRs and try-ins.
: there is no peripheral seal so the adhesive is necessary
When doing JRR for immediate cases & the CR/CO coincide w/ no posterior teeth, how do you treat it?
- Determine VDO, similar to CD/CD case
How is taking the Facebow for immediate dentures different than conventional dentures?
- Must use Dentate bitefork for the immediate denture cases
What steps must be completed Before setting any teeth?
- Max cast mounted w/ facebow
-Mand cast mounted w/ CR record
- Record pin location in case VDO change is planned
- Mark the master cast w/ reference marks
Anterior and Posterior teeth should be chosen at the same time for immediate cases. Teeth are selected based on existing size, shape, and color. With immediates, the anterior teeth are set first, just like complete dentures.
- False: they are set after the posterior try-in
How are the try-in appointments for Immediate dentures different than for conventional dentures?
- There is no Anterior try-in for immediate dentures
If the maxilla is planned for a denture and the mandibular arch planned for an RPD where #22-27 is being kept, the canine to canine distance of #6-11 can be determined by adding ______ mm to the #22-27 distance.
- 6 mm
List the criteria for selection of the posterior teeth for an Immediate denture.
- Opposing dentition: natural or another denture (denture teeth fit best w/ other denture teeth
- Condylar Inclination: influences Cuspal inclines (shallow inclination → flatter cusps)
- Horizontal and Vertical overlap: flatter teeth → less overlap
- Ridge resorption: more resorption → flatter teeth
- Tissue health
- Patient age: older patient → flatter teeth
- Ridge relation: class I, II, or III
- Repeat-ability of CR
- Previous denture experience
After setting the posterior teeth for the posterior try-in for an immediate denture, the teeth are in their final position.
- False: posterior teeth will likely be moved after setting anterior teeth
What should be done when the denture teeth don't fit into the provided space when setting teeth?
- Thin the baseplate or window the base plate first
- After thinning or windowing the base plate then you may grind the teeth shorter if necessary
What is the 1st thing that should be checked at the Posterior try-in for immediate dentures?
- Check the Centric Relation: if it is off then take a new CR record and remount the mandibular cast
List the items in the Posterior try-in checklist.
- Check CR record
- Occlusal plane
- Color and form of teeth
- Mark and transfer location of Posterior Palatal & seal to the cast
What needs to be done after the posterior try-in for immediate dentures?
- Patient signs 'Consent to process' form
- Confirm the midline, incisal edge location, and occlusal plane
- Set the anterior teeth: posterior teeth will likely need to be moved
When setting the anterior teeth for an immediate denture one can estimate the bone level on the teeth is approximately ______ mm below the gingival margin.
- 3 mm
List the Guidlines for Immediate denture tooth setting sequence
- Choose all teeth (anterior and posterior)
- Set posterior teeth onto wax rim for try-in
- Set anteriors directly onto cast in lab
- Remove posterior teeth from wax and reset directly onto the cast
- Complete wax-up and festooning: make sure the wax isn't too thin (≈3mm)
What is the Surgical guide?
- Clear plastic template made from the final cast after trimming has been done
- Used to guide the shaping of the alveolar ridge at the time the teeth are removed
How is the Surgical guide fabricated?
- Wax is boiled out and the cast in the ½ flask is returned
- The remaining ridge under the anterior teeth is trimmed to make it smooth and rounded
- An alginate impression is taken of the trimmed cast to make a copy of the master cast in the ½ flask (½ flask given back to the lab to complete processing)
- Clear suck-down template is made on the new cast
The surgical guide is placed in the patients mouth following tooth removal. You notice an area of blanched tissue through the surgical guide. How should you proceed?
- Blanching tissue indicates an area where additional alveoloplasty is still needed
What is the difference between Alveoloplasty vs. Alveolectomy?
- Alveoloplasty: minor recontouring of bone w/ rounding interdental crests
- Alveolectomy: extensive removal of bone height
After the surgery and delivery of an immediate denture, what factors may cause pain to the patient?
- Surgical trauma
- Post-op infection
- Careless anesthesia technique
- Poor care when handling the flap
- Increased VDO of the dentures
How is soft reline material different than normal acrylic?
- Uses the Same acrylic polymer Powder
- The liquid has a plasticizer that makes the acrylic not set completely: stays soft until the plasticizer leaches out
How is soft reline material used clinically?
- Powder and liquid mixed
- Reline material then coated on the intaglio surface of the denture
- Patient bites down to hold it in place
- Heated bard parker used to trim the excess from the denture
How is the 24 hour recall appointment different for immediate dentures?
- Immediate denture left in place for 24 hours
- Confirm blood clot and sutures are still in place
- PIP is still used but is avoided near the extraction sockets
- All other adjustments are done but care is taken to avoid the extraction sockets
- Pain on top of the ridges indicates heavy occlusion
What bone and tissue changes are expected long term with denture use?
- Bone and tissue shrinks further causing a space to develop between the denture and the soft tissue
- Ridge loss → flanges that seat further into the vestibules → pain and soft tissue problems (epulis fissuratum)
How is space under a denture measured?
- Place Light or medium body PVS inside the denture and have the patient bite down
- PVS is removed and measured
- Space indicates a Reline is needed
What is the general treatment plan sequence for a patient planned for an Immediate full denture over Natural dentition?
- Restorative work should be completed on the Natural dentition to stabilize the Occlusal plane before the denture is fabricated
- Fixed work and restorations on the Natural dentition to bring the Occlusal plane flat with the Wax rim (wax rim as a guide for fixed/restorative work)
What are the 5 phases of patient treatment?
- Acute: anything causing pain
- Disease control:
What is the difference between a Reline and a Rebase?
: changed intaglio and flange extensions to produce more intimate fit of the denture base to the ridges (↑retention); indicated for minor changes to occlusal plane possible
: entire base below teeth is replaced for major changes; teeth of the denture retained and a new wax rim placed underneath the teeth; allows for change of VDO
When is a Reline indicated?
- Poor fit or extension of the denture but esthetics/phonetics are acceptable
- Ridge resorption after an immediate denture
List the steps in performing a Reline.
- Relieve the Intaglio surface and flanges
- Make an impression (w/ border molding)
- Box the impression and Pour the cast
- Trim cast w/ denture in place
- Mount cast in Reline jig and make a tooth index
- Remove denture and clean intaglio surface w/ bur (remove impression material and some acrylic)
- Place denture back onto tooth index
- Secure master cast back onto the jig
- Fill the space between the cast and the denture w/ wax
- Turn in for processing
When performing a Reline, what is the purpose of the green compound 'Stops' that are placed on the denture before impression taking?
- Orients the denture in the patient's mouth
- Confirms that the Midline and Occlusal plane are accurate
______, ______, and ______ are necessary for most Immediate over Immediate relines and rebases.
- CR record
Other sets by this creator
Medical Pharmacology Exam I
Periodontics Summer Final
Office Medical Emergencies Exam I
Other Quizlet sets
Biology Unit 1 Test: Hunger