Removable Prosthodontics 1

Removable Prosthodontics 1

• Anatomy of edentulous maxilla: The anatomical structures of the upper jaw without teeth.
• Principles of removable complete dentures:
  • Retention: The denture's ability to resist forces displacing it opposite to the path of insertion. Crucial for preventing dislodgment.
  • Support: The denture's ability to withstand tissue-ward (inward) movement.
  • Stability: The denture's ability to resist dislodgement forces that are not parallel to the insertion axis. Important for lateral stability.
• Denture contact mucosa: The contact between the denture and the tissues of the mouth demonstrates a spectrum of compressibility/movement across arches and patients.
• Short-term and long-term health: The adaptation and methods of the denture base to the tissue has a big impact on the health of the mucosa.
• Maximum denture base extension: Increasing the surface area of the base spreads the pressure from mastication and swallowing, over a larger area.
• Intaglio surfaces of dentures: Composed of stress-bearing and peripheral areas.
• Supporting structures (Denture bearing area/Denture Foundation): Made up of bone and soft tissue, including mucosa, which acts as a cushion for the denture base, thus contributing to healthy tissues.
• Maxillary and mandibular stress-bearing areas:
  • Maxillary:
    • Primary stress-bearing areas (firm tuberosities, hard palate).
    • Secondary stress-bearing areas (alveolar ridge, rugae area).
  • Mandible:
    • Primary stress-bearing areas (buccal shelves, retromolar pads).
    • Secondary stress-bearing area (alveolar ridge).
• Mucosa:
  • Stratified squamous epithelial cells: Forming the outer layer of mucosa.
  • Lamina propria: Connective tissue layer underneath the epithelium.
  • Submucosa: Layer of connective tissue varying in density from dense to loose areolar tissue, affecting tissue thickness and resiliency. Valuable in managing complete dentures.
• Residual ridge mucosa: Keratinized mucosa is the remaining gingival tissue, having good stress-bearing ability. Gingival tissue needs to be considered/maintained at extraction sites.
• Bone resorption and mucosa: Greater bone resorption results in more compressible and displaceable mucosa. Healthier tissue generally has greater resiliency.
• Concept of relief: Reducing the surface area of the denture to relieve pressure and create space between the denture and the soft tissues..
• Areas requiring relief in impression: Stress bearing areas, tori, palatal raphe, retro-mylohyoid ridge, and bony prominences.
• Residual ridge: Varying in size and shape, crucial to consider in denture design during and after teeth extraction. This involves the changes in alveolar ridge height and width following tooth extraction. The ridge's shape can influence denture lateral stability and peripheral seal.
• Maxillary and Mandibular resorption: These areas will affect the design of the denture's base. The maxillary ridge is often proclined (leaning forward), affecting denture base size.
• Hard palate:
  • Palatine processes of the maxilla and the palatine bone form the hard palate.
  • Provides foundation and considerable surface area, covered by a keratinized epithelium. Important for the support and stability of the denture.
• Rugae area: Mucosal ridges in the anterior third of the palate important for speech and suction functions. Secondary support area.
• Incisive papilla: Location near the central incisors, it provides indication of bone resorption and needs relief to avoid pressure on the nasopalatine vasculature.
• Tuberosities: Dense fibrous tissue, serving as primary support when opposing teeth are absent.
• Torus palatinus: Hard bony enlargement in the midline, potentially needing reshaping for optimal denture fit and palatal seal.
• Peripheral border tissue (Limiting structures):
  • Labial vestibule: Area between the buccal frenum and the labial side of the ridge.
  • Labial frenum: Fan-shaped structure attaching to the lip.
  • Buccal frenum: Dividing line between labial and buccal vestibules.
  • Buccal vestibule: Opposing the tuberosity.
  • Hamular notch: Forming the distal limit of the buccal vestibule.
• Vibrating line: Marks the junction between the movable and non-movable soft parts of the palate. Important for denture peripheral seal and retention.
• Fovea palatinae: Two small depressions on the posterior aspect of the soft palate. Usually located behind the vibrating line.

Overall Recommendation

• Maximizing success in complete denture treatment often requires a firm understanding of anatomical landmarks and their function. The success in treatment is greatly influenced by complete understanding of the anatomical structures and their implications in treatment planning.

This quiz covers essential concepts in removable prosthodontics, focusing on the anatomy of the edentulous maxilla, principles of complete dentures, and the critical aspects of denture retention, support, and stability. Additionally, it addresses the relationship between denture bases and mucosal health, alongside maximum base extension techniques.