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Questions and Answers
What effect can a lack of proper lip support have on appearance?
What effect can a lack of proper lip support have on appearance?
How can excessive lip support be identified through physical examination?
How can excessive lip support be identified through physical examination?
Which classification describes the length of the lip?
Which classification describes the length of the lip?
Which class represents the best retention and stability for complete dentures?
Which class represents the best retention and stability for complete dentures?
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What could potentially jeopardize esthetics when selecting dentures?
What could potentially jeopardize esthetics when selecting dentures?
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What is a normal nasolabial angle measurement?
What is a normal nasolabial angle measurement?
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What condition may cause more exposure of the teeth when the lip is short?
What condition may cause more exposure of the teeth when the lip is short?
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Which material consideration affects patient satisfaction with complete dentures?
Which material consideration affects patient satisfaction with complete dentures?
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What is the significance of pre-extraction records in denture therapy?
What is the significance of pre-extraction records in denture therapy?
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Which type of lip requires careful consideration of labiolingual positioning of teeth to avoid changes in support?
Which type of lip requires careful consideration of labiolingual positioning of teeth to avoid changes in support?
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What type of arch form is characterized by being square?
What type of arch form is characterized by being square?
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What is the primary goal when evaluating the occlusion during denture fitting?
What is the primary goal when evaluating the occlusion during denture fitting?
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Which class of ridge relation describes a retrognathic relationship?
Which class of ridge relation describes a retrognathic relationship?
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What is suggested if the interarch space is insufficient?
What is suggested if the interarch space is insufficient?
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What consequence results from having anterior teeth positioned too far palatally?
What consequence results from having anterior teeth positioned too far palatally?
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What does the classification of facial profiles according to Angle help assess?
What does the classification of facial profiles according to Angle help assess?
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Which class of mandibular ridge form has broad crests and parallel walls?
Which class of mandibular ridge form has broad crests and parallel walls?
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What is a disadvantage of having a large inter ridge distance?
What is a disadvantage of having a large inter ridge distance?
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What is the ideal ridge form for maxillary support and stability?
What is the ideal ridge form for maxillary support and stability?
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Which condition may require patient training to avoid denture injury?
Which condition may require patient training to avoid denture injury?
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Which classification describes the facial form that exhibits diverging lines at the chin?
Which classification describes the facial form that exhibits diverging lines at the chin?
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What interarch space classification is characterized by accommodating artificial teeth ideally?
What interarch space classification is characterized by accommodating artificial teeth ideally?
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How can tissue contact distribution be assessed in patients with complete dentures?
How can tissue contact distribution be assessed in patients with complete dentures?
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What aspect of denture satisfaction is related to the ability to articulate speech clearly?
What aspect of denture satisfaction is related to the ability to articulate speech clearly?
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What effect does a small inter ridge distance have on denture retention and stability?
What effect does a small inter ridge distance have on denture retention and stability?
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Which of the following factors is NOT evaluated during a clinical examination of complete dentures?
Which of the following factors is NOT evaluated during a clinical examination of complete dentures?
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What is the implication of a prominent bilateral undercut in denture construction?
What is the implication of a prominent bilateral undercut in denture construction?
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How can implant-supported dentures help with ridge parallelism issues?
How can implant-supported dentures help with ridge parallelism issues?
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What class indicates the absence of tori in relation to denture construction?
What class indicates the absence of tori in relation to denture construction?
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How is the horizontal lip relation (lip step) classified when there is slight negative positioning?
How is the horizontal lip relation (lip step) classified when there is slight negative positioning?
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How does the tongue assist in enhancing retention of complete dentures?
How does the tongue assist in enhancing retention of complete dentures?
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What classification describes when both ridges are parallel to the occlusal plane?
What classification describes when both ridges are parallel to the occlusal plane?
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What should be documented regarding an unerupted tooth?
What should be documented regarding an unerupted tooth?
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Which findings are necessary to correlate with TMJ assessment?
Which findings are necessary to correlate with TMJ assessment?
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What does a well-defined lesion suggest?
What does a well-defined lesion suggest?
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In which situation is it necessary to refer to a pathologist or surgeon?
In which situation is it necessary to refer to a pathologist or surgeon?
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How is mild resorption classified according to Wical and Swoop?
How is mild resorption classified according to Wical and Swoop?
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What characterizes Class IV bone quality?
What characterizes Class IV bone quality?
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What does Class B bone quantity indicate according to Branemark's classification?
What does Class B bone quantity indicate according to Branemark's classification?
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What is the method to estimate the original crest ridge height?
What is the method to estimate the original crest ridge height?
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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.
- Classified as:
-
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.