Complete Denture Study Notes
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Questions and Answers

What effect can a lack of proper lip support have on appearance?

  • Collapsed appearance and wrinkling (correct)
  • Enhanced stability of the dentures
  • Improved overall facial aesthetics
  • Increased fullness of the lips
  • How can excessive lip support be identified through physical examination?

  • By assessing the philtrum and mentolabial fold (correct)
  • By observing the vertical height of the chin
  • By checking if the upper lip covers the teeth
  • By measuring the nasolabial angle
  • Which classification describes the length of the lip?

  • Short, normal, and long lips (correct)
  • Droopy and elevated lips
  • Thin and thick lips
  • Full and flat lips
  • Which class represents the best retention and stability for complete dentures?

    <p>Class 1</p> Signup and view all the answers

    What could potentially jeopardize esthetics when selecting dentures?

    <p>Arch size being too small for head size</p> Signup and view all the answers

    What is a normal nasolabial angle measurement?

    <p>Greater than 110 degrees</p> Signup and view all the answers

    What condition may cause more exposure of the teeth when the lip is short?

    <p>Incompetent lip</p> Signup and view all the answers

    Which material consideration affects patient satisfaction with complete dentures?

    <p>The degree of suction of the denture.</p> Signup and view all the answers

    What is the significance of pre-extraction records in denture therapy?

    <p>They allow for the reproduction of anterior esthetics and guide jaw relation.</p> Signup and view all the answers

    Which type of lip requires careful consideration of labiolingual positioning of teeth to avoid changes in support?

    <p>Thin lip</p> Signup and view all the answers

    What type of arch form is characterized by being square?

    <p>Class 1</p> Signup and view all the answers

    What is the primary goal when evaluating the occlusion during denture fitting?

    <p>To achieve harmony with jaw relationship.</p> Signup and view all the answers

    Which class of ridge relation describes a retrognathic relationship?

    <p>Class II</p> Signup and view all the answers

    What is suggested if the interarch space is insufficient?

    <p>Proper jaw stabilization</p> Signup and view all the answers

    What consequence results from having anterior teeth positioned too far palatally?

    <p>Instability of the maxillary denture</p> Signup and view all the answers

    What does the classification of facial profiles according to Angle help assess?

    <p>The jaw relation and occlusal harmony.</p> Signup and view all the answers

    Which class of mandibular ridge form has broad crests and parallel walls?

    <p>Class 1</p> Signup and view all the answers

    What is a disadvantage of having a large inter ridge distance?

    <p>Increases risk of denture tilt.</p> Signup and view all the answers

    What is the ideal ridge form for maxillary support and stability?

    <p>High ridge with flat crest and parallel sides</p> Signup and view all the answers

    Which condition may require patient training to avoid denture injury?

    <p>Small arch size with developed jaw muscles</p> Signup and view all the answers

    Which classification describes the facial form that exhibits diverging lines at the chin?

    <p>Ovoid</p> Signup and view all the answers

    What interarch space classification is characterized by accommodating artificial teeth ideally?

    <p>Class 1</p> Signup and view all the answers

    How can tissue contact distribution be assessed in patients with complete dentures?

    <p>By applying pressure indicating paste.</p> Signup and view all the answers

    What aspect of denture satisfaction is related to the ability to articulate speech clearly?

    <p>Phonetics</p> Signup and view all the answers

    What effect does a small inter ridge distance have on denture retention and stability?

    <p>It creates difficulties in arranging teeth.</p> Signup and view all the answers

    Which of the following factors is NOT evaluated during a clinical examination of complete dentures?

    <p>Pre-extraction photographs</p> Signup and view all the answers

    What is the implication of a prominent bilateral undercut in denture construction?

    <p>Surgery is necessary to correct it.</p> Signup and view all the answers

    How can implant-supported dentures help with ridge parallelism issues?

    <p>They provide additional support for uneven ridges.</p> Signup and view all the answers

    What class indicates the absence of tori in relation to denture construction?

    <p>Class 1</p> Signup and view all the answers

    How is the horizontal lip relation (lip step) classified when there is slight negative positioning?

    <p>Normal step</p> Signup and view all the answers

    How does the tongue assist in enhancing retention of complete dentures?

    <p>By filling the oral cavity and sealing the denture.</p> Signup and view all the answers

    What classification describes when both ridges are parallel to the occlusal plane?

    <p>Class I</p> Signup and view all the answers

    What should be documented regarding an unerupted tooth?

    <p>Retention of the root and foreign bodies</p> Signup and view all the answers

    Which findings are necessary to correlate with TMJ assessment?

    <p>History and examination findings</p> Signup and view all the answers

    What does a well-defined lesion suggest?

    <p>It is potentially a benign condition</p> Signup and view all the answers

    In which situation is it necessary to refer to a pathologist or surgeon?

    <p>When the diagnosis cannot be established</p> Signup and view all the answers

    How is mild resorption classified according to Wical and Swoop?

    <p>Loss of up to 1/3 of original height</p> Signup and view all the answers

    What characterizes Class IV bone quality?

    <p>Thin cortical and fine trabecular</p> Signup and view all the answers

    What does Class B bone quantity indicate according to Branemark's classification?

    <p>Loss of alveolar bone</p> Signup and view all the answers

    What is the method to estimate the original crest ridge height?

    <p>Use the distance from the lower border of the mandible to the inferior margin of the mental foramen</p> Signup and view all the answers

    Study Notes

    Complete Denture Study Notes

    • Existing/Current Denture
      • Patient's satisfaction with denture (retention, stability, esthetics, comfort, vertical dimension, phonetics)
      • The length of time the patient has been wearing their current denture.
      • Note any denture care habits.
      • Identify any denture problems (nature, type, and if they are correctable).
      • Use pressure indicating paste to check for denture tissue contact.
      • Evaluate the occlusion to ensure it's in harmony with jaw relations.
      • Determine if the denture's esthetics are acceptable and if the patient wants to change them for a new denture.

    Pre-Extraction Records

    • Pre-extraction photographs, radiographs, casts/scans, and facial close-ups are helpful for denture therapy in recreating esthetics and support, evaluating vertical dimensions (VD), and determining the patient's unique anatomy.
    • The cast/scan is the most valuable record due to its 3D information.
    • Pre-extraction records can help reproduce anterior esthetics and guide jaw relation.

    Clinical Examination

    • Extra-Oral Examination: Examine the head and neck region for any nodules, nevi, or ulcerations.

    Facial Examination

    • Facial Form: Leon Williams classified facial forms into four types:
      • Square
      • Tapering
      • Square-tapering
      • Ovoid
    • Facial Profile: Classified according to angle:
      • Class 1: Normal
      • Class 2: Retrognathic
      • Class 3: Prognathic
    • Lip Support:
      • Lack of lip support can lead to a collapsed appearance and wrinkles around the mouth.
      • If only the mouth area is wrinkled, and the rest of the face is normal, it suggests a lack of lip support.
      • Adding wax to the anterior teeth can help confirm if too palatal positioning of the anterior teeth is causing the lip support issue.
      • However, teeth placed too far anteriorly can cause leverage on the maxillary denture, leading to loss of stability.
      • Assess the nasolabial angle. An increased angle after wearing dentures indicates lip drooping and loss of lip support.
    • Lip Fullness:
      • It is related to the support the lip gets from the mucosa, teeth, or denture base.
      • Thick labial flanges on the denture can make the lip appear too full.
      • An obliterated philtrum or mentolabial fold suggests excessive lip support.
    • Lip Thickness:
      • Determined by the lip's intrinsic structure.
      • Two types:
        • Thin lip
        • Thick lip
      • In thin lips, any change in the labiolingual position of teeth can alter the lip's fullness, support, or drape.
    • Lip Length:
      • Classified as:
        • Long
        • Normal
        • Short
      • Lip length affects the amount of teeth exposed during rest and function.
      • Short lips lead to more exposure of the teeth or denture base, often seen in incompetent lips.
      • People with long lips tend to hide their dentures and most of their teeth.
    • Checking Lip Length:
      • Vertical Lip Relation: In lower facial height, the upper lip length is equal to one-third, while the lower lip and chin length combined should be two-thirds.
      • Horizontal Lip Relation (Lip Step): Refers to the anterior-posterior relation of the upper and lower lip. Classified as:
        • Normal - Lip step is slightly negative
        • Positive - Lip step positive (seen in class III cases)
        • Marked negative - Seen in class II cases

    Nasolabial Angle

    • Normal is 110 degrees (>90 degrees).
    • It is measured by drawing a line joining subnasale to the most anterior point of the columella and subnasale to the upper lip border.
    • In class II (protrusion of the upper lip), the angle decreases.
    • In class III (retrusive position of the upper lip), the nasolabial angle increases.

    Basal Seat Examination:

    • Arch Size:
      • Determined by the amount of basal seat available for the denture foundation.
      • Classification:
        • Class 1: Large (ideal for retention and stability)
        • Class 2: Medium (good for retention and stability but not ideal)
        • Class 3: Small (difficult to achieve good retention and stability)
      • If the arch size is small and not in harmony with the face size, it can jeopardize esthetics.
      • If the arch size is smaller than the head size, and the muscles of mastication are well developed, the functional demand of the denture can cause injury.
      • Smaller arch size can be due to genetics, trauma, early tooth loss, or severe class II and III malocclusions.
    • Arch Form:
      • Class 1: Square
      • Class 2: Tapering
      • Class 3: Ovoid
      • Arch form influences denture support and helps select the correct stock tray, teeth, and arrangement.
    • Ridge Form (Maxillary):
      • Class 1: Square to generally round
      • Class 2: Tapering or V-shaped
      • Class 3: Flat
      • Ideal for maxillary ridge is high, with a flat crest and parallel sides, providing maximum support and stability.
    • Ridge Form (Mandibular):
      • Class 1: Inverted U-shaped, parallel walls, high to medium height with a broad crest
      • Class 2: Inverted U-shaped with a short and flat crest.
      • Class 3: Unfavorable -
        • Inverted W-shaped
        • Short inverted V-shaped
        • Ridge with undercut (results from lingually or buccally placed teeth).
    • Inter-Arch Space:
      • Class 1: Ideal interarch space, accommodating artificial teeth.
      • Class 2: Excessive interarch space.
      • Class 3: Insufficient interarch space.
      • Interarch space is challenging to determine initially without a properly mounted cast on the articulator.
    • Procedure:
      • Have the patient rest their jaw, carefully part their lips, and examine the distance between the ridges.
      • The dentist stabilizes the mandible by resting their thumb under the patient's chin.
      • Examine the inter-ridge distance around the entire arch, as it varies in different areas.
      • The most common problem is seen in the retromolar tuberosity area.
      • A small inter-ridge distance compared to a larger distance enhances retention and stability (Sharry).
      • Small interarch space provides a better seal due to the tongue contacting the denture's lingual and palatal surfaces more completely filling the oral cavity.
      • Stability increases because occlusal surfaces are closer to the ridge, minimizing tilting and side forces.
      • The disadvantage of small interarch space is the difficulty in tooth arrangement.
      • Large interarch space, due to significant ridge resorption, poses a challenge to retention and stability.
    • Ridge Parallelism:
      • Class 1: Both ridges are parallel to the occlusal plane.
      • Class 2: Mandibular ridge diverges from the occlusal plane anteriorly.
      • Class 3: Maxillary ridge diverges from the occlusal plane, or both ridges diverge occlusally.
      • Tell the patient to position their jaw at VDO (Vertical Dimension of Occlusion) and part their lips with a finger and mouth mirror, or use a mounted diagnostic cast to observe this relation.
      • Denture stability is enhanced by parallel ridges, as seen in natural dentition.
      • To address non-parallelism, consider implant-supported dentures.
    • Ridge Relation:
      • Class I: Normal
      • Class II: Retrognathic
      • Class III: Prognathic
    • Bony Undercut:
      • Class 1: Bony undercut absent.
      • Class 2: Small undercut, which can be managed by altering the path of insertion or selectively relieving the denture.
      • Class 3: Prominent bilateral undercut requiring surgery (one or both sides).
    • Exostosis/Tori:
      • Tori are benign bony enlargements covered by thin mucoperiosteum.
      • Class 1: Tori absent or minimal in size, not interfering with denture construction.
      • Class 2: Tori of moderate size, offering mild difficulties but not requiring surgery.
      • Class 3: Large tori compromising function and fabrication of complete dentures, requiring surgery.
      • Relief can be provided in the denture base for maxillary tori.
      • Mandibular tori should always be removed as they make denture seating difficult.
    • Other Considerations:
      • Examine for unerupted teeth, retained roots, and foreign bodies.
      • Examine radiographs for radiolucencies, radiopacities, rarefaction, sclerosis, expansion, bulging, or any well/ill-defined lesions.
      • Evaluate TMJ findings (correlate with history and examination). Determine if further investigation is required.
      • Examine the maxillary sinus for inflammation, cysts, polyps, and tumors.

    Assessment of Ridge Resorption:

    • Wical and Swoop's classification of resorption:
      • The lower edge of the mental foramen divides the mandible into thirds in a normal dentulous OPG.
      • By multiplying the distance between the lower border of the mandible and the inferior margin of the mental foramen by three, you can estimate the original crest ridge height.
      • Class I: Mild resorption - Up to 1/3 of the original height is lost.
      • Class II: Moderate resorption - 1/3 to 2/3 of the original height is lost.
      • Class III: Severe resorption - 2/3 or more of the original height is lost.

    Bone Quality (Lekholm-Zarb):

    - **Class I:** Homogeneous compact bone
    - **Class II:** Thick cortical/dense trabecular 
    - **Class III:** Thin cortical/dense trabecular 
    - **Class IV:** Thin cortical/fine trabecular
    

    Bone Quantity (Branemark):

    -  **Class A:** Normal bone
    - **Class B:** Loss of alveolar bone
    - **Class C:** Complete loss of alveolar bone
    - **Class D:** Resorption of basal bone
    - **Class E:** Rudimentary bone present (advanced loss of basal bone) 
    

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    Description

    This quiz covers key aspects of complete denture therapy, including patient satisfaction, denture evaluation, and pre-extraction records. It emphasizes the importance of understanding occlusion, esthetics, and unique patient anatomy for effective denture therapy. Test your knowledge on the evaluation and care of complete dentures.

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