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127 Cards in this Set

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  • Back
Inner/tissue surface of a denture?
Intaglio surface
Outside/cheek surface of a denture?
Cameo surface
Tissue extensions of denture?
Flange
Periphery of denture flanges?
Border
Is “Complete Denture” or “Full Denture” the proper terminology?
“Complete Denture”
Are tooth loss trends rising or falling?
falling rate
Are the number of edentulous patients increasing or decreasing?
increasing (due to increased pop and living longer)
What percent of edentulous patients are dissatisfied with their complete dentures?
5-20% (7.7% on pi chart)
What percent of edentulous patients are fully satisfied with their complete dentures?
66.7%
What percent of edentulous patients are moderately satisfied with their complete dentures?
25.6%
T/F.. Increase in esthetic awareness has prompted an increase in patient demand for prosth?
true
What are several consequences of tooth loss in a patients overall profile?
loss of facial support and muscle tonus
What are the factors that decrease with age, affecting the proper fit and function of dentures?
Denture support area, neuromuscular control, chewing force, salivary flow due to medication(s), Healing capacity, quality of denture bearing tissues
As a consequence of tooth loss, an edentulous patient will experience residual ridge resorption of the maxilla in a __________ and _________ direction at a rate of _______ per year?
vertical and palatal direction, rate of 0.1mm/year
As a consequence of tooth loss, an edentulous patient will experience residual ridge resorption of the mandible in a __________ and _________ direction at a rate of _______ per year?
vertical and oriented along cross sectional shape of mandible, rate of 0.4mm/year (4x maxillary)
When is residual ridge resorption the greatest?
the 1 year after extractions
What are the two components to a Pre-treatment patient evaluation?
1. Interview & 2. Detailed intra/extra-oral evaluation
What is the most important component of a new patient interview, and is even more important than the treating your patient?
Getting to know your patient
What are some helpful intra-oral areas to evaluate during an exam?
denture bearing sufaces, soft palate, tosillar regions, vestibule, buccal mucosa, hamular notch and definition of tuberosities
Where is the first sign of oral cancer often palpable?
a palpable lymph node
What are some diseases that can be evalualted/identified through a thourough oral exam?
Diabetes, Malignancies, HIV infection
What oral manifestations does Diabetes type I present?
Epithelium that is thin and less keratinized resulting in compromised support and impaired tolerance of complete dentures
What is the potential outcome of leukoplakia/erythroplakia in the oral cavity?
transformation into squamous cell carcinoma
What is the survival rate of patients with squamous cell carcinoma?
less than 50% (with early detection can better)
Are early oral cancers easy to detect?
No, can be confused with other phenomina
Are late oral cancers easy to detect?
Yes, but cure rates are low at this point
Retention is the resistance to _______ displacement of the denture from the denture bearing surface during function?
Vertical displacement
Stability is the resistance to _______ displacement of the denture from the denture bearing surface during function?
Lateral displacement
Support is the resistance to _______ displacement of the denture from the denture bearing surface during function?
Vertical forces of occlusion (resists or absorbs occlusal loads during function)
Factors that impact retention, stability, and support of a denture are?
Quality of oral mucosa (denture bearing surfaces), Alveolar ridge contour, Muscle attachments, Saliva, Neuromuscular control
How is the quality of the oral mucosa determined?
degree of keratinization, amount of attached mucosa vs unattached
In which arch is the availability of keratinized tissue most important?
the mandible (for better support = more resistant to occlusal forces)
Keratinized attached mucosa id the remnant of what?
attached gingival
Is it better to have more or less keratinized tissue on denture bearing surfaces?
more (better support = more resistant to occlusal forces)
Where is keratinized tissue found on a maxillary edentulous patient?
covering the entire palate and alveolar ridges
Where is keratinized tissue found on a maxillary edentulous patient?
narrow zone of attached mucosa confined to the alveolar ridges
When keratinized tissue is lost the result is?
reduced support, reduced tolerance to occlusal load
What are the three factors negatively impacted by residual ridge resorption?
Retention, Stability, Support
Which alveolar ridge contour resorbs faster?
mandibular is 4x faster (.4mm/yr) than maxillary (.1mm/yr)
What tends to result with residual ridge resorption in the mandible, and the mylohyoid attachment?
The mylohyoid ridge becomes sharp on the lingual surface (continued calcification of attachment), overlying mucosa is poorly keratinized and prone to perforation from denture trauma
What are the primary support areas of a mandibular complete denture?
Retromolar pad, buccal shelf, alveolar process
Of the primary support areas of a mandibular complete denture (Retromolar pad, buccal shelf, alveolar process), which is most affected by the process of bone resorption?
alveolar process
Of the primary support areas of a mandibular complete denture (Retromolar pad, buccal shelf, alveolar process), which is least affected by the process of bone resorption?
Retromolar pad (relatively unchanging structure, does NOT resorb from denture use)
What is the retromolar pad made of?
glandular tissue, loose areolar connective tissue, lower margin of the pterygo mandibular raphe, fibers of the buccinators/ superior constrictor/ temporal tendon
What are the boundaries of the buccal shelf?
crest of the alveolar ridge and external oblique line (Masster groove area)
What limits the extension/access of the buccal shelf?
attachment of the buccinator
Why is the buccal shelf a primary support area?
it is parallel to the occlusal plane, is relatively resistant to resorption
What is the dimensional pattern (not direction) off residual ridge resorption in the mandible?
1)buccal-lingual narrowing (compromising support) 2)Height reduced (compromising support, stability, retention)
Immediately following extraction of maxillary teeth, residual ridge resorption occurs in what direction?
Mostly due to the thin labial plate on the maxilla, resoption is from buccal-labial towards the lingual (palatal direction), affecting stability and support
What is the result of continued loss of vertical height of the alveolus?
less stability of denture, pseudo class III jaw relation, less retention (secondary to less stability – peripheral seal can be broken with lateral displacement)
What is “Combination Syndrome”, and what causes it?
When an edentulous maxilla is opposed by a partially dentate mandible (anterior dentition) that has a steep anterior guide, the lack of contacts in working, balancing and protrusive movements during chewing causes the denture to tip anteriroly in the maxilla compressing the mucoperiosteum in the premaxilla (anterior), resulting in specific pattern of bone resorption of the premaxillary area
What negative effects does “combination syndrome” present?
resorption of the premaxilla, hypertrophy of maxillary tuberosity, and occlusal plane problems
Can combination “syndrome occur” in the mandible?
Yes, if a dentate maxillary arch opposes a mandibular arch
What are some measure you can take to prevent or slow resorption?
1) well adapted and properly extended dentures with good design and good occlusion 2) retention of residual tooth roots in key locations 3) implants 4) tissue bar connected to implants
What is the frenum made of?
mucous membrane containing fibrous connective tissue
What is the main concern of the frenum?
may limit denture extensions or make seal difficult to maintain
Can the tongue position affect the stability and retention of the denture?
yes
Can the floor of the mouth affect the stability and retention of the denture?
yes it affects the lingual flange, the longer the flange the better it is referred to as “floor of the mouth posture”
What is a good way to test the functional depth of the alveolingual sulcus in the retromylohyoid sulcus?
place a mirror in the retromylohyoid space and ask patient to move tongue from side to side, if mirror not displaced much than space if favorable
What is a good solution to a retruded tongue position and unfavorable alveolingual sulcus?
1) Dentures retained with osseointegrated implants 2) skin graft vestibuloplasty
What is the purpose of a skin graft vestibuloplasty?
to augment (widen) keratinized skin zone and results in a lower muscle attachments in the floor of the mouth
What is present in the posterior palate that permits the compression of the tissues, helping create a peripheral denture seal (“posterior palatal seal”)?
posterior palatine salivary glands (is compressible and gives leeway to overcome discrepancy caused by acrylic resin shrinkage)
What happens to the tissues of the posterior palate when posterior palatine salivary glands atrophy?
the tissues become less compressible (difficult to obtain peripheral seal)
What is compromised when salivary flow rates decrease?
adhesion and cohesion of the peripheral seal in maxillary denture, and results in more friction in mandibular denture degrading denture bearing surfaces
How important is neuromuscular control in patient satisfaction of complete denture?
good neuromuscular control can overcome unfavorable bearing surface contours and anatomy and will be able to chew efficiently
What are the tissue factors affecting support of the mandibular complete denture?
retromolar pad, alveolar ridge contours, amount of attached keratinized mucosa, buccal shelf area
What are the tissue factors affecting support of the maxillary complete denture?
amount of keratinized mucosa, alveolar ridge contours, palatal shelf area and contour
What are the tissue factors affecting the stability of the mandibular complete denture?
alveolar ridge height, floor of mouth contour, tongue position, neuromuscular control, presence of flabby, moveable denture bearing surface tissues
What are the tissue factors affecting the stability of the maxillary complete denture?
alveolar ridge height, well formed maxillary moveable denture bearing surface tissues and tuberosities, presence of flabby ridges (mobile)
What factors affect mandibular denture retention?
Primary: tongue position, floor of mouth posture, neuromuscular control Secondary: peripheral seal, adhesion, cohesion
What factors affect maxillary denture retention?
Shape of palatal vault (peripheral seal), drape of soft palate (house classification), quality and quantity of saliva, compressibility of posterior palatal seal area, well shaped tuberosities, height of alveolar ridge
What are 3 anatomical factors impacting retention, stability, and support?
mucosa, bone and muscle attachments
What factors are consider when evaluating mucosa for dentures?
attached vs unattached, degree of keratinization
What factors are consider when evaluating bone for dentures?
height of contour of alveolar ridge, presence of tori, resorption patterns
What factors are consider when evaluating muscle attachments for dentures?
frenum, floor of mouth, mylohyoid, retromylohyoid space, tongue position
What structure defines the border of the denture in the oral cavity?
vestibule
What produces naroow vertical notch in denture flange?
labial frenum
What bony structure provides support, prevents denture from rotating, and improves stability?
canine eminence (not always present)
What area should always be relieved to avoid a disruption in blood flow and impingement on the nerve?
incisive papilla, produces a concavity in intaglio of denture
Lack of what may result in inadequate lip support on a denture?
canine eminence
What is the tuberosity used for in a denture?
primary support area and resistance to horizontal movements
What is another term used when referring to the junction of the hard and soft palate?
vibrating line
Where is the posterior palatal seal are located in relation to the vibrating line?
distal
Can rugae be used as support for a maxillary complete denture?
yes, as secondary support and resistance to anterior displacement
Does the hamular notch need to be captured in the denture impression?
yes, it is critical for retention of max. denture
What type of resistance do the tuberosities provide?
resistance to lateral movement and rotation in the horizontal plane
The width of the distobuccal flange will be contoured by the anterior border of the _________?
coronoid process, if too thick, coronoid process impinges on border
What are the two pits/depressions in the posterior portion aspect of the palate, on each side of the midline, near vibrating line (1.31mm in front of), and are useful in determining the posterior extent of the denture?
foveae palatine
Where are the minor salivary gland located in the palate?
posterior third of the hard palate, very glandular and displaceable
What is represented in the denture border as concavities on the posterior lateral borders?
Coronoid process
When you border mold, you should ask the patient to move the mandible from side to side, why?
to accomodate coronoid process movements
If the posterior palatal seal is lost in a maxillary denture, what will result?
loss of retention and patient will feel like gagging
What would be responsible for producing concavities on the border of the denture adjacent to each tuberosity?
pterygomandibular raphe
How do you capture the pterygomandibular raphe in a denture impression?
have the patient open wide and extend chin during border molding
What define the posterior border of the edentulous ridge (posterior border of denture)?
Hamular notches, need to always extend impression beyond
What structure in the maxilla can be likened to the buccal shelf in the mandible as a stress bearing area?
zygomatico-alveolar crest (not as good as load bearing, because mucosa is poorly keratinized)
If the zygomatico-alveolar crest is overextended, the denture could cut into the vestibular mucosa during use, where would this be identified on a cast?
a bony ledge extending form about the first molar region of maxillary vestibule
Is a high palatal vault conducive to stability and support of a denture?
no, due to underlying inclined planes
Where should relief be provided on a maxillary denture?
along midline palatal suture and major palatine foramen (except greater palatine foramen due to thick tissue)
What are the primary load bearing areas of a maxillary denture?
hard palate and posterior ridges
When fabricating a mandibular complete denture, is the alveolar ridge considered a primary or secondary support area?
secondary (due to high rate or resorption)
When fabricating a mandibular complete denture, what is considered the primary load bearing area?
buccal shelf
When fabricating a mandibular complete denture, what is considered the primary support areas?
buccal shelf, retromolar pad
What determines the access to the buccal shelf on a mandibular impression/denture?
buccinator muscle
Where does the buccinators attach on the mandible?
the external oblique line
What does the external oblique line an anatomic guide for when fabricating a denture?
the lateral termination of the buccal flange of the mandibular denture
If the mandible has severely resorption, what happens to the buccal shelf?
size and position change
What results if you overextend denture borders?
destabilizing forces and irritation to patient
Movement of which muscle during border molding influences the thickness of the anterior flange of the lower denture?
mentalis muscle, have patient elevate lower lip and purse lips during border molding
If the custom tray raises on its own when tried in, what does that indicate?
it is overextended
What purpose does the alveolar ridge provide in mandibular denture?
resistance to horizontal movement (should be free from undercuts)
How would you accommodate for the lingual frenum when border molding?
have patient elevate and extend tongue
If mandible has severe residual ridge resorption, what foramen must be relieved to prevent nerve compression and pain?
mental foramen
Along with the external oblique ridge, what structure in a that same vicinity must be considered when contouring the distobuccal flange to avoid displacement and soreness?
Masseter groove (masseter muscle)
What space lies posterior to the alveolingual sulcus, and what is its purpose when fabricating a denture?
retromylohyoid space (important for stability and retention), lingual denture flange should be extende into this area in mand denture
Could the geniotubercle spines ever present a problem in denture fabrication?
yes, in severe resorption cases, relief must be made for these cases
What muscle determines the lingual flange extension of the mandibular denture?
the mylohyoid muscle
What are the two types of muscles origins of the tongue?
Intrinsic and extrinsic
What percent of tongues are abnormal in size, position or shape?
35%
What tongue position is most unfavorable for denture retention and stability?
retruded
Do the muscles of facial expression generally insert into bone?
no
What is the modiolus?
concentration of several muscle groups and is lateral and slightly superior to the corner of the mouth, is very forceful
What influences the labial flange thickness of maxillary denture?
modiolus
If you lose tension of your buccinators as you age, what results?
cheek biting
What muscle determines the length and thickness of the labial flange extension of the lower denture?
mentalis muscle
How can you capture the masseteric groove in a denture impression?
have patient open wide, move chin forward and side to side (may not show up in every impression, that’s ok)
Is the retromylohyoid space important to capture? How do you do this when taking an impression?
yes, it provides great stability, have the patient extend and elevate the tongue and move it side to side