Removable Prosthodontics Overview

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Questions and Answers

What condition can result from excessive freeway space or inadequate occlusal vertical dimension (OVD)?

  • Dry mouth syndrome
  • Temporomandibular disorder
  • Angular cheilitis (correct)
  • Chronic migraines

Which factor does NOT influence the position of the occlusal plane?

  • The patient's shoe size (correct)
  • The patient's age
  • The length of the upper lip
  • How much tooth the patient is used to showing

What is the primary concern when modifying the upper wax rim for lip support?

  • Scientific measurement accuracy
  • Aesthetic appearance (correct)
  • Cost-effectiveness
  • Durability of materials

What may be a consequence of having ineffective chewing due to poor OVD?

<p>Difficulty with speech (B)</p> Signup and view all the answers

How is the height of the upper block established during jaw registration?

<p>By trimming on a heated registration block trimmer (C)</p> Signup and view all the answers

What subjective method is used to gain patient approval for lip support modifications?

<p>Using a face mirror (A)</p> Signup and view all the answers

What may indicate masticatory difficulties other than discomfort?

<p>Ineffective chewing (C)</p> Signup and view all the answers

What is a common consequence of angular folds at the corners of the mouth?

<p>Encouraged pooling of saliva (B)</p> Signup and view all the answers

What is the primary pathogen associated with DRS?

<p>Candida albicans (C)</p> Signup and view all the answers

Which of the following is NOT a factor related to the prosthesis in DRS?

<p>Systemic infections (C)</p> Signup and view all the answers

What is the standard material used for maxillary edentulous impressions?

<p>Alginate (C)</p> Signup and view all the answers

What type of trays should be used for making first impressions?

<p>Metal or rigid plastic trays (A)</p> Signup and view all the answers

Which treatment approach is appropriate when DRS is associated with significant infection?

<p>Prescription of antifungal therapy (D)</p> Signup and view all the answers

What should be done if DRS fails to resolve after initial treatment?

<p>Refer for an Oral Medicine opinion (C)</p> Signup and view all the answers

Which of these materials is suitable for modifying stock trays?

<p>Modelling wax or silicone putty (A)</p> Signup and view all the answers

What is a common symptom that may occur alongside DRS?

<p>Angular cheilitis (D)</p> Signup and view all the answers

What should be marked on the impression if the resultant impression is overextended?

<p>The sulcus extent (C)</p> Signup and view all the answers

What type of impression material is commonly used for maxillary second impressions?

<p>Alginate (D)</p> Signup and view all the answers

What spacing should be prescribed for a special tray when using synthetic elastomer?

<p>1.5 - 2 mm (C)</p> Signup and view all the answers

Which of the following modifications can be made to areas of significant under-extension in a special tray?

<p>Add softened ‘greenstick’ or iso-functional wax (B)</p> Signup and view all the answers

What is a key component of the design for the upper special tray used with alginate?

<p>A cranked handle and tissue stops (D)</p> Signup and view all the answers

What should be included in the mandibular impression for adequate coverage?

<p>The labial, buccal, and lingual sulci (B)</p> Signup and view all the answers

How can areas of tray overextension be reduced?

<p>By grinding with an acrylic trimmer (A)</p> Signup and view all the answers

What is the ideal under-extension adjustment for lower tray peripheries?

<p>1 mm (A)</p> Signup and view all the answers

What must be completed before performing a ‘wash’ impression?

<p>Periphery modifications and removal of undercuts (C)</p> Signup and view all the answers

What is the purpose of adding modelling wax to the occlusal surface of the lower wax rim?

<p>To record desired occlusal vertical dimension (OVD) (C)</p> Signup and view all the answers

In the absence of a registration, what will the laboratory do with wash impressions in wax trial dentures?

<p>Cast the impressions and finish the dentures (A)</p> Signup and view all the answers

What is a primary function of removable partial dentures (RPDs)?

<p>Restoring function, appearance, and maintaining oral health (D)</p> Signup and view all the answers

When would partial dentures not be necessary?

<p>To fulfill a philosophy of replacing every missing tooth (C)</p> Signup and view all the answers

How should partial dentures be designed concerning oral tissues?

<p>To avoid compromising health of the oral tissues (C)</p> Signup and view all the answers

What is the clinical stage that follows a wax trial with a successful registration?

<p>Fitting finished dentures (D)</p> Signup and view all the answers

Which of the following is NOT a purpose of removable partial dentures?

<p>To completely replace all natural teeth (B)</p> Signup and view all the answers

What is a crucial feature to incorporate into crowns or cast restorations for partial dentures?

<p>Adequate undercuts for clasps (C)</p> Signup and view all the answers

Which step should be completed before constructing a partial denture?

<p>All forms of periodontal treatment (A)</p> Signup and view all the answers

What type of tray is preferred for making impressions in partially dentate patients?

<p>Metal or rigid disposable polycarbonate trays (A)</p> Signup and view all the answers

Why is silicone putty used in the first stage of impression taking?

<p>To support the alginate and ensure proper extension (D)</p> Signup and view all the answers

In what scenario would the two-stage technique for impressions be necessary?

<p>When extensive edentulous saddles are present (A)</p> Signup and view all the answers

What should be done with alginate during the second stage of the impression?

<p>It should cover the previously placed silicone putty (C)</p> Signup and view all the answers

What is NOT a recommended action before prosthodontic treatment?

<p>Performing cosmetic whitening treatments (A)</p> Signup and view all the answers

Which impression material is accompanied by silicone putty when extensive resorption is present?

<p>Alginate (D)</p> Signup and view all the answers

What is a significant disadvantage of immediate dentures post-extraction?

<p>Rapid changes occur in the mouth, requiring adjustments. (C)</p> Signup and view all the answers

How can the fit of an immediate denture be improved after tooth extraction?

<p>By providing periodontal pocket depth information. (A)</p> Signup and view all the answers

What should patients be informed about prior to receiving immediate dentures?

<p>The treatment plan and potential adjustments needed. (D)</p> Signup and view all the answers

What occurs at the post-extraction sites that can affect denture fit?

<p>They may change shape and size significantly. (C)</p> Signup and view all the answers

What is necessary for effective treatment planning when providing immediate dentures?

<p>Liaising with Oral Surgery and understanding patient risks/benefits. (B)</p> Signup and view all the answers

What is a key aspect of professionalism in managing patients requiring immediate dentures?

<p>Clearly documenting extraction patterns in clinical notes. (C)</p> Signup and view all the answers

What is the likely timeframe for definitive relining or replacement of immediate dentures post-extraction?

<p>Approximately 6 months to 1 year. (A)</p> Signup and view all the answers

Why is it important to provide the technician with information on periodontal pocket depths?

<p>To estimate potential tissue changes post-extraction. (A)</p> Signup and view all the answers

Flashcards

Denture Stomatitis (DRS)

A condition that affects the hard palate, often associated with dentures, and is usually caused by Candida albicans.

Factors related to prosthesis

Factors that contribute to Denture Stomatitis, including poor denture fit, reduced vertical space for the jaw, denture age, continuous wear, and lack of hygiene.

Infective causes of Denture Stomatitis

Infections, mainly caused by Candida albicans, that arise between the denture and the underlying oral mucosa.

Treatment of Denture Stomatitis

Adjusting dentures, advising patients to avoid continuous denture wear, and promoting denture and oral hygiene.

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Primary Impression

The first impression taken of the edentulous mouth, aiming to capture the shape and contours without excessive tissue distortion.

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Materials for Tray Modification

Materials used to extend or modify stock trays, allowing for a better fit during primary impressions.

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Alginate for Maxillary Impression

The standard material for maxillary edentulous impressions, offering a balance of accuracy and convenience.

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Silicone Putty for Mandibular Impression

The preferred material for mandibular edentulous impressions, providing greater detail and stability.

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Special Tray

A special tray that is designed to capture a precise impression of the dental arch for denture fabrication.

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Second Impressions

The process of taking a second impression of the dental arch, using a special tray, to ensure an accurate representation of the denture bearing area.

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Visible Light Cured (VLC) Acrylic

The material used for special trays. It is a lightweight and durable material that can be easily molded.

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Alginate

A type of impression material commonly used for second impressions. It is a fast-setting material that is easy to use.

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Synthetic Elastomer

A type of impression material commonly used for second impressions. It is a flexible and accurate material.

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Denture Bearing Area

The area of the dental arch that supports the denture.

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Tray Spacing

The distance between the tray and the teeth, which is adjusted based on the impression material used.

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Tray Handle

The part of the tray that is designed to be held by the patient during the impression procedure.

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Freeway space

The space between the upper and lower lips when the mouth is closed.

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Angular Cheilitis

A condition characterized by cracks or sores at the corners of the mouth.

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Vertical Dimension (VD)

The vertical distance between the upper and lower teeth when the mouth is closed.

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Vertical Dimension of Occlusion (VDO)

The vertical distance between the upper and lower teeth when the mouth is closed and at rest.

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Vertical Dimension of Rest (VDR)

The vertical distance between the upper and lower teeth when the mouth is closed and the teeth are not touching.

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Jaw Registration

The process of establishing the correct vertical dimension for a denture.

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Lip Support

The adjustment of the upper wax rim to create the desired lip support for the denture.

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Occlusal Plane

The position of the occlusal plane, which is determined by the incisal edges of the upper anterior teeth and the upper lip.

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Wash Impression

Taking an impression after any necessary adjustments to the baseplate have been made and any significant undercuts have been removed.

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Wax Trial Dentures

A type of denture made from modeling wax with self-cure acrylic bases, used in the registration stage of denture construction. They act like adjusted registration rims.

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Registration

The process of determining the jaw relationship and transferring this information to an articulator for denture construction.

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Articulator

A device that simulates the movement of the jaw and allows teeth to be arranged in a functional relationship.

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Removable Partial Dentures (RPDs)

Partial dentures, designed to replace missing teeth, are intended to restore function and appearance, aid in chewing, improve speech, and help maintain oral health.

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RPD Design

Partial dentures should be designed to avoid harming the oral tissues and should only be made when necessary, not just to fill empty spaces.

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Cosmetic Appeal

The ability of a denture to be aesthetically pleasing.

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Mastication

The ability of a denture to help with chewing.

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Estimating post-extraction morphology

The process of creating an immediate denture by carving the master cast to anticipate the shape of the tissues after tooth extraction.

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Periodontal pocket depth

The depth of the gum pocket around a tooth, used to estimate the amount of tissue change after extraction.

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Immediate dentures

Dentures made immediately after tooth extraction, requiring adjustments and relining over time.

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Relining immediate dentures

Relining an immediate denture to adjust for tissue changes after extraction.

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Tissue changes after extraction

The rapid changes in the mouth after tooth extraction, impacting the fit of immediate dentures.

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Financial costs of immediate dentures

Financial implications associated with the adjustments and relining of immediate dentures over time.

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Collaborative planning for immediate dentures

The need for meticulous planning and accurate communication between dental teams when providing immediate dentures.

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Patient education on immediate dentures

Patients should be fully informed about the risks, benefits, and potential adjustments involved in immediate dentures.

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Two-Stage Impression Technique

A two-stage impression technique used to capture the full extent of the edentulous area and surrounding structures.

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Silicone Putty

A material used in the two-stage impression, provides support for alginate, and captures the edentulous area.

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Guide Planes

These guide the placement of the dentures and serve as a reference point for positioning.

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Rest Seat

A feature on the denture that rests on the tooth and provides stability and support.

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Study Notes

Removable Prosthodontics

  • Removable prosthodontics is a team approach involving clinicians, technicians, and patients.
  • Clinicians are responsible for the final prosthesis design.
  • Technicians are involved with the practical aspects of design and follow prescriptions precisely.
  • Technicians may benefit from observing patients in the surgery to understand potential problems.
  • Patients need to understand denture limitations and prepare for wearing them.
  • This guide follows the current standard guidelines from the British Society of Prosthodontics (BSSPD.org).

Complete Denture Provision

  • Complete dentures aim to restore normal speech, occlusal and facial support, and masticatory function.
  • A pleasing appearance and comfort is desired, not compromising supporting tissues.
  • Preparation of the mouth including treatment planning is crucial.
  • A thorough examination, including medical and dental history, must occur.
  • Denture-wearing history to assess patient's ability to adapt is vital.
  • The clinician should assess denture-bearing areas, including alveolar undercuts, ridge height and width, sulcus depth; and evaluate existing dentures for extension, retention, stability, position, and aesthetics.
  • Freeway space (FWS) estimations are crucial as many denture problems involve an incorrect occlusal vertical dimension (OVD).
  • Radiographs are only used when clinically indicated (e.g, for suspected retained roots).
  • Treatment plans should thoroughly detail potential problems (e.g., poorly extended peripheries, poorly designed dentures, or inadequate FWS).
  • Addressing potential treatment needs such as inflammation (denture-related stomatitis) prior to impressions is crucial.

Removable Partial Denture (RPD) Provision

  • RPDs aim to restore function and appearance, including mastication, speech, and maintaining oral health.
  • These are not a universal solution and should not be used for every missing tooth.
  • RPDs must consider supporting tissues, retention, and stability when designed.
  • Careful treatment planning and patient communication are emphasized.
  • Evaluation of existing dentures, natural teeth, and the oral mucosa is important.
  • Radiographic analysis may be required.
  • Individual cases should be thoughtfully addressed, as there's considerable variation.

Clinical Stages and Procedures

  • Clinical steps for both complete and partial dentures are described sequentially.
  • Initial stages involve taking impressions, registering jaw relationships and selecting artificial teeth.
  • Important aspects include determining occlusal vertical dimension (OVD), adjusting dentures for freeway space, correct positioning of posterior teeth.
  • Further stages include trying in and finishing the dentures, highlighting assessment and addressing problems such as sharp edges, surface blemishes, or defects.
  • Occlusion, articulation, and the patient’s experiences must be evaluated.
  • Subsequent stages follow the same principles as conventional dentures (e.g., fitting and finishing dentures).

Laboratory Procedures

  • Laboratory procedures depend on the type of dentures and clinical findings.
  • Specific procedures are outlined in detail in the different appendices depending on different types of dentures.
  • The preparation for sending study casts and different materials used is explained. These procedures are specifically outlined for immediate, complete, copy, and partial dentures.

Clinical and Laboratory Sequences

  • Diagrams and step-by-step sequences are provided for complete, immediate, copy and partial dentures in different appendices.
  • These are presented as flowcharts in appendices 1-4.
  • These sequences detail the various stages across both clinical and laboratory settings.

Additional Considerations

  • Immediate dentures address social concerns, but require careful procedures to account for changes in oral tissues after extraction.
  • Reline procedures are for improving denture fit, and different materials (e.g., temporary chairside relining materials) exist.
  • A follow-up appointment is important to check for discomfort and adjust dentures as necessary.
  • Appropriate treatment planning is vital due to the variations between each patient case and should not be made merely to fulfill a philosophy of replacing every single missing tooth.

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