Dental Prosthetics Quiz

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Questions and Answers

What is the consequence of over-extension of a lower denture?

Enhanced adaptation to the mucosa

Improved retention during function

Increased comfort for the patient

Easily displaced denture during function (correct)

What is the role of post-dam in denture design?

To increase the size of the denture base

To ensure good border seal on compressible tissue (correct)

To enhance aesthetic appearance of the denture

To minimize the weight of the denture

What is the purpose of using permanent cement after trial cementation of a dental bridge?

To improve the aesthetics of the bridge

To replace the bridge without evaluation

To ensure the bridge will not be removed in the future

To confirm the patient's satisfaction before final cementation (correct)

Which of the following statements about complete dentures is incorrect?

Preliminary impressions require a master tray Signup and view all the answers

Which of the following is NOT a common reason for bridge failure?

Patient dissatisfaction Signup and view all the answers

What is the purpose of the first set of impressions in complete denture fabrication?

To record information for a special tray Signup and view all the answers

If a dental bridge fails due to secondary caries, what is the recommended management approach?

Repair the minor issue if the bridge is otherwise satisfactory Signup and view all the answers

What is a major consideration when taking master impressions?

Develop an effective border seal and record the maximum denture-bearing area Signup and view all the answers

What type of dental bridge primarily uses an adhesive resin for bonding?

Cantilever adhesive bridge Signup and view all the answers

What materials are commonly used for preliminary impressions in dentures?

Impression compound and elastomer Signup and view all the answers

What is the recommended method for removing an intact bridge?

Tap gently at the cervical margin with a chisel Signup and view all the answers

Which area is typically the posterior limit for the upper denture impression?

Hamular notches and vibrating line Signup and view all the answers

What should be done if a bridge has one loose retainer during removal?

Support the bridge while attempting removal Signup and view all the answers

What is indicated by lack of freeway space (FWS) in a denture?

It may lead to occlusal errors Signup and view all the answers

What is a common clinical finding associated with fixed-fixed designs of bridges?

Debonding of one retainer Signup and view all the answers

What is the primary purpose of follow-up appointments after the cementation of a bridge?

To ensure the bridge functions satisfactorily Signup and view all the answers

Which adjustment is typically avoided when checking occlusion in dentures?

Adjustment of upper palatal cusps Signup and view all the answers

What should be checked using articulating paper during an occlusion assessment?

Contact between upper and lower cusps Signup and view all the answers

What is a suggested practice for patients during the adaptation period with new dentures?

Continuing to wear the dentures despite pain Signup and view all the answers

Why should denture wearers store their dentures in water when not in use?

To prevent them from drying out and warping Signup and view all the answers

Which statement about occlusal contacts is generally considered accurate?

Patients should adapt before achieving balanced articulation. Signup and view all the answers

What should patients do if they are unable to return for denture adjustments immediately?

Stop wearing the dentures until the next appointment Signup and view all the answers

What adjustment may be made to remove interferences during lateral movements?

Adjustments to buccal upper and lower lingual cusps Signup and view all the answers

What patient factor can contribute to denture looseness?

Inadequate volume of saliva Signup and view all the answers

Which of the following causes could lead to difficulty with articulation for sounds like 'd', 's', and 't'?

Alteration of palatal contour Signup and view all the answers

What contributes to the resorption of the mandibular ridge compared to the maxilla?

Quicker resorption rates in the mandible Signup and view all the answers

Which characteristic of the palatal structure could lead to whistling while speaking?

Palate vault too high behind incisors Signup and view all the answers

What is a likely reason for recurrent fractures of a denture?

Excessive occlusal force Signup and view all the answers

What technique may be employed to minimize destabilizing forces on a lower denture?

Maximizing the extension of the denture base Signup and view all the answers

What is commonly the cause of the Candida becoming pathogenic in denture wearers?

Poor oral hygiene habits Signup and view all the answers

Which management strategy is recommended for addressing grossly resorbed lower ridges?

Employing neutral zone impression techniques Signup and view all the answers

What is the primary purpose of using transfer copings in dental impressions?

To facilitate the capturing of multiple preparations in one impression Signup and view all the answers

Why is occlusal registration often unnecessary in the model mounting process?

They are usually mounted in ICP, indicating best fit Signup and view all the answers

What should be evaluated during a metal work try-in for a porcelain fused to metal bridge?

The fit of the framework and occlusion Signup and view all the answers

What is a common adjustment made if one retainer of a bridge does not seat fully during the try-in?

The bridge should be sectioned for adjustment Signup and view all the answers

What is the main advantage of trial cementation for a finished bridge?

It enables adjustments outside the mouth if needed Signup and view all the answers

Which tool is recommended for cleaning around a dental bridge?

Super Floss® or interdental brush Signup and view all the answers

What is typically used to secure the sections of a bridge after adjustment?

Acrylic resin (DuraLay®) Signup and view all the answers

What might indicate the necessity of taking an inter-occlusal record?

Numerous preparations complicating the fit Signup and view all the answers

What is the recommended time frame for a patient to be seen after fitting complete dentures for adjustments?

1–2 weeks Signup and view all the answers

What does the indelible pencil help to identify?

Areas causing irritation on the mucosa Signup and view all the answers

What common cause can lead to generalized soreness under the denture?

Excessive occlusal vertical dimension (OVD) Signup and view all the answers

Why is regular review of patients with dentures emphasized?

To prevent damage from ill-fitting dentures Signup and view all the answers

What is the main difference between rebasing and relining dentures?

Rebasing changes the entire denture base, while relining replaces just the fitting surface Signup and view all the answers

What is a potential consequence of poorly maintained dentures?

Oral tissue resorption Signup and view all the answers

What material is favored for rebasing dentures?

Heat-cure acrylic Signup and view all the answers

Which condition is NOT exacerbated by wear of the occlusal surfaces of dentures?

Reduced painful sensitivity Signup and view all the answers

Study Notes

Restorative Dentistry 3: Replacing Teeth

Treatment planning for patients with missing teeth involves considering the number, location, and function of missing teeth, and the patient's preferences. A minimally invasive approach is preferred. 21 or more teeth are considered the minimum for functioning dentition, though this can vary by age, pattern of tooth loss, and incisal relationship. Replacement isn't always necessary.
Bridges are a fixed option, advantages include their fixed nature, while disadvantages include the destruction of natural tooth tissue, cost, and clinical time, which can be lengthy. Resin-bonded cantilever design is minimally invasive. Implant-supported prostheses can be fixed or removable, offer advantage avoiding natural teeth prep, however, are expensive and require surgical procedures with high predictability if planned and executed carefully. Removable partial dentures require minimal tooth preparation. They may have less expense but can contribute to plaque accumulation and damage to soft tissues/teeth.
Complete immediate dentures are indicated for patients with failing remaining teeth. Complete dentures require patient cooperation and good clinical management. Successful dentures are also dependent on patient compliance and technical management.
Treatment planning for missing teeth prioritizes a detailed patient history to understand patient goals and past experiences with dentures, alongside medical history to assess their capability to cope with dentures and impacts on medical factors like, for example, if a drug lowers saliva flow. Social history should also be considered for travel and other social arrangements. Clinical examination includes assessment of pathology, existing restorations, periodontium, edentulous areas (ridge form and extent), mucosa compressibility, tongue size, and saliva viscosity, and evaluation of previously unsuccessful dentures.
Specific design problems for bridges include periodontally involved abutment teeth requiring periodontal treatment first before consideration of bridgework, pier abutments requiring a support for pontics on each side, consideration of tilted abutments that should be addressed via orthodontic treatment, or a split bridge. All design problems require careful consideration of patient factors to decide on suitable design and potential advantages and disadvantages.

Bridge-design

Evaluate the prognosis of all teeth in the vicinity to avoid unnecessary extractions. Assess abutment teeth (consider restoration, endodontic status, periodontal condition, and mobility) select a design for retainers (e.g., full or partial crown), consider pontics and connectors, and generate a list of possible bridge designs.

Bridges-practical stages

Comprehensive patient history and evaluation (TMD, OH, diet) are critical. Diagnostic mounting involves taking accurate impressions of both arches, facebow record, and mounting models on a semi-adjustable articulator (or using ICP, RCP, mounting).
Performing a diagnostic wax-up is necessary to simulate the final restoration on the models to evaluate aesthetics and occlusion. This wax-up also enables a silicone putty impression to be made to create the temporary bridge.
The abutment teeth preparations are closely examined to check for parallelism. Temporary bridges are used to mimic the final design and can be laboratory-made or matrix-cut from the wax-up.

Bridge Failures

Common failures include loss of retention, mechanical problems (i.e. casting), and issues with the abutment teeth (e.g., caries, periodontal disease, loss of vitality).
Management of failures considers options like repair or replacement depending on the extent and type of failure. A thorough analysis of the cause is required before any replacement.

Resin-bonded bridges

Classification, anterior and posterior. Resin-bonded bridges require a cast metal structure that's bonded to abutment teeth using adhesive resin. This technique is most effectively used in cantilever designs, with one abutment and one pontic, and is often less expensive while needing minimal tooth preparation.

Removable partial dentures--principles

Components of the denture include a saddle (area resting on the missing arch/teeth and that carries artificial teeth/gumwork), connectors, an area that joins the parts of the denture together, support (resistance to vertical forces towards the mucosa), and retainers (Components that prevent displacement).

Removable partial dentures-design

Survey to establish path of insertion, which undercuts for retention, for smooth processing.
Assess retention via direct or indirect ways, via clasps, guide planes, soft tissue undercuts or precision attachments.
Assess bracing with the maximum extension of the saddle and connector design and its adaptation.

Removable partial dentures--clinical stages

Record initial impressions using alginate or other material in a stock tray. Record occlusion, considering occlusal stop. Record second impressions using special trays. (Alginate or elastomer). Prepare and check the trial/waxed denture.

Immediate complete dentures

Consider if patient requires transition from partly-to-fully-edentulous. Assess whether immediate dentures or partial dentures can successfully adapted. Immediate dentures provide an advantage in copying existing teeth and their shape, allowing more rapid adaptation.
Consider whether patient will require early replacement.
Extraction of the majority of posterior teeth to maintain OVD/occlusion, and subsequently fitting of immediate dentures once healed. Directly following tooth extraction, it may be easier to use immediate dentures, while gradual extraction and adaptation may be more suitable where a significant period of healing is needed.
A clinical procedure requires taking preliminary and second impressions (using alginate or silicone), recording occlusion (using a method appropriate to the patient's condition, e.g., existing teeth), and trial insertion of the dentures.

Complete dentures--principles

The focus is on retention and stability. Retention concerns the resistance to displacement. Stability relates to resisting displacing forces during function. Important considerations for retention include peripheral seal, fit, contact area, and saliva viscosity/volume. Important considerations for stability include forces acting on the polished and occlusal surfaces.

Complete dentures--impressions

Use both stock trays and alginate or elastomer (or impression compound) for preliminary impressions, and ensure appropriate special trays are prepared to ensure enough space for the material.
Record master impressions to capture the maximum denture-bearing area and create a stable border seal.

Complete dentures--trial insertion

Trial dentures are wax-constructed on acrylic or shellac bases.
The dentist checks the trial dentures (via individually testing both the dentures and their fit, and finally, testing them both together checking for extension, stability and position).
Final check of the trial dentures, including vertical and occlusal dimensions should be done.

Denture maintenance

Regular check-ups/reviews to assess/manage ill-fitting dentures are necessary for long-term maintenance of effective dentures.
Rebasing of dentures can be performed if the existing fitting surface is worn-down.
Cleaning/hygiene maintenance is crucial for preventing plaque build-up, stains, and calculus to prevent illness and ensure a pleasant experience for the patient. Important to emphasize the need for thorough cleaning with soap and water, and to recommend using appropriate denture cleaners.

Denture problems and complaints

Pain from a flaw in the fitting surface to the occlusion to problems with existing teeth,
Loose dentures can be caused by errors in fitting surfaces, incorrect occlusion or lack of structural support, which can lead to an unstable occlusal condition,
Burning mouth can be caused by errors in the OVD, or related to the dentures,
Evaluation of speech difficulties caused by excessive extension or inaccurate position of teeth.

Candida and dentures

Oral candidiasis (Candida infection) is common in denture wearers and can be caused by factors like poor denture hygiene, night-time denture use, and systemic factors.
Initial evaluation requires a dental and medical history review to understand factors/conditions that may exacerbate oral candida.
Appropriate management includes advising the patient to remove their dentures at night, maintain thorough fitting surface cleaning of their dentures, and suggest reducing sugar intake.

Denture copying

Denture copying methods involve creating a replica of a patient's existing denture(s) to be used as a guideline to create new dentures.

Overdentures

Overdentures (ODs) can improve retention, stability, support, and aid transition from partial to full dentures (F/F).
Advantages include preservation of bone and tooth structure, and some degree of preserving proprioception.
Involves selecting specific abutment teeth, considering need for root canal treatment (RCT).
Clinical procedure (for abutment teeth prep consideration) involves root canal treatment if impacted, and fitting and recording of the impressions.

Dentistry and the older patient

Age changes impact oral health (e.g., bone, mucosa, teeth),
Challenges include age-related physical and systemic changes, medication impacts, and access to care.
Modifications may be required for denture maintenance that take these changes into account.

Age changes

Age changes in oral soft tissues, dental hard tissues, dental pulp, periodontium, and systemic immune system are common.
Changes are related to ↓ microcirculation, ↓ cellular reproduction, ↓ tissue repair, ↓ metabolic rate, and ↑ fibrosis.
These factors all contribute to oral/medical issues for the elderly.

Dental care for the elderly

Management of older patients requires careful consideration of medical history and communication.
Access and timing of appointment options must be considered.
Modifications to the dental chair are necessary to ensure appropriate positioning and support, considering physical/health conditions and mobility.

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Description

Test your knowledge on dental prosthetics, including denture design, bridge failure, and impression techniques. This quiz covers important concepts related to complete dentures and dental bridges, their fabrication, and common challenges in dental practice.