History taking for
construction of a partial or complete denture Patient complain
1.
Appearance: Aesthetics
2.
Function: to restore function
Previous denture
wearer
1.
Pain
2. Retching
3. Problems eating with prosthesis
Denture history
1. New denture wearer
2. Old denture wearer
3. Age of denture when was first worn
4. How many sets of denture worn
5. Haterial of denture
General dental
history
1.
Number of Missing teeth in upper arch
2.
Missing teeth in lower arch
3. Oral hygiene condition
4.
Alveolar bone status
5.
Upper and lower arches
6.
Any areas of bone resroption
7.
Periodontal problems and gum recession
8.
Number of filled teeth
9.
Any crowns present
10.Bridges
11. Orthodontic therapy ,
12. Endodontically treated tooth
13. Splints
14. Previous treatment tried for present complaint
Medical history
Any
medical condition
Anxiety
and depression status of patient
History
of stroke ,muscle disorders
Social history
1.
Marital status
2.
Mobility
3.
Access for treatment
4.
Drinking
5.
Smoking
6.
Job
7.
Examination
Extraoral examination
1.
TMJ positioning while closing and opening of
jaw
2.
Any clicking of TMJ
3.
Masseter hypertrophy
4.
Tenderness in joint or muscle of mastioation
Facial counture
1.
Old photographs
2.
Loss of dental bulge
3.
Perioral skin wrinkling
4. Angular cheilitis
5. Vertical hight
6. Lip seal , over closure , or anterior
openbite
Intra oral
examination
1.
mucosa
2.
xerostomia,
3.
candida mucosal ulceration
4. gingival hyperplasia
5.
undercuts
Periodontal
health
1.
oral hygiene
2.
periodontal status
3.
mobility and drifting of remaining teeth
Caries
1.
number of carious teeth
2.
and filled teeth ,
3.
recurrent caries
Occlusion
1.
skeletal classification ,
2.
competent lips ,
3.
prognathism ,
4.
overerypted teeth crowding or
5.
spacing of teeth
Endodontic status of
teeth
Vital
and non vital teeth
Endodontically
traeated teeh
Support of edentulous
area
1.
Quality of saddle area of alveolar bone
2.
Degree of bone resorption
3. Presence of tori , tubercle
4. Bony or flabby ridges or muscle attachment
Denture
examination
1.
present denture or
2.
previous denture examination
3.
Examine both interiorly and
4.
extra oral exmmination
When
existing denture in place examine
1.
Is the freeway space appropriate?
2.
Is the most retruded contact position
registered correctly?
3.
Are the lips supported well
4.
Are both the posterior and anterior
occlusal plans in harmony
5.
Are the upper and lower dentures retentive at
rest?
6.
Are the dentures stable in function?
7.
Is there any pain on occlusion?
8.
Does the patient like the appearance of
denture?
9.
Can the patient articulate properly with the
denture
With
existing denture out of the mouth look for,
1. Is the base extension, anterior
posterior, lingual and buccal appropriate
2. Is the denture Under extended in lingal pouch and retromolar pads and on
hard palate or
3. Is the denture overextended
overextended to the external oblique
ridige of the mandible
Is
the tooth position appropriate ?
Common
problem includes,
1.
excessive
lingual positioning of posterior mandibular teeth
and,
2.
excessive
labial positioning of anterior teeth
Underextension
= Lower Dentures are frequently
underextended In lingual pouches and retro molar
pads
Upper
denture = Underextended,distally on the hard palate
Overextension = Lower Dentures are frequently
Overextended
to,The external oblique ridge of mandible
Has
the denture been altered since the insertion
1.
Addition
2.
Relining
3.
Repair
Is
there any sign of parafunction e.g.
1.
Excessive wearing of denture = aged denture
2.
Wear facets
3.
Tongue thrust,
4.
Clenching of jaw ,
5.
eating on one side only
Radiographic Examination
Radiographic
examination of partial denture wearer,
can
reveal
,
1.
Periodontal bone level
2.
proximal caries
3.
Apical pathology
4.
Retained roots
5.
Unerypted teeth
6.
Ridge contour
7.
Bone height and width
8. Anatomical features such as the inferior alveolar canal
9. Mental foramen , maxillary sinus TMJ anatomy
useful
radiographs for prosthodontics are ,
1.
periapicals
2.
panaromics
3.
occlusal
4.
lateral cephalometrics and
5.
tomograms
Some cases require
special tests and additional features of prosthodontoc examination
These are,
1.
study cast
2.
surveying
3.
full occlusal assessment
4.
diagnostic wax up
Study cast determine
,
Interarch
and intra-arch relationship
Reveal
overerypted and tilted teeth
Helps
plan the design of saddle area
Helpful
for construction of primary bases or
tray construction
Used
for wax pattern
Helpful
for outlining the difficult daddle area
Surveying
1.
Surveying of cast is useful in areas of
undercut and
2.
determine potential path of insertion ,
3.
removal or displacement of partial denture
4.
Is helpful for design of denture
Full occlusal
adjustment
1.
For determination of lateral jaw movements
2.
May be required for face bow mounting of
maxillary cast and
3. The use of semiadjustable articulator
4.
Particularly useful for tooth wear and
craniomandibular disorders
Diagnostic wax up
May
be helpful; for evaluation of alternative design
Can
help patient evaluation of options
Partial Dentures
design
1.
May be in acrylic or
2.
Cobalt chrome denture
Alternative to
denture
1.
Fix appliance e.g. crown & brides or
2.
Implant Or
3.
Not wearing denture at all
Preprosthetic
management
1.
Any caries
2.
Endodontic treatment
3.
Periodontal trement must be controlled before
any prsthodontic construction
No prosthodontic
treatment for cases
1.
Less motivated
2.
No aesthetic problem
3.
No functional problem
4.
Stable occlusion or in harmony
Changes following
extraction of teeth
There are 3 types of
changes
1.
Facial changes
2.
Intraoral changes
3.
Psychological changes
Facial changes
following extraction of tooth
1.
Loss of dental bulge
2.
Loss of lip support
3.
Witches chin
4.
Lips folds inwards
5.
And look thinner
Intraoral changes
following extraction of teeth
1.
Loss of mandibulr height = 4 mm after one
year
2.
9-10 mm after 25 years
3.
Loss of maxillary height is ine quarter of
loss of mandibular height
4.
Decreasded masticatory performance
5.
Decreased propioceptive ability
6.
Resorption of buccal bone width
Psychological changes
following tooth extraction
1.
Some people find edentulousness difficult to
accept
2.
Or growing old or as a result of underline
systemic disease
3.
Or lack of
self motivation and lack of interest
Complete dentures
principles
"The artificial teeth
should replace the denture space( space previously oocupied by natural
teeth ) approximitelt the same position number shape and size and place"
Features of complete
dentures
1.
Good retention
2.
Good support
3.
Good muscle balance
4.
Good occlusal balance And
5.
stability
Complete denture
Retention
1.
Retention is the resistance to displacement
of a denture away from the ridge
2.
Good retention gives psychological comfort
3.
For good Retention close contact between
denture and tissue
Retention of lower
denture is more difficult to achieve because of the,
Mobility
of mandible and floor of mouth than maxilla
Support of complete
denture
Support
is resting of denture on the mucosa and alveolar bone
Effective support requires
- Denture cover the maximum surface area without moving or impinging on soft tissue
- Good tissues are the tissue resistant to resorption capable of taking load during function
Different areas in
complete dentures
1.
Primary support area
2.
Secondary support area
3.
Areas non contributing to support
4.
Areas to be relieved
Primary support area
is,
Primary
support area in upper denture is hard
palate
Secondary support
areas in complete dentures is,
alveolar
ridge crest
Areas non –
contributing to support,
Denture border
Areas to be relieved
in upper complete denture construction
1.
Mid line suture and
2.
incisive papilla
Primary support area
in lower denture
1.
buccal shelf and
2.
Pear shaped retro molar pad
Secondary support
area in lower denture,
Lower
alveolar ridge crest and
Genial
tubercles
Areas non-
contributing to support,
Labial
ridge incline
Relief area in lower
denture,
1.
Lingual ridge incline and
2.
mylohyoid ridge
3.
prominent genial tubercle
4.
prominent mental tubercle
Muscle
balance
1. Muscle balance is achieved when the forces of
muscles of lips , tongue , cheeks do not dislodge the denture during functional
movements of the mouth and
2. When the teeth are out of contact
3. Concave shape of denture polished surface
gives a vertical seating force when buccinator contract
4. A thinner denture flange in the premolar
region results in more free movement of the Modiolus ( the site of muscle fiber
decussation from buccinator and orbicularis oris muscle)
Muscles
balance provided by muscles
1.
Orbicularis oris = lips
2.
Buccinator = cheek
3.
Tongue
4.
Modiolous
5.
Retromolar pad = pterygomandibular raphae
Occlusal
balance
1.
Occlusal balance is achieved when the forces
of one denture do not dislodge the other denture during functional jaw
movements with the teeth in contact
2.
This can be achieved by a balanced
articulation
Stability
1.
Is the ability of dentures to resist
displacement by functional stresses.
2.
Stability gives physiological comfort
Design
features of complete denture
1.
Maxium extention of denture bases
2.
Peripheral seal
3.
Postdam
4.
Fraena
5.
Relief areas
6.
Retruded contact position
7.
Balanced articulation
8.
Freeway space
9.
Tooth position
10.Aesthetics
Denture faults
1.
Incorrect peripheral extension
2.
Teeth set not in neutral zone
3.
Un- balanced articulation
Polished surface is
unsatisfactory
1.
Patient factors
2.
Inadequate saliva
3.
Poor ridge forms
4.
Decreased adaptive skills
Burning mouth.
Sensitivity
to acrylic monomer
Speech difficulties
1.
Difficult F, V sounds = incisors are set too
far palatally
2.
Difficulty with S, T, D sounds = incorrect
palatal contour ->correct palatal contour
3.
S becomes ‘th’ - incisors set too far palatally or palatal plate too thick
Whistling sound
produced
Palate
vault too high behind incisors
Clicking teeth
Due
to increased occlusal vertical dimension
Recurrent fractures
of denture.
1.
Carelessness
2.
Notching of denture
3.
Flabby ridges
4.
Occlusal faults
5.
Acrylic fatigue due to constant stressing
6.
Flexing of denture
Candida and denture
1.
Use antifungals
2. Nystatin suspension 100,000 units /ml or
3.
Amphotericin suspension 100mg /ml or 2%
miconazol gel
For Complete denture
Maximum extension of denture base by
Covering the whole of the available space
of denture bearing area
In
maxillary upper base,
Posterior extension is just anterior
to the line of flexure of the soft palate
In
mandibular ( lower ) denture base,
1.
Posteriorly
extended to the retromolar pad and
2.
lingually to Lingual sulcus region
Peripheral
seal
1.
Is the of contact between the mobile mucosa
and the denture surface and ,
2.
is determined at the master impression stage
3.
Good peripheral seal is good for the
retention and stability
Potsdam
is,
1.
A round smooth line at the junction of hard
and soft palate
2.
Aids in peripheral seal of maxillary denture
Fraena,
1.
Labial frenum ,
2.
buccal frenum,
3.
lingual freum and
4.
buccal frenum
5. A technique of impression taking is adopted
to obtain fraenal relief
Relief areas,
1.
Small tori
2.
Prominent mylohyoid ridge
3.
prominent mental nerve foramen Often have to
be relieved
Retruded contact position
1. Complete denture should be registered in the
most retruded contact position
2. This is the position of the mandibular
condyles in the most retruded position in the glenoid fossa
3. As this is the most reproduciable position
Balanced articulation
1.
The complete denture should have a balanced
articulation
2.
Which is the continuous contact position of
upper and lower cusps
3.
all around dental arch during all closed
grinding movements of mandible
Freeway space
1.
2-4 mm of free space in vertical dimension for construction of complete denture
2.
This is the distance between the two arches
in rest position
3.
This space is variable in individual
mandibular movements in speech
Position of Upper
anterior teeth
1.
Are set labial to the residual ridge
2.
They are 10mm labial to the middle of the
incisive papilla
3.
About 2-3 mm of teeth are shown when lips are
apart and relaxed
Lower anterior teeth
1.
If there is little ridge resorption ,
2.
teeth should be placed marginally in front of
the ridge crest
3.
In cases where there is lots of ridge
resorption
4.
teeth should be placed to the buccal sulcus
Upper posterior teeth
set up
1.
slightly buccal to the residual ridge
2.
and parallel to the ala-tragus line
Lower posterior teeth
set up
Teeth
should be set directly over the ridge
Aesthetics
According
to individual needs of patient
Without
loss of functional concepts
Types of impressions
1.
Mucocompressive and
2. Mucostatic
Mucocompressive
impression is,
1.
an impression under load
2.
so that the mucosa is reduced in volume
equally and evenly condensed
Mucostatic
impression is,
1.
Made without load application
2.
so that mucosa is neither displaced nor
compressed
for insertion of complete denture incorrect
occlusal balance is checked by ,
1.
using articulating paper
2.
and modified by selective grinding
If there is muscle balance problem ,
grinding of denture periphery may be required
overextention should be
corrected
speech checked
and patient allowed to comment on
denture
Common
denture problems
1.
Inadequate support
2.
Pain on pressure on supporting areas
3.
Discomfort under denture
4.
Burning sensation in denture bearing areas
5.
With no redness or ulceration
Inadequate
retention Loose denture
1.
At rest and in function
2.
Denture can be removed without any resistance
3.
Denture is removed from mouth after firmly
seated in mouth
4.
is treated by improving peripheral seal by
self cure acrylic
5.
relining the denture may be required
Muscle
balance problem
1.
dentures becomes loose during function and
drops
2.
denture feel too large
3.
cheek biting
4.
on tongue protrusion lower denture comes out
5.
this
is treated by careful trimming of denture area encroaching on muscles .
Occlusal
balance problem
1.
patient wears denture well but find difficult
to eat with it
2.
there may be pain on pressure or
3.
denture moves when teeth grind together
4.
problem can be treated by slective grinding or
5.
laboratory remounting or
6.
resetting of teeth
Appearance
problem
1.
shade of tooth wrong
2.
shape of teeth wrong
3.
too much or too little tooth shows
4.
lips look odd
5.
face looks asymmetrical , patient unhappy
6.
problem is treated by resetting of teeth
7.
is due to incorrect recording vertical or
horizontal components of occlusion
Speech problems
1.
problem with F and V sounds or hissing S
sounds
2.
may be due to tooth position
3.
or vertical dimension of occlusion
4.
notoriously difficult problem to solve
Retching
1.
Retching is a
protective reflex
2.
Examination and impression taking is
difficult
3.
There may be psychiatric elements to retching
4.
is treated by progressive adaptation to
denture
5.
construction of base plates first
6.
hypnotherapy or desensitization therapy
Acrylic allergy
For
proven acrylic allergy an alternative material may be considered
Acrylic alternatives
are
1.
Vulcanite
2.
Nylon
3.
Polycarbonate
are useful alternative materials
4.
porcelain
teeth are alternative to acrylic teeth
Partial Dentures Aim
1.
Partial denture should not damage the
adjacent teeth
2.
Or restoration
3.
Partial denture is designed according to the
periodontal health
4.
Should restore function and aesthetic
Problems arising as a
result of non replacement of missing teeth ,
1.
Dirffting and tilting of adjacent teeth
2.
Overeryption of opposing teeth
3.
Decreased masticatory function
4.
craniomandibular disorders
5.
overloadoing of remaining teeth or mucosa
6.
tooth wear
7.
poor oral hygiene
8.
speech problems
9.
aesthetic problems
Negative effects of
partial dentures
1.
increased plaque accumulation
2.
dental caries
3.
gingivitis
4.
periodontitis
5.
gingival stripping
6.
overloading of abutment teeth
These problems can be
solved by,
1.
careful partial denture design
2.
patient selection
3.
motivation
4.
oral hygiene instructions
5.
regular checkups
6.
and achieved before partial denture
construction
Partial denture
Design
Systematic
approach to partial denture design construction must be followed for each case
according to the Kennedy classification
Kennedy
classification of edentulous space
Class I = bilateral
free end saddle
Class II = unilateral
free end saddle
Class III =
unilateral bounded saddle
Class IV = anterior
across the mid line
Saddle classification,(Craddock's classification)
1.
Saddle is part of alveolus from which teeth
are missing
2.
Mucosa borne – e.g. bilateral free end saddle
3.
Tooth borne – e.g. small bounded saddle
4.
Tooth and mucosa borne
Types
of connectors in maxilla
1. Anterior palatal bar – used
for anterior saddle or for indirect retention in a bilateral free end saddle
2.
Mid palatal bar – connect 2
posterior bounded saddle
3. Posterior palatal bar - Posterior
border on the vibrating line used for free end saddles
4.
Palatal horse shoe connector – for anterior
saddle
5.
Full coverage palatal plate is used
when very few natural teeth are present.
Types
of connectors in mandible
1.
Lingual bar – needs to be 4 mm
deep and 3 mm thick , 1.5 mm away from the gingival margin and 1.5 mm above the floor of mouth
2.
Lingual plate used when insufficient room for lingual bar
3.
Lingual bar and continuous clasp -
provides indirect retention than lingual bar but had many sharp edges
4.
buccal bar –very few
indications
5.
sub lingual bar – lies low in floor
of mouth
Metals
sued for clasp are ,
1.
stainless steel
2.
cobalt chromium
3.
wrought gold
For
different undercuts depths different metals are used
1.
For 0.75 mm undercut - stainless steel is
used
2.
For 0.25 mm undercut - cobalt chromium is
used
3.
For 0.5 mm undercut - wrought gold is used.
Partial
denture clasps can be
1.
Occlusally approaching clasp
2.
Gingivally approaching clasp
3.
I bar clasp
Rests
provide tooth support common types include,
1.
Occlusal rests
2.
Cingulum rest
Occlusal
rests – placed mesially or distallty on
1.
occlusal surface of molars or premolars .
2.
may require tooth prepration ,
3.
must not interfere occlusion
Cingulum
rests are placed on the
1.
cingulum of incisors and canine
2.
may require tooth prepration
Prosthotics
1. During fabrication of lower denture it was
slightly extended so what muscle does it touch.
2.
Why is it that you cure slow overnight than
rapid cure
3.
Which nerve supplies the posterior third of
the tongue?
What is an immediate denture?
An immediate denture is a complete
denture or partial denture inserted on the same day, immediately following the removal of
natural teeth.
What are the advantages of an immediate denture?
1. There are several advantages of an immediate
denture.
2. The most important factor is that the
patient will never need to appear in
public without teeth.
3. It is also easier to duplicate the shape,
color and arrangement of natural teeth
while some are still present in mouth.
4.
When an immediate denture is inserted at the
time of extraction,
5. It will act as a Band-Aid to protect the
tissues and reduce bleeding.
6. An immediate denture will allow establishing
speech patterns early. You will not have to learn to speak without a denture in
place and then later relearn to speak with a new denture.
7. An immediate denture will also allow to chew
better than without any teeth and minimize facial distortion that may occur
when teeth are removed.
What are the disadvantages of an immediate denture?
1.
The biggest disadvantage is the increased
cost.
2.
Another disadvantage is that you cannot
always see how the denture will look before the teeth are extracted and the
immediate denture is inserted.
3. Also, initially, an immediate denture does
not always fit as accurately as a conventional denture,
4. Which is made after the tissues have healed
for six to eight weeks following extractions, and without wearing a denture.
Why does
an immediate denture cost more?
1.
An immediate denture is initially more
expensive than a conventional denture because additional time is needed for
construction.
2.
A surgical stent (a guide for recontouring
tissues after extraction) is often necessary and
3.
more follow-up visits are needed for
adjustments and re-fitting.
A soft temporary
reline material will be utilized for re-fitting denture when it becomes loose
during the healing process.
1.
After the soft tissues have healed and
2.
shrinkage of the underlying bone has occurred
3.
about six months following extractions
The immediate denture
must be finalized
1.
by a permanent reline or new denture.
2.
At this time, patient will be charged for
either a reline or a new denture, depending on choice.
3.
discuss with
the patient the pros and cons of a permanent reline versus
making a new denture,
A major advantage to
making a new denture is,
that the immediate denture can be a spare
denture if the new denture breaks, is misplaced, or has to be repaired or
relined in our laboratory.
A major disadvantage
to relined, denture is
If the immediate denture is relined, it will
usually need to be left overnight while it is permanently relined in the
laboratory.
Is an
immediate denture for everyone?
1.
Not everyone is a candidate for an immediate
denture.
2.
Some people may be advised against this
treatment,
3.
due to general health conditions, or
4.
because of specific oral problems.
How long
does it take to complete?
1.
Four to five visits may be necessary for the
fabrication phase of an immediate denture,
2. Plus any preliminary surgery.
3.
For patients requiring a complete immediate
denture, the back teeth are often extracted six to eight weeks prior to the
fabrication phase.
4.
This allows the extraction sites to heal and
a better-fitting immediate complete denture to be fabricated.
The fabrication phase
consists of,
1.
impressions,
2.
bite records,
3.
tooth selection and
4.
try-in of the back teeth.
On the day of
delivery,
1.
patient will be seen in oral surgery
2.
for extraction of the appropriate teeth,
3.
followed immediately by the insertion of the
immediate denture.
Dentures reline helps
1.
an
old denture fit better
2.
As
with age gums and bone underneath the denture changes
3.
the
bone in the mouth was meant to support natural teeth and
4.
when
these teeth are lost, the bone resorbs quickly
5.
denture acrylic keeps its shape and form while the gums and
bone change
6.
so
that older denture can get loose and rub
the underlying gums tissues resulting in
ulceration
chairside dentures reline,
1.
Grinds
away some of the acrylic that contacts the gums.
2.
This
makes room for new acrylic without significantly changing the plate.
3.
New
acrylic is added to the old and
4.
the
new acrylic base is custom fitted to the shape of the gums and bone.
The self cure acrylic used for relining
is not as
hard and durable as the processed acrylic used to make the heat cure acrylic
advantage of chairside procedure is,
1.
its
quick and
2.
patients
don't have to wait a day or two to get their plates back.
Alginate Impression Materials
1.
Container
of powder should be shaken before use to get an even distribution of
constituents.
2.
Powder
and water should be measured to manufactures instructions.
3.
Water
at room temperature should be used,
- this gives a reasonable working time of ,a couple of minutes.
- Faster or slower setting times can be achieved ,by using warm or cold water respectively.
- The material nearer the tissues, sets first .
Retention
is needed to the impression tray and is provided by
perforations
in the tray and/or adhesives.
Once removed from the mouth the impression
should be,
1.
Rinsed
with cold water to remove any saliva or blood.
2.
It
should then be covered in a damp gauze/napkin to prevent syneresis
3.
(not
placed in water which would cause imbibition-expansion).
4.
The
impression should be soaked in hypochlorite for 60 seconds and then cast as
soon as possible.
Properties of Alginates
CHEMISTRY
1.
On
mixing the powder with water a sol is formed,
2.
a
chemical reaction takes place and
3.
a
gel is formed.
The powder contains
1. Alginate
salt (e.g. sodium alginate)
2. Calcium salt (e.g. calcium sulphate)
3. Trisodium phosphate
2. Calcium salt (e.g. calcium sulphate)
3. Trisodium phosphate
The setting reaction is as follows:
On mixing
the powder with the water
SODIUM ALGINATE
|
SODIUM SULPHATE
|
|
+
|
®
|
+
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CALCIUM SULPHATE
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CALCIUM ALGINATE
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The chemical reaction occurs too quickly
often during
mixing or loading of the impression tray.
It can be slowed down by,
1.
adding
trisodium phosphate to the powder.
2.
This
reacts with the calcium sulphate
3.
to
produce calcium phosphate,
4.
preventing
the calcium sulphate reacting with the sodium alginate to form a gel.
This second reaction occurs in preference to
the first reaction
1.
until
the trisodium phosphate is used up,
2.
then
the alginate will set as a gel.
There is a well-defined working time during which there is no viscosity change.
There is a well-defined working time during which there is no viscosity change.
PROPERTIES of alginate
- Good surface detail
- Reaction is faster at higher temperatures
- Elastic enough to be drawn over the undercuts, but tears over the deep undercuts
- Not dimensionally stable on storing due to evaporation
- Non toxic and non irritant
- Setting time can depend on technique
- Alginate powder is unstable on storage in presence of moisture or in warm temperatures
ADVANTAGES
1. Non toxic
and non irritant
2. Good surface detail
3. Ease of use and mix
4. Cheap and good shelf life
5. Setting time can be controlled with temperature of water used
2. Good surface detail
3. Ease of use and mix
4. Cheap and good shelf life
5. Setting time can be controlled with temperature of water used
DISADVANTAGES
1. Poor
dimensional stability
2. Incompatibility with some dental stones
3. Setting time very dependent on operator handling
4. Messy to work with
2. Incompatibility with some dental stones
3. Setting time very dependent on operator handling
4. Messy to work with
Denture maintenance
Ill-fitting denture
results in
1.
Resorption
of ridges
2.
Candida
infection
3.
denture
irritation hyperplasia
4.
Inflammatory
papillary hyperplasia of palate
Rebasing is,
1.
Replacement
of all of denture base
2.
When
improvement in the fitting surface is required
3.
Heat
cure acrylic is the material of choices
Relining is,
Replacement
of fitting surface with a self cure acrylic
Laboratory dentures relining is a similar
procedure.
1. Instead
of using self cure acrylic,
2.The
old denture is used to take a precise impression of the underlying tissues with
very accurate impression material.
The old denture is sent to a dentures lab and new acrylic
1.
is processed to the old
denture in the same manner that the original denture was manufactured.
2.
The
result is a very nice well fitting old denture.
A dentures
relining
1.
can
help make wearing dentures much more comfortable ,
2.
but
they should always be replaced every five years
3.
to
adjust to the natural changes of face and
4.
the
changes in the bone within mouth.
Immediate denture definition,
denture
provided to the patient soon after extraction of a tooth
Q: advantages of Immediate denture for dentist,
1.
smooth wound healing ,
2.
conservation of apace,
3.
provision of primary basis,
Advantages of immediate denture for patient
1.
immediate replacement of extracted tooth
2.
no aesthetic loss,
Disadvantages of
immediate denture
1.
denture becomes loose with time
2.
due to bone resorption and
3.
tissue regression,
4.
cost of new denture due to repeat denture
Copy denture is
1.
When old denture is used to make new denture.
2.
definition: patient’s old denture is used as a model to make new
denture.
Indications of copy
denture;
1.
when patient is satisfied with the old
denture , or
2.
not willing to pass through any of the steps
of denture making
3.
e.g. impression taking or trial
Contraindications of
copy denture
1.
When denture is loose or
2.
has a major defect, or
3.
there is change in the oral structures
4.
e.g extraction of a tooth or boone resorption
Disadvantages of copy denture
Any
fault present in the old denture is likely to be repeated.
Maxillary tuberosity and tooth fracture management?
Maxillary tuberosity and tooth fracture management?
Allow the
fracture to heal by providing a supportive appliance e.g a denture or splint
Centric Occlusion
Centric Occlusion
1.
the
maximal intercuspation of the teeth.
2.
The
relationship of the mandible to the maxilla
3.
when
the teeth are in maximum occlusal contact,
4.
irrespective
of the position or alignment of the condyle-disk assemblies.
Centric Relation = retruded contact position
1.
The
position of the mandible
2.
when
the condyles are in an orthopedically stable position.
This occurs when the condyles are in their
most superoanterior position,
1.
Resting
on the posterior slopes of the articular eminences with the disks properly
interposed.
2.
The
maxillomandibular relationship
3. in
which the condyles articulate with the thinnest avascular portion of their
respective disks
4. With
the complex in the anterior-superior position against the slopes of the
articular eminences.
5.
This
position is independent of tooth contact.
6.
syn.
retruded contact position
Compensating Curve
1.
The
anteroposterior curvature (in the median plane) and the mediolateral curvature
(in the frontal plane)
2.
in
the alignment of the occluding surfaces and incisal edges of artificial teeth
3.
that
are used to develop balanced occlusion.
Cross-Bite= reverse articulation
1.
When
the maxillary teeth occlude with buccal cusps contact the central fossa of the
mandibular teeth.
2.
An occlusal relationship in which the mandibular teeth are located facial to
the opposing maxillary teeth;
3. the maxillary buccal
cusps are positioned in the central fossae of the mandibular teeth.
syn. reverse articulation
syn. reverse articulation
Curve of Monson
archaic sees Compensating Curve
archaic sees Compensating Curve
Functional Occlusion
is the contacts of the maxillary and mandibular teeth during mastication and deglutition.
is the contacts of the maxillary and mandibular teeth during mastication and deglutition.
Most common Denture problems
Most common denture
problem is,
1.
Pain on insertion or
2.
loose denture
Can be due to ,
1.
Denture errors or
2.
Patient factors
Patient fctors are ,
1.
patient should be warned in advance the
limitations of a denture
2.
excessive salivation
3.
speech problems pain
4.
bruxism
5.
other paranormal habits , like clenchinh of
teeth
Causes of pain,
1.
Rough fitting surface
2.
Errors in occlusion
3.
bruxism
4.
Retained root
5.
Sharp alveolar ridge
6.
Premature contact
7.
Excessive bone resorption – mental foramen
pressure or exposure in localised area of pain
8.
Leverage – due to unstable denture
9.
Clasp arm too high
Complain of loose
denture is more in,
Lower
denture
Altered Cast Technique
1.
In
Free end saddles dentures ,
2.
There
is displacement of denture under
occlusal pressure
3.
There
is anteroposterior rocking around the abutment tooth, which acts as a pivot.
4.
This
is as a result of the displaceability of the mucosa.
The altered cast technique is employed
1.
to
try and prevent this anteroposterior rocking around the abutment tooth,
2.
by
taking an impression of the mucosa under controlled pressure.
3.
The
metal framework is constructed on a cast produced by a mucostatic impression
material, usually alginate.
4. Baseplates
are then constructed in self-cured acrylics on the framework in the saddle
areas, these are close fitting.
5. Impression
paste or a medium viscosity silicone paste is then applied to the fitting
surface of the self-cured acrylic.
6.
The
denture is then inserted in place, held in place by the framework only,
7.
no finger pressure is applied as this would
lead to over displacement of the mucosa.
8.
Border
moulding is then carried out as the is impression material is setting.
1. In
the laboratory, the free end saddle areas on the master cast are sectioned off.
2. The
denture is then positioned on the model and the new saddle areas are poured.
3. The
resulting model represents the free end saddle areas under conditions, which
mimic functional load.
4. Denture
construction then continues as normal.
5. The
distribution of loading of the free end saddles is improved and denture is more
stable.
How long do I leave the impression in the mouth before
it's fully set?
1. Setting time in the mouth is based on use of room temperature water.
2. All materials will gel in 5 minutes except one.
3. Lavender Acculoid requires 7 minutes to gel.
How do I disinfect my hydrocolloid
impressions?
Hydrocolloid impressions may be disinfected by immersion in one of the following:
Hydrocolloid impressions may be disinfected by immersion in one of the following:
1.
Sodium Hypochlorite,
2.
Iodophor,
3.
Acid Gluteraldehyde.
Sterilization Pouches
Sterilization
Pouches offer not only the highest quality dental pouch, but also features the
patented Internal-Processing-Indicator. Available in 12 sizes
Fixed and Removable Prostheses
Any fixed or removable prosthesis which has
been in the patient's mouth ,
1.
must
be rinsed under running water to remove excess blood and saliva.
2.
Do
not splash water excessively;
3.
droplet
spatter can carry microorganisms.
For
Cleaning Dentures Place the prosthesis in,
1.
an
ultrasonic cleaner
2.
with
Midwest Stain and Tartar Remover
3.
for
the manufacturer’s recommended time.
4.
This
is the pre-cleaning step of the disinfection procedure.
Prior to adjustment or transport to the
laboratory, disinfect the prosthesis as follows:
1.
Rinse with water and spray with a complex
phenol disinfectant.
2.
Place in a plastic bag for 10 minutes, and
3.
Rinse with water.
4.
Wrap prosthesis in plastic (or place in a
plastic bag) and send to the laboratory.
5.
Do not add disinfectant to the bag.
Cleaning Dentures
1.
Use Midwest’s Stain and Tartar Remover and
follow manufacturer's directions for proper dilution.
2. With gloves and safety glasses on, pour Stain
and Tartar Remover solution directly into bag containing dentures.
3.
Close bag and place in a glass cylinder.
4.
Fill
cylinder with water.
5.
Place cylinder in ultrasonic cleaner and
vibrate for manufacturer’s recommended time.
6.
Wearing clean gloves,
7.
remove dentures from bag and thoroughly rinse
with water.
8.
Place dentures in denture cup containing
mouthwash.
9.
Remove and discard gloves and wash hands.
10. Return
denture cup to the student or faculty member.
Disinfecting Impressions; Alginate or polyether:
1. Rinse with water and
2. spray with a complex phenol disinfectant.
3. Place the impression in a plastic bag for 10 minutes,
4. rinse with water, and pour.
5. Pour alginate impressions immediately;
6. pour polyether impressions immediately or within 24 hours.
Polysulfide,
silicone, and polyvinylsiloxane:
1.
Rinse
with water and
2.
immerse
in a complex phenol disinfectant for 10 minutes.
3.
Remove
and rinse again with water.
Pour
polysulfide and silicone impressions,within 15-60 minutes;
Pour polyvinylsiloxane impressions , within 15
minutes to seven days.
Cleaning/Disinfecting Prosthodontic Items
1.
Items
contaminated only by handling or
2.
that
have minimal contact with oral fluids
3.
do
not require sterilization for routine reuse,
4.
but
should be cleaned and disinfected with an EPA-registered disinfectant.
Such items include,
1.
torches,
2.
face
bows (not including the facebow fork),
3.
articulators,
4.
rulers,
5.
mixing
spatulas,
6.
knives,
7.
rubber
bowls,
8.
shade
guides, and
9.
mold
guides.
Any items such as impression trays and
facebow forks that are placed in the mouth,
Should be heat-sterilized.
Contaminated Stone Casts
Contaminated stone casts transferred to or
from a laboratory area or a clinic
1.
should
be sprayed with a complex phenol disinfectant and
2.
allowed
to set for 10 minutes before rinsing thoroughly with water.
3.
A
protective mask must be worn when using a model trimmer.
Other Work-Related Items
1.
All
other work-related items (articulators, case pans, etc.)
2.
which
are transferred from a clinic to a laboratory area or vice versa
3.
must
be disinfected.
4. Moving
parts of the articulator should not be disinfected since this may impair
function.
The following items should be cleaned and
heat-sterilized or chemically disinfected as indicated:
STAINLESS STEEL CROWNS indications
1.
recommended
on primary molars
2.
Grossly
carious molars
3.
tooth
has received a pulpotomy
4.
provide
more durable and reliable restoration.
Avoid:
Sticky foods like caramel, gum, taffy
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Hard candy
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Chewing on ice
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Popcorn kernels or "old maids
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The crown of the tooth is protected
1.
Where
the crown meet the gum tissue is an area where bacteria can live and cause
decay.
2.
It
is important that parents supervise the cleaning of this area.
3.
Make
sure child brushes not only his teeth
but where their teeth meet the gum tissue.
4.
It
is also important to floss,
especially in this area, once a day.
5.
Brush
teeth and not flossing is leaving 40% our mouth loaded with acid protecting
bacteria!
6.
The
crowned tooth will usually fall out normally when the permanent tooth comes in.
BROKEN DENTURE,
BRIDGE, OR PLATE
1.
Save all the parts of broken denture, bridge
or partial denture
2.
Repair or replace as soon as possible
3.
Temporary bridges, plates and dentures until
the permanent one is repaired or replaced
ORTHODONTIC PROBLEMS -Braces
- If a wire is causing an irritation, cover the end of the wire with some bees wax or a piece of gauze
- If a wire becomes embedded in the gum or cheek DO NOT remove it, go to the dentist immediately
CROWN COMES OFF
1.
Try to snap it back in
2.
Purchase a small tube of denture adhesive
paste put a small amount in the crown and place it back on your tooth
3.
Try Dent Temp or Tempenol as a temporary
adhesive
4.
Do NOT use ordinary household glue
5.
Call the dentist as soon as possible to
recement it properly
Q: Instructions for Denture?
1. For dentures, a written leaflet is given which is discussed with patient.
2. Major highlight of this is emphasis on denture hygiene- twice daily routine of brushing, soaking and then brushing again should be adopted.
3. Brushing is with small multitufed toothbrush to help gain access to awkward corners.
4. after brushing, denture should be soaked in a specialist cleaner to help to remove stubborn stains, calculus and plaque.
5. If patient has to leave the new dentures out because of pain or soreness, request that the dentures be worn 24 hours before the review appointment,
6. in order that the cause of the discomfort may be more readily detected.
An Articulator
1. An articulator assists in the fabrication of removable appliances
(dentures),
2. is a mechanical device used to casts of the maxillary and mandibular teeth
are fixed and
3. reproduces recorded positions of the mandible in
relation to the maxilla.
4. fixed prosthodontic restorations (crowns, bridges, inlays and onlays)and
orthodontic appliances.
Plane line articulator
1. The simplest type of articulator consisting of a simple hinge joint.
2. No lateral or sliding movements are possible with a plane line articulator.
3. An articulator that allows that reproduces movement of the mandible only in
a sagittal plane.
