Complete Dentures PDF

COMPLETE DENTURES. 1ST ID the patient per Appt school protocol CD Vitals patient  COMPLETE DENTURES Personal data:-. Name (must for ) – Identification Building rapport Gaining confidence of patient...

COMPLETE DENTURES. 1ST ID the patient per Appt school protocol CD Vitals patient  COMPLETE DENTURES Personal data:-. Name (must for ) – Identification Building rapport Gaining confidence of patient For data record keeping Age could indicates ability to wear dentures successfully from prosthodontic point of view.  COMPLETE DENTURES. In 4th decade we see :- Rapid healing of tissues. More resilient tissues. Ease in patient adaptation to denture. Patients are more esthetically concerned.  COMPLETE DENTURES In 5th decade onwards:-. No rapid healing. Tissue not much resilient. Menopausal hormonal changes make women patients more exacting or hysterical type for esthetics. Longer learning period because of muscle insufficiency.  COMPLETE DENTURES Sex. Women have high priority for esthetics. Young men though have high priority for looks, older men grow indifferent for the looks. However men shift their concern more towards comforts & function. Osteoporosis is more seen in women above 50 years of age. This may lead to more bone resorption & less support for the denture.  COMPLETE DENTURES  Occupation: It influences the degree of importance of factors like. esthetics, phonetics & general appearance. Job & social standing determines the value patient gives on his/her dental health/esthetics. Professionals having direct people contact prefer appearance/retention more often then efficiency. Public speaker / singer need perfect retention as well as proper palatal shape/base thickness for phonetics. Wind instrument player need special modification for instrumental playing  COMPLETE DENTURES  Cosmetic Index It is basically about esthetics expectations.. Class 1 – (High Cosmetic Index)- they are often exacting but usually appreciate & co-operative Class 2 –(Moderate Cosmetic Index)-they are the patient with nominal expectations. Class 3 – (Low Cosmetic Index)-patient are indifferent, un-cooperative & place little value on the effort of Dental Providers.  COMPLETE DENTURES  Personality:. It consists of mental health, patient attitude towards new denture, patients adaptive response. Analyzing personality gives opportunity to dentist to peep inside his brain. mental attitude may be classified According to Dr. MILUS Patients MARYLSON HOUSE (1960).  COMPLETE DENTURES.  Philosophic: Willing to accept the dentist’s judgement without question. Best mental attitude for denture acceptance. Motivation is generalized. Ideal attitude for successful treatment, provided the biomechanical factors are favorable.  COMPLETE DENTURES  Exacting: All good attributes of philosophic patient.. Require extreme care, effort and patience on the part of the dentist. Immaculate appearance and dress. Methodical, precise and accurate and at times make severe demands. Likes each step of the procedure to be explained. If intelligent and understanding  they are the best or else extra hours must be spent, prior to treatment, in patient education until an understanding is reached.  COMPLETE DENTURES Hysterical: Submit to treatment as a last resort, have negative. attitude, often poor health, unfounded complaints. Emotionally unstable, excitable, apprehensive and hypertensive. Unrealistic expectations.(demand equals to natural teeth) Prognosis is often unfavorable. Additional professional help (psychiatric) is required prior to and during treatment.  COMPLETE DENTURES  Indifferent: Questionable or unfavorable prognosis.. Little concern for their teeth or oral health. Without dentures or worn out dentures for years. Seek treatment because of the insistence of family. Pay no attention to instructions, are uncooperative & give up easily if problems are encountered with their new teeth. Do not value the efforts or skills of the dentist. Require more time for instruction on value and use of their dentures.  New M.M. HOUSE Classification 29 MM HOUSE MENTAL CLASSIFICATION REVISITED : INTERSECTION OF PARTICULAR PATIENT 13 TYPES & PARTICULAR DENTIST’S NEEDS(J Prosthet Dent 2003;89:297-302.) SIMON GAMER,TUCH,GARCIA  COMPLETE DENTURES A complete health history should include:. Name of the physician, including data & reason for last appointment. A record of status of all major systems of body. A record of all medications the patient is currently taking. A record of any hospitalization. A record of any complication that was result of previous dental treatment. A record of patient opinion of his/her general health. Space to update health history whenever patient is recalled  COMPLETE DENTURES Many systemic diseases might or might not have oral manifestation but some have a direct relation to denture. success these are:- Debilitating disease Debilitating diseases includes diseases like diabetes , tuberculosis , blood dyscrasias etc. These patients require extra instructions in oral hygiene, eating habits & tissue rest.  COMPLETE DENTURES  DIABETES An uncontrolled or poorly controlled diabetics may pose problem of: Bacterial viral & fungal infections including candidiasis.. Xerostomia: it causes dry atrophic oral mucosa accompanied by mucositis, ulcers, desquamation & opportunistic infection. Inflamed, depapillated painful tongue. Difficulty in lubricating, masticating & swallowing are the complications that make denture wearing an unsatisfactory experience. Poor wound healing / multiple abscess Burning mouth syndrome  COMPLETE DENTURES Hypoglycemia: Most common dental complication seen.in patients taking insulin. Dizziness Shakiness / tremors Confusion Agitation / anxiety Sweating Tachycardia Unconsciouness Seizures  COMPLETE DENTURES. Treatment: Prevention-instruct the patient to take regular diet & then insulin. Schedule the appointment in morning. Keep treatment visit short.  COMPLETE DENTURES. Tuberculosis:- Immunity is low Clinician should find whether disease is active/passive Precaution in sterilization/protective gear should be worn.  COMPLETE DENTURES Blood Dyscrasias:- Anemia- most commonly found. Results in mucosal ulceration / infection Tongue becomes atrophic, inflamed & sore Other blood dyscrasias are like leukemia, neutropenia which may affect denture success. In all cases care should be taken not to bruise oral mucosa while extending or recording border tissues  COMPLETE DENTURES Cardiovascular disease: Consultation with cardiac physician is a must.. If CVD is present, denture procedure of any type may be contraindicated. Short appointment with pre-medication if necessary. Determine if prophylactic antibiotic coverage for surgical dental procedure is indicated. Prosthetic cardiac valves/material Unrepaired, repaired with residual defects or less than 6 months from surgery History of previous IE Cardiac Transplant with valvulopathy  COMPLETE DENTURES Other Precautions In Case Of CVD. Reduce stress or anxiety. Make patient free to express. Keep short appointments & in morning. Premedication with diazepam 5-10 mg to decrease apprehension. (Texas requires training) In case of angina pain Tab. nitroglycerine sublingually (BSL, ACLS)  COMPLETE DENTURES Osteoarthritis: Occurs under 45 yrs. of age, men are twice more susceptible then. women. 45-65 yrs. women affected more. >65 yrs. both affected equally. Normally affects weight bearing joints & secondarily TMJ. Prosthodontic considerations If terminal finger joints become arthritic, it is difficult to clean or insert dentures.  COMPLETE DENTURES Osteoarthritic TMJ presents problems in CD construction as mandibular movements are painful & jaw relation records are difficult to record & repeat.. Occlusion correction must be made often because of subsequent change in joint. Special impression trays are necessary due to limited access from reduced mouth opening. In extreme cases surgery may be required.  COMPLETE DENTURES Disease of Skin. Dermatological conditions like pemphigus, erosive oral lichen planus may make oral mucosa extremely painful. The constant use of denture is contraindicated  COMPLETE DENTURES Neurological disorders. Bell’s Palsy & Parkinson’s Disease Patient may be given normal prosthetic treatment but denture retention, Maxillo-mandibular relation record & supporting musculature pose denture problems  COMPLETE DENTURES Radiations. Patients treated with radiations may develop: Mucositis Trismus Xerostomia Secondary infection ( candidiasis ) Loss of taste Osteoradionecrosis  COMPLETE DENTURES Before radiation treatment is started:-. Infection should be treated Extraction of all remaining teeth should be done if CD is planned Pre-prosthetic surgeries should be performed Accurate casts are made before surgery/radiation that later aid in treatment. Denture bearing area should be carefully watched for Osteoradionecrosis. Denture should be used on limited basis.  COMPLETE DENTURES Hormonal Disturbances. Acromegaly- increase in growth hormone. Patient need frequent adjustment and/or new denture. Hyperthyroidism-decrease salivary flow. Mucosal Inflammation. Thyrotoxic crisis may get precipitated by stress/trauma during prosthodontic treatment. Osteoporosis also might get developed.  COMPLETE DENTURES Hypothyroidism-may develop to hypothyroid coma under stress Increase tongue size & gingival edema leads to poor denture design & stability.. Hyperparathyroidism- increased alveolar resorption. Allergies. Allergy to any drug or denture material is noted. Avoid all allergic factors. In case of emergency- 0.3-0.5 ml of epinephrine 1:1000 IM should be given  COMPLETE DENTURES. Asthma /COPD/ Pneumonia. Consult physician. Short morning appointments. Keep inhaler in handy. Avoid NSAID( IBUPROFEN)  COMPLETE DENTURES Drug History. Dentist should know all the medicines patient takes because: It indicates systemic diseases the patient is suffering from & this could alter dental treatment. Compatibility of dentist’s prescribed medicines & physician should be there. Conditions which affect the prosthodontic treatment & the drugs causing them.  COMPLETE DENTURES Dental History Chief complaint:. The dentist should meet the mind of the patient before he meets mouth of the patient This helps in determining the factor for which the patient is seeking treatment If not asked, chief complaint may be overlooked by dentist which should not happen Dentist can access whether the expectation is realistic or attainable.  COMPLETE DENTURES Expectations: Patients expectations must be determined, then it should be evaluated whether it is realistic or attainable.. Dentist must be able to classify patients personality & accordingly should not make unrealistic promises. Years of Edentulousness: It provides information regarding bone resorption pattern & progression as well as timing of tooth loss. Patient should be questioned for reason of tooth loss.  COMPLETE DENTURES Detailed information should be obtained & this should contain:- Cause of tooth loss.. History of difficult extraction. Order of tooth loss. Length of edentulous time- gives idea of resorption. History of healing-sufficient / incomplete.  COMPLETE DENTURES Denture experience/history:. Information to be recorded are: No. of dentures the patient has used. Length of time each has been used & reason for replacement. Denture adhesive / suction cup if used. Type of material used. Degree of satisfaction with Mastication, Retention, Stability, Esthetics, Comfort, VD, & Phonetics  COMPLETE DENTURES Existing Or Current Dentures Length of time patient is wearing. Satisfaction.. Point on denture care ability should be noted. Problems associated with current denture, its nature, type, & whether it can be corrected. Distribution of tissue contact can be revealed by pressure indicating paste. Occlusion in harmony with jaw relation should be evaluated. Esthetics whether acceptable & whether should be altered or duplicated in new denture should be determined keeping in mind its possibility/ patient’s desires.  COMPLETE DENTURES Pre-extraction records Pre extraction photographs.. Radiographs. Casts/Scan & Facial close up is always helpful in denture therapy for recreation of esthetics & support as well as evaluation of VD. Cast/Scan is most valuable among all because of its 3-D information. Pre extraction records can be used to reproduce the anterior esthetics. They can also be used to guide jaw relation.  COMPLETE DENTURES. CLINICAL EXAMINATION  COMPLETE DENTURES Extra-oral Examination. Head & neck region should be examined in general. Nodules, nevi, ulcerations if any should be noted.  COMPLETE DENTURES FACIAL EXAMINATION Facial form:-. Leon Williams classified facial form into 4 types:- Square Tapering Square tapering Ovoid  COMPLETE DENTURES To determine the type, clinicians imagine two lines, one on either side of the face, running about 2.5 cm in front of the tragus of the ear & through the angle of the jaw.. If these lines are almost parallel:- SQUARE If they converge towards the chin:-TAPERING If they diverge at the chin:- OVOID  COMPLETE DENTURES Ideally face can be divided in thirds (Greek. Concepts)  COMPLETE DENTURES Facial profile According to angle. Class 1- Normal Class 2- Retrognathic Class 3- Prognathic Consider line joining forehead and edge of the upper lip and upper lip to chin.  COMPLETE DENTURES According to profitt:- Line joining the forehead, bridge of nose, & border of upper lip.. Line joining upper lip to chin (soft tissue pogonion ). 3 points are choosen: Glabela, Subnasion & Pogonion When joined, if these 2 lines are :- Straight- class 1 Convex- class 2 Concave- class 3  COMPLETE DENTURES Muscle Tone House Classification- Class 1 – patient exhibits normal tension, tone,. & placement of muscles of mastication & facial expression. No degenerative changes. Normally seen in immediate denture patient only. Class 2-patient displays approximately normal function but slightly impaired tone. Seen in recently edentulous patient Class 3- greatly impaired muscle tone & function. This is associated with poor health, inefficient dentures, loss of VD, wrinkles, decreased biting force & drooping commissure.  COMPLETE DENTURES Muscle development According to house classification. Class 1 – Heavy Class 2 – Medium or normal Class 3 – Light Complexion With age, skin becomes thinner and melanin pigmentation accumulates in skin and hair leading to darker in shade with age. (Heartwell)  COMPLETE DENTURES Hair, eye and skin color provide useful guides in shade selection.. Yellow is dominant with fair hair ,blue eyes and fresh complexion Grey tinged with blue is dominant with dark hair brown eyes and dark complexion Opal is dominant with clear, pale complexion irrespective of color of hair and eyes.  COMPLETE DENTURES Smile architecture Type 1(based on lip component). Straight smile The lower margin of upper lip is straight horizontally Smile space is seen as having a hemisphere like outline and having a straight upper border and usually concave lower border  COMPLETE DENTURES Concave smile. Lower margin of upper lip is concave horizontally with concavity upward. Smile space is seen as having a crescent shape outline and concave upper border and usually concave lower border.  COMPLETE DENTURES Convex smile. Lower margin of upper lip has to be convex horizontally. Smile space is seen as having a convex upper border and concave lower border.  COMPLETE DENTURES Type 2 (tooth and soft tissue component). Tooth smile Papilla smile  COMPLETE DENTURES Gingival smile. Mucosal smile  COMPLETE DENTURES Lip Lip should be examined for cracking fissure and ulceration because these changes are seen in vitamin B complex. deficiency, infection such as herpes labialis candida , or neoplasia. Lip should then be examined for lip support, fullness, thickness and length.  COMPLETE DENTURES Lip support: Lack of proper lip support can. lead to a collapsed appearance and wrinkling. How to find out lip support? If only tissues around mouth is wrinkled and rest of the face is normal then lack of support is suspected.  COMPLETE DENTURES If this lacking is due to too palatal positioning of anterior teeth it can be confirmed by adding wax. However too far anteriorly placed teeth to support the lip may cause leverage on maxillary denture causing loss of stability.  COMPLETE DENTURES Another way is by assessing nasolabial angle.. If nasolabial angle is increased after wearing denture --means drooping of lip and loss of lip support occurs.  COMPLETE DENTURES Lip fullness It is related to the support lip gets from. mucosa or teeth or denture base. Denture with thick labial flange may make the lip appear too full. An obliterated philtrum or mentolabial fold suggests excessive support. COMPLETE DENTURES Lip thickness It is because of intrinsic structure of lip itself.. Two types of lip thickness 1. Thin lip 2. Thick lip In Thin lip type any change in labiolingual position of teeth can alter fullness/support or drape of thin lip.  COMPLETE DENTURES Lip length Classified as Long. Normal Short  COMPLETE DENTURES Length of the lip will affect how much the teeth will be exposed during rest and function. Short lip More exposure of the teeth or sometimes denture base also. Seen in incompetent lip Long lips hide denture base and most of the teeth  COMPLETE DENTURES How to check lip length?. Vertical lip relation: In lower facial height, length of upper lip is equal to one third. Length of lower lip plus chin should be two third.  COMPLETE DENTURES Horizontal lip relation (lip step) It is A-P relationship of upper to lower lip. Can be classified as Normal-lip step is slightly negative Positive -lip step positive (seen in class III case) Marked negative - seen in class II cases  COMPLETE DENTURES Nasolabial angle Normal is 110 degree (>90 degree) It is measured line joining subnasale and.anterior most point of collumella and subnasale and upper lip border. In class II or protrusion of upper lip angle is decreased. In class III or retrusive position of upper lip nasolabial angle increases.  COMPLETE DENTURES Mouth opening Normal mouth opening is 40-45 mm (Rakosi) Decrease is called as trismus.. Causes of trismus are: Trauma Tumor Localized inflammation TMJ disorders Pericoronitis Myositis ossificans Scleroderma  Palpation Of Muscles Of Mastication Temporalis It is palpated bilaterally and extra orally in isometric contraction. Tendon of temporalis is palpated intraorally. when mouth is half open in the posterolateral region of buccal vestibule near coronoid process  COMPLETE DENTURES  Lateral pterygoid Palpated intraorally in close proximity to neck. of condyle and joint capsule behind maxillary tuberosity. Examination is carried out with mouth open and mandible displaced laterally.  COMPLETE DENTURES Medial Pterygoid It can be palpated by placing the finger on the lateral aspect of the pharyngeal wall of the throat, this palpation. is difficult and sometimes uncomfortable for the patient. Functional manipulation is done when the muscle becomes fatigued and symptomatic. The muscle contracts as the teeth are coming in contact Also stretches when the mouth is open wide  COMPLETE DENTURES Masseter Examined extraorally in isometric contraction. Superficial muscles are palpated beneath. the eye inferior to zygomatic arch. Deep portion is palpated two fingers width in front of the tragus  Temporomandibular Joint Examined by visualization/palpation and auscultation.. Temporomandibular joint disorder symptoms Pain and tenderness at TMJ and muscles of mastication Sound during condylar movement Limitation of mandibular movements TMJ problem affects mandibular movement and masticating efficiency. This can be checked by asking patient to open mouth about half way and move the lower jaw from left to right then to put the tongue into right cheek and then to left cheek, to stick it out and to back and up inside mouth.  COMPLETE DENTURES Lateral palpation Exert slight pressure on condyloid process with index figure. Palpate both sides together. Register any pain/ tenderness /irregularity in movement while closing or opening Co ordination between left and right TMJ should be noted  COMPLETE DENTURES  Posterior palpation. Position little finger in external auditory meatus and palpate posterior surface of condyle during opening and closure. Palpation should be carried out in such a way that the condyle displaces the little finger when closing in full occlusion.  COMPLETE DENTURES Auscultation done by stethoscope. Types of clicking Initial movement –sign of retruded condyle in respect to disc Intermediate—sign of unevenness of condyle and disc Terminal – occurs most commonly results in condyle being moved too far anteriorly on maximum opening Reciprocal – occurs during opening and closing and expressed in coordination between disc and condyle  COMPLETE DENTURES Neuromuscular control House classification Class 1 Enough muscular control to use denture. effectively and not to exceed physiologic tolerance of denture bearing tissues by putting excessive pressure on teeth. Class2 Patient chews with great force. Heavy force can cause sore mouth as tissue tolerance limit exceeds. Class 3 Slight deviation of muscle coordination.They are light chewers and can not control dentures effectively.  COMPLETE DENTURES Intraoral examination.  Mucosa Examine for color/ texture / contour and continuity. Normal color—healthy pink. Angry red indicates inflammation caused by mechanical / chemical / bacterial irritation  COMPLETE DENTURES Causes of abnormally thick mucosa Excessive load in A-P or lateral direction e.g natural lower anteriors against upper CD causes resorption of the. ridge which then gets covered by bunched rugae from palatal mucosa/submucosa Hyperplasia: It may occur from resorption and excessive load e.g. papillary hyperplasia in center /fibrous hyperplasia in peripheral tissue Adverse periodontal disease: Results in loss of bone and after extraction of teeth excess gingival tissue may lead to thick flabby tissues.  COMPLETE DENTURES Thin mucosa gets ulcerated and not good for developing PPS and hence retention is difficult.. Thick mucosa leads to lack of stability ,less tissue tolerance and jaw relation will be difficult to obtained. In this case non anatomic teeth should be preferred. Inflamed and abused mucosa should be treated first, etiology should be determined and stopped before impression procedure. For existing denture 5-7 days of rest is recommended. Unusual slow recovery indicates low general health index.  COMPLETE DENTURES Common prosthetic cause of irritation of mucosa Overextension of denture. periphery Dry ill fitting denture Continuous wearing of denture Faulty occlusion of denture Rubber suction discs Traumatic injury Small spicules of alveolar ridge Denture stomatitis  COMPLETE DENTURES Basal seat examination  Arch size. The size is determine by amount of basal seat available for denture foundation Classification Class 1 – Large (best 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) COMPLETE DENTURES.  COMPLETE DENTURES If arch size is small and arch size and face size is not in harmony ,esthetic will be jeopardized.. If arch size is smaller than head size and muscle of mastication is well developed, the functional demand of denture may cause injury. Hence in this case patient training might be required. Smaller arch size may be due to genetics ,trauma, early tooth loss, severe class II and III malocclusion.  COMPLETE DENTURES Arch form Class 1 square Class 2 tapering. Class 3 ovoid The arch form affects support of the denture. It helps in proper stock tray selection as well as teeth selection and arrangements  COMPLETE DENTURES Ridge form Maxillary Class 1 square to generally. round Class 2 tapering or v-shaped Class 3 flat Ideal is high ridge with flat crest and parallel side – this gives max support and stability  COMPLETE DENTURES Mandibular Class 1 Inverted U- shaped, Parellel walls ,high to medium height with. broad crest. Class 2 Inverted U- shaped with short flat crest Class 3 Unfavourable Inverted w Short inverted v Ridge with undercut (results from lingual or buccally placed teeth)  COMPLETE DENTURES Inter arch space Class 1 - Ideal interarch space to accommodate the artificial teeth Class 2 - Excessive interarch space. Class 3 - Insufficient interarch space Interarch space is usually difficult to determine during initial period of diagnosis unless the cast is properly mounted on the articulator, but an early attempt should always be made for proper diagnosis  COMPLETE DENTURES Procedure Have the patient rest the jaw and carefully part the lips to examine the distance. To stabilize the mandible dentist. should rest his thumb under patient chin. (Sharry) Inter ridge distance should be examined around entire arch as it varies in different part of the ridge. Most frequent problem is seen in retro molar tuberosity area. Small inter ridge distance in contrast to larger distance enhances retention and stability (Sharry)  COMPLETE DENTURES Retention is enhanced because the tongue contacting the lingual and palatal surfaces of denture more completely fills the oral cavity providing an excellent seal. Stability increases because occlusal surfaces of the teeth are more close to the ridge --- minimizes undesirable tilt and tongue forces. Disadvantage of small ridge distance is difficulty in teeth arrangement. Large inter ridge distance caused by the marked resorption of the ridge is a threat to retention and stability.  COMPLETE DENTURES Ridge parallelism Class 1 Both ridges are parallel to occlusal plane Class 2 Mandibular ridge is divergent from. occlusal plane anteriorly. Class 3 Maxillary ridge is divergent from occlusal plane or Both the ridges are divergent occlusally.  COMPLETE DENTURES To observe this relation tell patient to position jaw at VDO and part the lip with finger and mouth mirror, or. mounted diagnostic cast can be used. Denture stability is enhanced by parallel ridge. In Natural dentition the ridges are parallel To overcome un-paralellism implant supported denture should be considered. COMPLETE DENTURES Ridge relation Class I Normal. Class II Retrognathic Class III Prognathic  COMPLETE DENTURES Bony undercut Class 1: Bony undercut absent. Class 2: Small undercut over which denture can be placed either by changing path of insertion or selectively relieving Class 3: Prominent bilateral undercut to be corrected by surgery(one side/two side)  COMPLETE DENTURES Exostosis/Tori Tori are benign bony enlargement covered by thin mucoperiosteum. Class 1 - Tori absent or minimal size. They. do not interfere with denture construction Class 2- Tori of moderate size. Such tori offer mild difficulties but surgery is not required class 3- Large tori. Compromises function and fabrication of CD. Surgery is required.  COMPLETE DENTURES In most of the cases of maxillary tori, relief can be provided in the denture base.. Mandibular tori should always be removed because seating the denture will always be difficult. (Shafer) However maxillary tori if extended to soft palate beyond the vibrating line should be reduced or removed. If surgery is opted, the thin cortical plate of tori which is removed naturally, get replaced in 2-6 months (Zarb)  COMPLETE DENTURES Maxillary tuberosity (sharry) Large tuberosity offer best option for success permitting wide areal coverage and providing. fine bearing surface. But they may pose problems such as Encroached inter ridge distance Large or opposing undercuts Pendulous unstable bearing surfaces  COMPLETE DENTURES Lateral throat form (Retromyelohyoid fossa) According to Neil Class 1 -Deep : 0.5 inch space exists between myelohyoid. ridge and the floor Class 2 -Moderate : Less than 0.5 inch space exists Class 3 -Shallow : Myelohyoid fold is at the same level as myelohyoid ridge. Retention is difficult  COMPLETE DENTURES Palatal throat form Class 1 - Large and normal. Relatively immovable band of resilient tissue 5-12 mm distal to line drawn across distal. edge of tuberosity Class 2 - Medium in size and normal in form. 3-5 mm of band of tissue posteriorly. Class 3 - Soft tissue turns down abruptly 3-5 mm anterior to line drawn across palate distal to tuberosity. It is seen in smaller maxilla  COMPLETE DENTURES Soft palate classification (Winkler) Class 1 - Soft palate rather horizontal with minimum muscular activity. Here PPS area is maximum and not deep. Most.favorable for retention Class 3 indicates most acute contour of soft palate with hard palate. Usually seen in V shaped palatal vault. PPS area is smaller and deeper. Least favorable for retention Class 2 in between class 1 and class 3  COMPLETE DENTURES Hard palate(Winkler). U shaped- Most favorable for retention and lateral stability. V shape- Less favorable for retention. Slight movement of denture base may cause break in seal. Flat palate- Unfavorable because accompanied by resorbed ridge. Although retention is good, lateral stability is very poor.  COMPLETE DENTURES U shaped hard palate (Mc greggor)- It is well developed normally thick ridges with moderate vault. Advantage Centre of palate presents almost flat horizontal area leading to good retention Sulcus allows development of good peripheral seal Well developed ridge resist lateral and AP movement  COMPLETE DENTURES High v shaped palate It is associated with thick bulky ridge which is unfavorable This is because forces of adhesion and cohesion. is not at right angle to the surface when counteracting the normal displacing forces of gravity. In this case peripheral seal is essential. Flat palate with small ridge and shallow sulci are unfavorable because ill developed ridge do not resist movements in lateral and AP direction. Sulci do not provide good peripheral seal  COMPLETE DENTURES. Palatal sensitivity(gag reflex) House classification Class 1 Normal response to palpation Class 2 Subnormal response(hyposensitive) Class 3 Supernormal response(hypersensitivity)  COMPLETE DENTURES Borders attachment House classification. Class 1 – Attachment high in maxilla or low in mandible in respect to ridge crest (0.5 inch or more between level of attachment and ridge crest) Class 2 - Attachment height is between 0.25 – 0.50 inches Class 3 - Attachment height is less than 0.25 inch from the ridge crest.  COMPLETE DENTURES Frenum attachment: House classification: Class 1-High in maxilla low in mandible with crest ridge. Class 2 -Medium (notch required) Class 3 -Freni encroach on the ridge crest and interfere with the seal. Surgery needed. Mostly maxillary/mandibular, labial /lingual frenum require surgery. Buccal frena rarely need correction In mouth exhibiting very poor retention the removal of all frenum increases peripheral seal.  COMPLETE DENTURES  Tongue Size House classification Class 1- Normal in size, development and. function. Sufficient teeth are present to maintain normal form and function. Class 2- Teeth have been absent long enough to permit a change in form and function Class 3- Excessively large tongue. Extended period of complete edentulism allowing for abnormal development of size of tongue. (Insufficient denture can lead to class 3 tongue development.)  COMPLETE DENTURES Wright’s classification of tongue position Class 1 Tongue lies in the floor of mouth. with the tip forward and slightly below the incisal edges of mandibular anteriors. Class 2 Tongue is flattened and broadened but tip is in normal position Class 3 Tongue is retracted and depressed into floor of the mouth with tip curled upward downward or assimilated in body of the tongue.  COMPLETE DENTURES Class 1 is most favourable prognosis. Floor of mouth will be high enough for proper border seal. Class 2 and 3 are unfavorable. Because retracted tongue deprives patient of border seal in sublingual crescent and may produce dislodging force on distal region of lingual flange. Prosthodontic consideration In edentulous cavity tongue can be enlarged. Increased instability of denture and difficulty in impression making. Small tongue – Decreased border seal.  COMPLETE DENTURES Saliva. Class 1 - Normal quality and quantity of saliva. Cohesive and adhesive properties are ideal Class 2 - Excessive saliva, contains much mucous Class 3 – Xerostomia. Saliva is mucinous. COMPLETE DENTURES Quality Thin watery. Mucinous(mixed) Thick mucous Quantity Normal Sialorrhea Xerostomia.  COMPLETE DENTURES Saliva collection Methods include draining/spitting/suction/absorbent swab method.. Draining---passive saliva is collected in Pre-weighed test tube or graduated cylinder for a timed period Spitting ---Patient allows saliva to accumulate in oral cavity and expectorate into pre-weighed graduated cylinder usually every 60 sec for 2-5 min Suction --- Use aspirator or saliva ejector to collect saliva(carlson-crittenden collector for parotid) Absorbent--- Use pre-weighed gauze sponge for a period of time.  COMPLETE DENTURES Materials used to stimulate saliva Chewing unflavored gum , paraffin. wax, rubber band or 2% citric acid. Salivary secretion Normal salivary secretion is 1 ml/min (Zarb) 0.38 -/+ 0.21 ml/min Unstimulated 4.3 +/- 2.1 ml/min Stimulated (Budtz jorgensen)  COMPLETE DENTURES. Radiographic examination  COMPLETE DENTURES Interpretation of OPG should be in a 5 step analysis as outlined: Step 1-. A)Screen jaw for defect in structure, reactive bone formation, bone enlargement and displacement of jaw parts. B) Unerupted tooth, retained root , foreign bodies should be noted C)Radiolucency/Radio-opacity /rarefaction or sclerosis /expansion or bulging or any well/ill defined lesion should be noted D)TMJ finding (correlate with history plus examination).Decide if more specific investigation is required E)Maxillary sinus for inflammation ,cyst , Polyp, Tumor  COMPLETE DENTURES Step 2- Describe appearance of lesion as well as any bone changes adjoining lesion.This should be confined. to physical bone change and include location, size, shape, number and description. Step 3 – Correlate R/f with clinical/ history and lab finding. Step 4- Perform differential diagnosis.  COMPLETE DENTURES Step 5-. Estimate the growth of lesion by appearance of jaw structure bordering the lesion Slow growth-sclerosis/Expansion/Displacement Rapid growth-Bone destruction.. If cannot be diagnosed refer to Pathologist/Surgeon  COMPLETE DENTURES Assessment of Ridge resorption Wical and Swoop classified the amount of resorption. They found lower edge of mental foramen divides the. mandible into thirds in normal dentulous OPG. Means if the distance between the lower border of the mandible and inferior margin of Mental foramen is multiplied by 3 ,original crest ridge height can be estimated  COMPLETE DENTURES Class I –mild resorption - Loss of up to 1/3rd. original height Class II –Moderate resorption 1/3rd to 2/3rd loss of height Class III -Severe resorption 2/3rd or more loss  COMPLETE DENTURES 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 COMPLETE DENTURES.  COMPLETE DENTURES Bone Quantity According to 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)