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239 Cards in this Set
- Front
- Back
retromolar pad
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a mass of comprised of non keratinized mucosa located posterior to the retromolar papilla and overlying the loose glandular connective tissue.
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mylohyoid ridge
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the boney ridge close to the inferior lingual border of the mandible onto which the mylohyoid muscle is attached.
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mylohyoid concavity
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the fossa in the mandible below the mylohyoid line in the molar region.
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retromylohyoid space
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an anatomic area in the alveololingual sulcus just lingual to the retromolar pad bounded anteriorly by the mylohyoid ridge, posteriorly by the retromylohyoid curtain, inferiorly by the floor of the alveololingual sulcus, and lingually by the anterior tonsillary pillar when the tongue is in a relaxed position.
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genial tubercle
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mental spines, rounded elevations, clustered around the midline on the lingual surface of the lower protion of the symphysis.
- serve as attachment for the genioglossus and geniohyoid muscles. |
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buccal shelf
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- the area between the mandibular buccal frenulum and the anterior edge of the masseter muscle. Bounded medially by the alveolar crest, laterally by the external oblique ridge and distally by the retromolar pad.
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pterygomandibular raphe
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the fibrous band of paired tissue meeting between the pterygomaxillary notch and the height of the retromolar pad.
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palatal vault
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the deepest and most superior part of the palate
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postpalatal seal area
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the soft tissue area at or beyond the junction of the hard and soft palates
- on which pressure, within physiological limits can be applied by a complete denture to aid in retention |
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vibrating line
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- an imaginary line across the posterior part of the palate marking the division between the movable and immovable tissues of the soft palate.
- this can be id'd when the movable tissues are functioning. |
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fovea palatinae
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- two small pits or depressions in the posterior aspect of the palatal mucosa, one on each side of the midling, at or near the attachment of the soft palate to the hard palate.
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maxillary tuberosity
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the most distal portion of the maxillary residual alveolar ridge
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pterygomaxillary notch
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the palpable notch formed by the junction of the maxilla and pterygoid hamulus of the sphenoid bone.
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incisive papilla
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- the elevation of soft tissue covering the foramen of the incisive or nasopalatine canal.
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median palatal raphe
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the thin keratinized mucosal covering to the medial palatal suture
- denotes the location of the union of the palatine process of the maxillae. |
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rugae
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an anatomic fold or wrinkle - usually used in the plural sense; the irregular fibrous connective tissue ridges located in the ant. third of the hard palate.
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commisure
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- the corner of the mouth (an anatomic union of two parts)
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nasion
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bony cephalometric landmark at which the naso frontal suture is bisected by the midsagittal plane.
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ala - tragus line
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- a line running from the inferior border of the ala of the nose to some defined point on the tragus of the ear, usually considered to be the tip of the tragus.
- ideally considered parallel to the occlusal plane. |
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frankfort horizontal plane
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- a plane established by the lowest point on the margin of the right or left bony orbit and the highest point on the margin of the right or left bony auditory meatus.
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infra orbital notch
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the notch at the location of the infra orbital foramen, generally just below and medial to the lowest point on the margin of the boney orbit.
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intaglio surface
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the portion of the denture that has its contour determined by the impression.
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cameo surface
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the viewable portion of a removable denture prosthesis-
- preferred = polished denture surface. |
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dental casts
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- a positive life sized reproduction of a part or parts of the oral cavity
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read the manual and know the step by step processes.
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1. measure 60 ml of water to 200 grams of dental stone
2. add the stone to water, not water to stone 3. hand mix until you have achieved a consistent mix 4. vacuum mix the stone for 1 minute 5. condense for 15 seconeds with vibrator. 6. total mixing time is no more than 2 mins. leaving about 3 mins. of working time with. room templ. water. 7. slowly add stone to the impression while vibrating 8. add until the entire entaglio surface has been covered. 9. use the remaining stone to form the patty 10. invert the impression filled with stone on the patty material. on the mandible be sure to add stone to the retromolar pad area. 11. let the impression sit for 45 mins. |
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make the cast level
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this is checked from the 1st molar area forward.
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special reminders
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- no adding to bases
- err thick until better at cast fabrication - remember cast indexing - all casts in this course must be indexed. |
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block out
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- elimination of undesirable undercuts on a cast
- the process of applying wax or another similar temporary substance to undercut protions of a cast so as to leave only those undercuts essential to the planned construction of a prosthesis. |
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max. block out
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- most common area of need
- facial portion of ant. residual ridge - incisive papilla - pterygomaxillary notch |
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custom tray purpose
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- required for accurate final impression
- tray reflects proposed denture extensions and dimensions. |
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mandibular block out most common area for need
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- facial portion of ant. residual ridge
- including canine fossa - retromylohyoid space - knife edge residual ridges |
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key areas to block out
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- incisive papilla, the incisive and canine fossa, the retromylohyoid space and the pterygomaxillary notch.
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complete denture therapy sequence of care
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start lecture 2
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goals of complete denture therapy
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1. restore dentate appearance
- always should be achieved 2. improve function - limited improvement shooud be expected 3. psychological comfort - dentist management of patient expectations will determine success or failure of case. |
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basic appt. sequence
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- examination
- final impression - mmr records - trial evaluations - denture placement |
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examination appt.
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- establish rapport with patient through psychological assessment
- medical and dental history - diagnostic information - preliminary impressions - may select teeth |
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examination appt.
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- eliminate disease prior to definitive therapy
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lab procedures of the exam. appt.
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- preliminary casts
- custom trays |
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final impression appt.
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- examine and adjust custom tray
- border molding - mark PPS - make impression |
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lab procedures of final impression
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- definitive cast fabrication
- trial bases and occlusion rims |
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MMR records appt.
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- evaluate trial base fit and occlusion rims
- confirm occlusal plane and midline - record occlusal vertical dimension - facebow record - record MMR relationship |
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lab steps of MMR appt.
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- articulate definitive casts
- begin tooth arrangement - wax final contours |
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trial evaluation appt.
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- can be multiple appt.
- patient evaluation - confirm max/ mand. relationship records |
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trial eval. lab procedures
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- final waxing and balancing
- preserve facebow - record of tooth and cast position - lab prescription |
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review of processing procedures
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- investing of final wax dentures sealed to definitive casts
- wax heating and removal packing of acrylic resin - curing of acrylic resin - devesting of dentures on cast |
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preparations for placement
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- completion of devesting
- trim and polish of dentures - remount casts - attach max. remount cast with preserved facebow. |
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denture placement appt.
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- base and flange adjustments
- patient remount procedures - patient instructions - written and verbal - adjustment appt. sequence |
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prosthodontics
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the dental specialty pertaining to the diagnosis, tx planning, rehab, and maintenance of the oral function comfort appearance and health of patients with clinical conditions ass. with missing or deficient teeth.
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tooth loss
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is a disease SYMPTOM
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the ultimate reference for dentures
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healthy, unrestored dentate condition.
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complete edentulism
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the state of being edentulous, without natural teeth
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of the USA pop. in 91
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30.5 % of the pop. has 28 of thier teeth.
- avg. number of max. teeth is 10.2 - avg. number of mand. teeth is 10.8 |
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age and tooth loss
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- increased age is directly ass. with every indicator of tooth loss
- incidence of tooth retention is increasing - tooth loss is NOT a result of increased age. |
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in 91
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10.5% of the pop. was completely edentulous
another 7.2 was edentuouls in one arch. |
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in 91
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33.6 million americans were edentulous in one or both jaws in 1991
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by 2020
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thier will be 38 million edentulous patients.
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who is edentulous
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- geriatric patients
- lower education groups - lower class economic groups - patients with poor general health |
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tooth loss predicts tooth loss
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if you have already lost teeth you are far more likely to become edentulous in an arch or completely.
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consequences of edentulism
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esthetic
- functional - anatomic |
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esthetic
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- loss of tooth display
- loss of extra oral soft tissue support - loss of occlusal vertical dimension - loss of ability to smile - exxagarated morphological changes - increase in nasolabial angle - decrease in horzontal labial angle - narrowing of lips - decrease in mentolabial angle - prognathic appearance |
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psychological consequences
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aging complex
- exxagarated morphological changes - percieved fatalism of edentulism - difficult adaptation to new situation |
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functional consequences of edentulism
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- disruption of masticatory cycle
- loss of periodontal proprioception - disruption of ability to chew - increased keratinization of mucosa - restoration prevents taste and feel of ood |
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anatomic
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- residual ridge resorption
- a term used for the diminishing quantity and quality of the residual ridge after teeth are removed. |
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residual ridge resorption is ...
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chronic
progressive and irreversible - greatest during first year post extraction - greater rate in the mandible estimated 4 to 1 ratio with the maxilla individual variation |
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life consequences of edentulism
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- oral health related quality of life
- self esteem related to oral health status may be - the fewer the number of remaining teeth the lower the quality of life indicators are. - a large drop in OHRQ ol will occur when the last few remaining teeth are extracted. |
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objectives of tx for total tooth loss
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restore dentate appearance
- improve function - psychological comfort - dentist management of patient expectations will determine success or failure of case. |
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the first objective of dentate appearance ...
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to restore dentate appearance
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improve function
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- will enhance the masticatory function of the patient
- will allow them to chew and pulveize food. - protects oral mucosa by distributing force. |
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complete dentures only restore how much funcit0on ...
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1/6
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ability of patient to chew iwth dentures does not rely on ...
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technical quality
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technical quality helps to determine...
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patient comfort
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high technical quality will facilitate comfort with dentures
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- percieved improvement in chewing ability is one aspect of improved comfort.
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psychological comfort
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- perhaps the most important part of dentures is to make the patient comfortable with the prosthesis
- the level of comfort will determine success or failure of the tx. |
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psychological comfort
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- psychological comfort creates physical comfort
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create comfort
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- patient acceptance of their situation achieved with
- pt. mgmnt. skills - patient education - lowering expectations |
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patient acceptance of therapy
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high technical quality of work
- pt. involvement |
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denture comfort quality
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- maximum tissue base contact
- maximize denture bearing surface area - proper extensions - prosthetic teeth where natural teeth existed - prosthetic teeth where natural teeth existed - even and simultaneous bilateral contact - smooth, clean, stable restorative material. |
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comfort and acceptance
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- the more a prosthesis feels like ones own, the more likely it will be.
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start of lecture 5 here
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- start of lecture 5 interaction and dx
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tx begins
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usually at the first appt., the examination appt.
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communication can be more difficult with edentulous pts. because...
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they are usually geriatric
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if personalities conflict and its ID'd early
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- discuss directly with the patient
- locate reason for conflict - if no understanding can be reached, or if you feel mismatch can not be resolved do NOT treat the patient |
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be honest about the situation
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- educate the pt. about the edentulous state
- explain progressive nature of the disease - this is THERE problem and not yours, you are only there to help out. |
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authoritarianism
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- reduces patient satisfaction
- leaves the responsibility with the denitst too.this is dangerous if things dont go well. |
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Diagnosis
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- the SECOND part of the examination appt. if the psychological assessment goes well.
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residual ridge resorption
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- maxilla - .1
- mandible - .4 mm |
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chronic, progressive and irreversible
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multifactorial disease and at the present time the various cofactors are not known well.
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classification system for completely edentulous pts.
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- diagnostic criteria
- bone - height mandibular - MMR - Residual ridge resorption - muscle attachments |
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classification of the edentulous state
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- class 1 - ideal or minimally compromised
- class 2 =- moderately compromised - class 3 - substantially compromised - class 4 - severely compromised |
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bone height - quantity of underlying bony foundation
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- denture foundation area
- tissues remaining for reconstruction - loss of facial muscle support/ attachment - decrease in total facial height - residual ridge morphology. |
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what affects residual ridge measurements
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- magnification and variance of radiographic procedures and equipment of different manufacturers.
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HOWEVER residual ridge measurements offer ....
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the most information of all the criteria
- |
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to minimize variance the measurement of the mandibular bone that remains should be done at....
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the LEAST VERTICAL HEIGHT
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type 1
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- residual bone height of 21 mm or greater measured at the least vertical height of the mandible
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type 2
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- residual bone height of 16-20 mm measured at the least vertical height of the mandible.
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type 3
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- residual ridge of 11-15 mm measured at the least vertical height
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ype 4
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- 10 mm or less vertical height
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CLASS 1 MMR records
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- MMR relationship allows tooth position that has normal articulation with the teeth supported by the residual ridge.
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CLASS 2 MMR
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- MMR tooth position that doees not sit in the normal ridge relation and in order to attain phonetics the teeth can't be ass. with the ridge.
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class 3 MMR
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- I.e. CROSSBITE and athe ant. or post. tooth position is NOT supported by the residual ridge.
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residual ridge morphology of the maxilla is...
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the most objective criteria for the maxilla since measurement of the residual bone height by radiogrophy is not reliable
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TYPE a
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- HARD palate form
- anterior maxillae - max. tuberosities - ant. labial and post. buccal vestibular depth that resists vertical and horizontal movement of the denture base - palatal morphology that resists vertical an dhorizontal movemetn of the denture base - sufficient tuberosity definition that resists vertical and horizontal movement of the denture base - pterygomaxillary notch is well defined to establish the post. extension of the denture base - absence of tori or exostoses. |
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type b maxilla
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- hard palate form
- residual alveolar ridge - ant. post. - max. tuberosities |
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TYPE b max.
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- loss of post. buccal vestibule
- tuberosity and hamular notch are poorly defined compromising deliniation of the post. extension of the denture base. - max. palatal and or lateral tori are rounded and do not affect the post. extension of the denture base - palatal vault morphology that resists vertical and horizontal movement of the denture base |
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TYPE c
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loss of ant. labial vestibule
- prominent midline suture - max. palatal and or lateral tori with bony undercuts that do not affect the post. extension of the denture base. - hyperplastic, mobile ant. ridge that offers minimum support and stability of the denture base - palatal vault morphology that offers minimal resistance to vertical and horizontal movement of the denture base - reduction of the post malar space by the coronoid process during mandibular openine and or excursive movements. |
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TYPE D maxilla
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- loss ant. labial and post. buccal vestibules
- max. palatal and or lateral tori are rounded or undercut, that interferes with the post. border of the denture. - hyperplastic, redundant ant. ridge - palatal vault morphology that does not resist vertical or horizontal movement of the denture base - prominent anterior nasal spine |
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location and influence of the muscle attachment is most affected in the ...
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mandibular arch
- also prob. the hardest to quantify compared to the other criteria |
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this is all based on the anatomy that resists the ant. movement of the denture base.
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types a through d
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type a muscle
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- adequate attached mucosal base without undue muscular interference during normal function in all regions.
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type b mus.
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- adequate attached mucosal base in all regions except ant. buccal vestibule, cuspid to cuspid
- high mentalis attachment |
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type c mus.
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- adequate attached mucosal base in all regions except ant. buccal and lingual vestibules, cuspid to cuspid
- high genioglossus and mentalis muscle attachments. |
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type d muscle
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- adequate attached mucosal base only in the post. lingual region
- all other regions are detached |
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type e mus.
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- no attached mucosa in any region
- cheek and lip movement = tongue movement |
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class 1
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this level is the most apt to be succesfully treated by conventional prosthodontic techniques with complete denture prosthesis
- all four of teh diagnostic criteria are favorable - residual bone height is grietaer than 21 mm - class 1 MMR - type a maxilla Type A OR B mandible |
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class 2
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- distinguihes itself with the noted continuation of the physical degradation of the denture supporting structures and in addition is characterized with the early onset of systemic disease interactions, localized soft tissue factors and patient management/ lifestyle considerations
- residual bone height of 16-20 mm - class 1 MMR relationship - Type a OR b maxilla - type a OR b Mandible - minor modifiers, psychosocial considerations, mild systemic disease with oral manifestations and localized soft tissue conditions |
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class 3
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- need for surgical revision of denture supporting structures to allow for adequate prosthodontic function
- residual bone height of 11-15 mm - class 1 2 or 3 mmr - Type C maxilla - Type c mandible |
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conditions requiring pre prosthetic surgery
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- minor soft tissue procedures
- minor hard tissue procedures - implant placemtn - multiple extractions leading to immediate denture placement - limited inter arch space 18-20 mm - moderate psychosocial considerations and or moderate oral manifestations of systemic disease or localized soft tissue condisiont - tmd symptoms present - large tongue with or without hyperactivity - hyperactive gag reflex. |
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class 4
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most debilitated edentulous state
- surgical reconstruction is almost always indicated but can't be accomplished due to multiple factors - when surgical revision is not selected prosth. techniques of a specialized nature must be used to achieve adequate outcomes. |
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class 4
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- class 1, 2 or 3 MMR
- Type D max. - Type D or E mandible |
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principles of final impressions
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1. tissues being recorded must be healthy
- this will alter tissue contour and resiliency - disease - irritation - constant denture wear achieved by initial therapy allowing tissue rebound prior to impression 2. must include all denture bearing surface area - within the limits of anatomy during function - required to maximize distribution of functional forces - stability - retention achieved by preliminary impression technique - allows creation of cutom tray which will guarantee recording of appropriate anatomy. 3. border of impression must be in harmony with the anatomical and physiological limitations of teh oral structures - required to determine proper length and width of denture extensions - for retention and comfort - achieved by physiological border molding techniques by or guided by the dentist |
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principles 2 and 3 combine to result in
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- external form of final impression closely matching the external form of the complete denture
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principle 4 if final impression
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- must be removed without damage to oral tissues
- rigid or caustic material should be avoided is it safe - free from allergy reaction - preliminary evaluation of undercuts - ZOE and plaster were used |
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principle 5 of final impression
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- tray and impressoin material must be dimensionally stable
- impresssion must maintain its accuracy until the definitive cast has been created - sources of distortion are - removal from mouth - handling - reactions - achieved by - proper material selection - proper material handling (time dependent) |
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principle 6 of final impression
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- have a reference for positioning in the mouth
- improper positioning results in failure - alters the extensions and bearing surfaces - repetition is time consuming - achieved by knowledge of anatomy and technique used - maxillae - palatal vault as positional reference - proper border molding - mandible; retromolar pad and borders contain and position tray if not over seated. |
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the TWO MOST IMPORTANT THINGS IN impression making
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- properly formed and accurately fitting impression trays
- proper positioning of the tray in the mouth. |
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materials
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- rarely define success or failure
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needed properties of a good impression material
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- fluid enough to adapt, viscous enough to remain in the tray
- sets in a reasonable amount of time - does not distort upon removal from the mouth and remains stable until cast is made. |
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materials
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- reversible - thermoplastic
- irreversible - chemical setting and polymerization setting - elastic - non rigid - inelastic - rigid |
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materials
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- reversible - agar, compound and wax
- irreversible - alginate, zoe, polyether, polysulfide and silicones - elastic - hydrocolloids, polyether, polysulfide and silicones - inelastic - plaster, ZOE paste and compound |
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elastic - alginate
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- imbibition and syneresis may occur here.
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elastic (elastomers)
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- polysulfide
- polyether - silicones |
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irreversible elastic
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- polysulfide (rubber) the stuff we used to make our final impressions
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impression philosophy
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- mucostatic
- functional (mucodisplacing) |
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mucostatic
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- reduced supporting tissues
- mobile or redundant tissue - metal based dentures - materials that cause this - ZOE paste - plaster - polysulfide |
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functional (mucodisplacing)
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- selective pressure
- record anatomy in functional state - compressed - excellent supporting tissues remain - firm resilient mucosa - tore present (press in the non tori areas) - materials - alginate, high viscosity elastomers and wax. |
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techniques for impression appt.
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- preliminary then final - two appt.
- same day final - one appt. |
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same day final impression
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- pros - expedites tx, reduces lab time and works with functional impression philosophy
- cons - initial therapy often ignored, challenging techniques and dificult to record exact extensions and surface area. |
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marquette philosophy
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- mucostatic with preliminary then final impression appt.
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analysis of pressures from the Frank RP article
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- analysis of pressures rediced during max. edentulous impression procedures
- 4 diff. types of tray modifications - none, holes, relief and both - materials used were, alginate, rubber base and ZOE |
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tray modification effect
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- least to most pressure
- both- holes or relief- neither - materials effect - least to most pressure - ZOE- Rubber- Alginate (regular mix) |
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reduce pressures by
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- holes - easier, more efficient than wax relief
- material - flowable material rather than stiff. WE USED - holes number, size and locations determined by case - material was low viscosity polysulfide |
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start lecure 7 material
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- the goal is to complete time consuming procedures while the patient is NOT in the chair
- this requires accurate transfer of edentulous arches to the articulator - necassary because - most accurate way to confirm intra oral procedures - lab work is more time efficient - prosthesis is indirectly fabricated |
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MMRR's
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- a registration of any positional relationship of the mandible relative to the maxilla
- for our purposes MMRR"s include all the steps required to transfer positional relationships of the maxilla and mandible to the articulator. |
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4 bsic steps of the MMRR appt.
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- occlusal plane
- occlusal vertical dimension - facebow record - MMRR |
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occlusal plane
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- the average plane established by the incisal and occlusal surfaces of the teeth
- during the MMRR the srface of the wax occlusion rims is contoured to guide in arrangement of denture teeth This is NOT a jaw relation - actually a plane of jaw seperateion |
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goal of positioning
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- to make it parallel with the ala tragus line when viewed from the side
- mediolaterally we want it to be parallel to the inter pupillary line when viewed from the front the goal is to be level in the horizontal plane |
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occlusal plane steps continued
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- 1st was the parallel to ala tragus and interpupillary line
2nd - transfer teh midline to teh maxillary occlusion rim - generally a line from the glabella through the philtrum of the max. lip |
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occlusal vertical dimension (2nd part of the 4 step MMRR appt. )
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def. - distance measured between two points when the occluding members are in contact
- establishes the amount of vertical seperation between the maxilla and mandible - controlled by the mandibular musculature and the occlusal stops (occlusion rims at this point) |
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methods used to measure OVD
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- ridge parallelism
- measurement of former dentures - physiologic rest positoin - phonetics - esthetics - swallowing threshold - tactile sense and patient percieved comfort |
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We used
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- esthetics
- physiologic rest position - phonetics |
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esthetic determination of OVD
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- competent lips
- relaxe extraoral musculature - proper soft tissue extension - rule of facial thirds |
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physiologic rest position
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- the postural position of the mandible when an indiv. is resting comfortably in an upright position and the ass. muscles are in a state of minimal contractual activity.
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to measure the phys. rest position
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- swallow
- have patient relax face - say the letter m or MOM - then have the patient hold sitll while you part the lips to evaluate - Should have 3 mm of interocclusal space at rest - rest vertical dimension is 3 mm. |
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phonetics test for OVD
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- more accurate once teeth are positioned
- used to determine the closest speaking space |
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closest speaking space
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- the space between the ant. teeth that should be more or less than 1 to 2 mm of clearance between the incisal edges of the teeth when the patient is unconcsiously repeating the letter S
- we had the patient say the days of the week and focused on saturday |
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using complete dentures ' two major reasons why this shouldn't be done and is inacurrate for teh most part
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- residual ridge resorption
- acrylic tooth wear |
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facebow
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- a caliper like instrument used to record the spatial relationship of the maxillary arch to some anatomic reference point or points and then transfer this relationship to an articulator
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facebow record
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- alignment - frontal and sagital planes of facebow should match the maxillry occlusal plane
- this iwll transfer the max. arch in accordance to the occlusion rim/ occlusal plane which you have just recorded |
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two reasons for proper max. arch positioning in the articulator
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1. occlusion
2. esthetics |
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facebow record
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- will NOT improve accuracy or efficacy of complete denture occlusion
- you are using an arbitrary facebow - degree of change in occlusion due to arbitrarily positioning of max. cast is miniscule - all copmlete dentures move |
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hanau spring bow
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- arbitrary facebow
- uses average anatomic distance from true hinge axis to simplify transfer. |
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primary goal of the facebow record
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- must position the max. arch on the articulator in the same spatial relationship as it exists in the mouth.
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challenges with the arbitrary facebow
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- 3rd point of reference is infra orbital notch - often not clear since covered by elastic tissues
- assymetry of facial features - will result in canting of facebow away from ideal reference planes |
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challenges with arbitrary facebow
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- dictates review of record while on transfer assembly prior to addition of the plaster
- if teh occlusion reim is not in the same orientation as it is intraorally than a correction must be made |
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MMR (4th part of the MMRR appt. )
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- a registration of any positional relationship of the mandible relative to the maxilla
- we will always use a CENTRIC RELAITION RECORD for this purpose. |
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to prepare the mand. arch for MMRR
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- remove at least 2 mm of wax from post. occlusion rims (space for registration wax)
- do NOT disturb anterior portion of mand. occlusion rim - this portion of teh rim maintains OVD during the record making procedure. |
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using alluwax for the MMRR recod
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- allows accuracy, stabilization and repeatability
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Centric relation record sequence for edentulous patients
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- prepare occlusion rims
- soften and temper alluwax - seat and stabilize mandibular baseplate - instruct and direct pateitn on mand. positioning and closure - confirm patient positioning - remove mand. rim to chill record |
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incisal plane is dependent upon
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- age
- extra oral musculature - phonetics |
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incisal plane frontal plane
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- height and contour of occlusion rim adjusted to estimate amount of incisor display during full smile.
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trial base and occlusion
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show more wax rim for incisal plane
- in younger patient - short upper lip - hypermobile lip show less wax rim for incisal plane - older patient - long upper lip - non mobile lip |
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incical plane in the sagital plane
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- correct position in the sagital plane assessed by proper lip support
- 100 degree nasolabial angle - 140 degree mentolabial angle - length also assessed in profile. |
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trial base and occlusion rim
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- arch form - the particular position and shape by the wax occlusion rim or prosthetic teeth.
- often discussed in relaition to the residual alveolar ridge |
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arch form effects
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- esthetic appearance
- effects extra oral soft tissue support |
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occlusal plane
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- the seperation line between the max. and mand. arches
- the surface of the wax occlusion rims contoured to guide in the arrangement of denture teeth - always level in the frontal plane - left and right sides are the same height and are therefore horizontal in the frontal plane level with ala tragus line in sagital plane - wax will be level with ridges and ala tragus line at this point in the evaluation - when you set teeth you will change this from flat to slightly curved |
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occlusal plane in the frontal plane
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- begin assessment at distal of canines
- level in frontal plane |
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occlusal plane - frontal plane height
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- determined by height of incisal plane
- max. begins just apical to canines |
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max. vs. mand. tooth arrangement
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max. is done first so mand. will follow this.
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anatomic landmarks used in tooth arrangement
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- incisive papilla
- mandibular ant. residual ridge crest - retromolar pads |
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incisive papilla
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- on the average = the facial surface of maxillary central incisor is 12 mm ant.to the distal most point on the incisive papilla
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mand. ant. residual ridge crest
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- often very narrow
- limited buccal lingual space for teeth - lingual - genial tubercle/ tongue - buccal - mentalis/ lower lip - A/P position of this poriton of residual ridge crest is determined by the MMR relationship - these limitations dictate that the mand. ant. teeth should be positioned near the crest of the residual alveolar ridge - this makes the ant. residucal alveolar ridge the A/P start point of the mand. ant. teeth arrangement |
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retromolar pads
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- a landmark for the distal height of the plane of occlusion
- end occlusal plane at 2/3 the height of the retromolar pad |
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occlusal plane of the mand. rim
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- began at canines, ended wih occlusal surface of second molars at 2/3 the height of the RM pads
- changed to accomodate max. occlusal plane transfer - when mand. post. teeth are arranged they will be placed at 2/3 the height of the RM pads |
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retromolar pads
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- determines sagital plane height of the occlusal plane
- this results in the AP curve - also called curve of spee and compensating curve |
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functional component of tooth arrangement is composed of 3 parts
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1. esthetic
2. phonetic 3. occlusal |
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esthetic
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- appearance will dictate final details of ant. tooth positioning
- if it doesn't look good it own't feel good and therefore wont work good |
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incisal edge position in the frontal plane
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- incisal edge should follow the curvature of the mand. lip line
- max. central incisor location is the most important - midline centerred - level - determine the amount of display |
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esthetics continued
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- correct position in teh sagital plane
- correct position in the sagital plane assessed by proper lip support - 100 degree nasolabial angle - 140 degree mentolabial angle |
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functional ; phonetic
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- if teeth are near the proper position
= speech will be normal - closest speaking space will be present. - phonetic - "f" sound - vermillion border of the mand. lip just touches the max. central incisors - non contact = centrals are too apical - distorted sound/ hypercontact |
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edentulous examination form
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1. health questionaire form
2. radiographic survey findings 3. previous denture experience 4. evaluation of current dentures 5. current denture habits and hygiene 6. clinical assessment 7. extractions required prior to therapy 8. misc. intraoral 9. psychological assesment 10. list any other modifiers 11. list modifires from 1-10 12. diagnostic classification of complete edentulism (1,2,3,4) |
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clinical assessment on the edentulous exam form
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- mandibular bone height
- >21 mm ; 16-20 mm; 11-15 mm ; <11 mm - MMR - class 1 2 or 3 - max. residual ridge morphology type A B C or D - muscle attachment - Type A,B,C,D,E |
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to prevent soreness thier are 2 major procedures post placement
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base adjustments - tissue base relationships
patient remount - confirm and corrects occlusal discrepancies |
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we used
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PIP - predicts eventual denture soreness according to firtell
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remount procedures
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- uses the intra oral relationship as the desired reference position... relates restorations to an articulator for analysis and or to assist in dev. of a plan for occlusal equilibriation or reshaping.
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cant make adjustments to occlusion intra orally because
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denture base movement
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before you do the patient remount you must...
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confirm correct tissue base relationship with base adjustments.
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order for patient remount
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1. confirm/ correct base relationship
2. create a new stable MMRR 3. rearticulate dentures using new stable remount casts 4. adjust occlusion and articulation as neede |
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patient remount study by
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someone
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Nicol article from 11.9
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- high technical quality of complete dentures does not guarantee success
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success of denture placement is determined by 2 things
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1. the adaptive ability of the paitnt
2. patient dentist interaction |
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What is the GOAL of therapy?
Chamberlain BB. JPD ’84 52:744 |
patient goal - determined by their previous experience
- natural teeth - removable prosthesis prior to RRR |
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dentist goal for dentures
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- determined by educationol experience
- dental school cirriculums focused on mechanical solutions - varied patient tx experiences. |
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diagnosis limits goals
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class 4 will never restore to normal function.
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achieving tx goals
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- manage patients ability to adapt
- manage patient - if y0ou do these two things well you will have success. |
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manage adaptation
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- pre tx. - educaiton of pt. should result in lowering of expectations
- understanding of what the goals are. - their problem, not the dentist. |
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initial therapy
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- gain the patients trust and confidence
- test response prior to large commitment. |
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definitive tx.
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- educating the pt. on how to use complete dentures
- making prosthesis comfy. |
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new way of eating according to tallgren
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- change mand. pattern
- phys. accomodations for movement of the prosthesis. |
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Denture comfort
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- the ultimate definitive tx. that will help you manage adaptation.
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from gamer article
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patient dentist interx.
- participation leads to acceptance - avoid authoritarian attitude - psychologicial "risk indicators" - esthetics |
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Hirsch B, Levin B, Tiber N. J Prosthet Dent 1972;28:127-32
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As long as patients were given a choice, the outcome was improved no matter if they actually received what they selected
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authoritarianism
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- reduces pt. satisfaction
- patient less likely to be pleased with outcome. - regardless of qualitit or appearance. |
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esthetics
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- can't expect return to function but should expect a return to pleasing age appropriate appearance.
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denture esthetic concepts
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- natural
- supernormal - denture look |
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dentogenics
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- esthetic principles + biometric guidelines
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the natural concept
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- tempermentalists
- individuality - victor sears - establish the norm - frush and fissher - dentogenics - dynesthetics |
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natural concept
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- appearance in accordance with or determined by the inherent character or basic constitution of a person.
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dr. lombardi
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- applies artistic principles to daily practice
- perceptual principles apply to all patients - guess work and averages eliminated in favor of reality. - eye is the perfect evaluator. |
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psychological comfort will result in functional comfort
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this is the importance of esthetics or at least a big part of it.
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in review of ppt 11
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- agree on attainable goal
2. manage adaptation 0 a continuous process - pre tx - patietn must accept responsibility - agree on tx goals - educate patient - initial therapy - eliminate disease - stabilize situation - percieved improvement - definitive therapy - how to eat - prosthesis contour - comfort during function 3. manage patietn - patient dentist interaction - participation leads to acceptance - avoid authoritarian attitude - psychological risk indicators - esthetics |
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denture consequences
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- stomatitis
- irritation hyperplasia - traumatic ulcers - gagging - residual ridge resorption |
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denture stomatitis
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- type 1 - localized
type 2 generalized - diffuse erythema type 3 - granular type, inflamatory papillary hyperplasia |
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denture
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- frequency of use
- clenaliness - denture base quality |
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stomatitis tx
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- denture use habits
- denture huygience |
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denture irritation hyperplasia
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- mucosal hyperplasia due to chronic denture injury
- most often the result of unstable dentures or thin over extended flanges. |
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traumatic ulcers
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- etiology over extensions
- uneven occlusion - poor base adaptation predisoposing factors - any disease that weakens oral mucosa |
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retention factors
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- interfacial forces
- adhesion - cohesion - oral and facial musculature - atmospheric pressure - undercuts - gravity. |
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viscous tension
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- increased viscosity of interposed fluid results in increased viscous force
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adhesion is retention principle 2
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- amt. of retention provided by adhesion is proportional to the area covered by the denture.
- maximize denture bearing surface area. |
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cohesion
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- works to maintain the integrity of the interposed fluid.
- cohesion attraction of like molecules. |
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most retention features
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come from adhesive and interfacial factors.
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oral and facial musculature
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- supplementary retentive forces
- teeth must be within denture space - proper denture contours |
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atmospheric pressure
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- suction - only possible with proper border seal.
- means proper border molding. |
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undercuts
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- the portion of the surface of an object that is below the hoc
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denture adhesives
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do NOT improve chewing performance
- increase retention - improve confidence |
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idications for dental adhesive
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maladaptive patients
- anatomically limited patients - muscular control problems |
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zerostomia patients
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- adhesive should NOT be used alone
- requires moisture to be efffective |
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denture change
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- acrylic tooth war
- dneture base fracture - acruylic aging |
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denture hygiene
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- the cleanseres need to KILL the yeast and bacteria
- kleenite - vigourous brushing of denture with soap is Far more effecteve than soaking in polident or efferdent |