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37 Cards in this Set
- Front
- Back
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What are the goals of the insertion visit?
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Efficient and enjoyable for
patient, staff and you. • Quickly troubleshoot and correct problems |
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3 things you need to do to prepare for insertion
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1. Lab remount: by lab before decasting
2. Finishing and polishing: lab o you, checked by you 3. Patient remount: prepare remount casts and mout maxillary cast with facebow preservation.Lab or you do this. 4. hydration |
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3 purposes of the lab remount
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• 1. Correct for wax up errors and Acrylic
expansion during processing until VDO is restored. • 2. Correct for tooth movement during processing until VDO is restored. • 3. Correct for increases in VDO caused by processing error. **Not to check occlusion, Its simply to restore the VDO back to where you sent it to them. |
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On average due to normal expansion of acrylic, how much will the pin rise?
What is the most common reason for why this happens? Where do you grind? |
1-2 mm.
-Heel interferences are the most common. -Generally grind the lower first. grinding the upper may result in perforation and loss of suction. Contacts generally occur in the posterior. Selective grinding stops when pin hits the table. |
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• During LAB Remount with MONOPLANE
Denture Occlusion…….there is increased VDO & a premature posterior contact on the right side. • What do you adjust and why? |
Remenber adjust to VDO only!
• 1. Lower first to flat and 2/3 RM pad….if it is incorrect. • 2. Maxilla once lower is correct • 3. If major adjustment needed last option is both equally. |
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Purpose of finishing and polishing
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To correct wax up, processing
and esthetic issues and prepare complete dentures for insertion. |
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Slow speed acrylic burs do what?
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• Remove flash from wax up and
processing. • Remove gross roughness & defects on external surface of acrylic and flash on teeth. • Carefully adjust internal sharp areas or projections. • Refine anatomy. |
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What view do you want to use during flash removal?
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View from occlusal surface permits flash removal without thinning the border.
-Non uniform border thickness if not viewed correctly. You want a 2-3 mm rounded form all around the borders. |
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Polishing materials - pumice
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• 1. Pumice: used with water, low speed &
moderate pressure. Removes acrylic, creates a smooth matte or slightly shiny surface. • Warning! Pumice can remove acrylic borders, anatomy and denture teeth. • Use on external surfaces only |
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Polishing materials - Moldent
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• Moldent used dry w/ high speed & light
pressure, w/suction. Creates high gloss. • Can also damage acrylic and teeth if used incorrectly • Use on external surfaces only |
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What area should you never polish?
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Never polish the internal surface - this destroys the adhesion and cohesion
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Patient remount
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Preparing remount
casts and mounting maxillary cast with facebow preservation. -correct slight increased VDO. -temporary cast made in blocked out denture for patient remount. -blockout of undercuts is made with mortite |
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How do you do the facebow preservation?
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-upper denture + temporary cast is seated on the facebow preservation
-separate mounting not related to incisal pin setting |
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Describe the insertion sequence
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• Adjust upper alone
• Adjust lower alone • Insert U/L w/o occluding • Rehearse/record CR (use aluwax) • Mount lower • Perform Patient remount- refine occlusion • Re-polish • Review home care instructions • Reappoint for 1st adjustment |
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Materials used to adjust complete dentures
1. peripheral seal + borders 2. pressure indicating paste (PIP) 3. post dam marking pencil 4. articulating paper |
• Sorenson’s Paste- peripheral seal &
borders • Pressure Indicating Paste (PIP)- cohesion • Post Dam marking Pencil- small area checks (indelible pencil) • Articulating paper- occlusion and heel interference • Your skill and patient’s input! |
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What is Sorenson's paste used for?
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Confirms what you believe the problem is. Your skill tells you what may be wrong, usually in areas that are dynamic such as borders and post-dam.
-Applied thickly to borders of a tongue blade. Can also be placed on the polished surface |
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PIP paste is for what?
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PIP paste: white,
thin, static like final impression material- checks internal surfaces for Ad. & CO. |
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What if you get Sorenson's paste in the static areas?
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You should remove the whole thing and redo it. Its too thick to be place on static areas.
-Show through can ocur due to excessive overextension or thickness of denture. |
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What is one reason for why the ends of the lower denture may pinch?
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Due to interference with the masseteric notch
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What prevents the upper and lower denture from occluding? What is this step in preparation for?
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Cotton rolls.
Prepares you for CR, only after rehearsing movements with patinet. If there's show through, you'll need to redo the CR. |
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What decreases VDO?
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Patient remount will decrease VDO. Its better to have less vertical than more.
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How do you adjust monoplane occlusion?
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• Perfect lower Plane (Area “C”) & (“B” for
interferences) • Adjust Maxillary (Area “D”) • If significant adjustment is needed or to reduce VDO adjust both. • Remember- flat adjustments. Do not create inclines or cusps! |
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How do you adjust anatomic occlusion?
1. Adjust centric interferences 2. Lateral? 3. Protrusive? |
Don't do this in the mouth, must be done through remounting.
1st centric interferences - vertical 1. grinding fossas Centric and eccentric: grind cusp 2. Lateral: working side: buccal upper, lower lingual balancing side: buccal of lower. inclines only canine: 1>2>3 3. Protrusive: wear facet for anterior; posterior DUML |
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What are 4 things that the patient remount can do?
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• What can it do?
• 1. Refine occlusion & correct processing errors (tooth movement). • 2. Correct to denture occlusion rules. • 3. Refine anatomical occlusion. • 4. Reduce VDO if needed. How much? Up to 3 mm due to use of arbitrary hinge axis. |
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• Articulating paper is used very differently
on Complete Dentures than on natural occlusion. • Why? |
Intraorally, occlusal interferences in CD
can cause the bases to move leading to false marks and improper adjustment! • 1. Locate heel interferences. • 2. For monoplane teeth, helps precisely locate occlusal interferences seen intraorally • 3. Dangerous to use to “check the bite” or adjust anatomical set ups intraorally. WHY? • 4. Best use- to adjust the occlusion on the articulator after a patient remount. |
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When to do a pt remount
1. Insertion 2. Adjustment |
1. Insertion: • To perfect occlusion ,
less movement and fewer sore spots • Required for anatomical occlusion 2. Adjustment: • Final impression weeks beforeprocessing changeslet dentures and tissues adapt then perfect occlusion • Useful for Monoplane Occlusion |
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When do you bring the patient back in for adjustments?
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• Whenever the patient needs you!
• Generally, for CU/CL in a “good case” up to 1 week may be fine. • First time denture wearers/difficult case no longer than 48 hours • Immediate denture wearers, 24, 48 and either 72 hours to 1 week. • Follow up adjustments depend on individual and difficulty of case |
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How do you conduct post insertion adjustments?
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• 1 Listen to and carefully record patients
chief complaint • 2.Ask pertinent questions about how the denture has been worn, what the diet has been and look for clues to the problem. • 3. Carefully inspect the denture and the mouth for more clues. • 4. Make your diagnoses and use pastes etc. to confirm and adjust |
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Soreness. What are the causes of the following complaints?
1. Vestibule 2. Posterior of upper 3. Single sore on ridge 4. At lower lingual border 5. At lower labial border |
1. • Overextended border
• Occlusal/heel interference 2. • Post dam too deep • Post dam too sharp • Overextension/CO ≠ CR 3. • Malocclusion • Inaccurate denture base • Blebs on tissue surface 4. Excessive VDO; innacurate denture base; CO doesn't equal CR • Overextended lingual border • Excessive overbite • Incisal guidance/ heel or • Occlusal interference 6. • Overextended labial border |
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Burning sensation
Complaints 1. anterior palate or ridge 2. Bicuspid to molar 3. Lower anterior ridge |
Pressure on
1. anterior palatine foramen 2. posteiror palatine foramen 3. mental foramen |
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TOngue and cheek biting Cause
1. cheek biting 2. tongue biting |
1. posteriors edge to edge; deficient VDO (overclosure); posterior too buccal
2. posterios too lingual |
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Tissue redness
1. Denture bearing tissue only 2. Overall tissue redness |
1. • Excessive VDO
• Poorly fitting denture • Failure to remove denture • Avitaminosis 2. acrylic allergy (extremely rare) |
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TMJ complaints: pain, clicking, limitation of movement
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Cause:
excessive or deficient VDO, CO doesn't equal CR, arthritis, trauma |
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Instability:
1. when no occluding 2. when not incising 3. when occluding in centric |
1. • Border overextension
• Border underextension • Loss of posterior palatal seal • Tissue dehydration • Flabby tissue displacement 2.• Loss of posterior palatal seal • Anteriors too labial • Poor denture foundation • Improper incising habits 3.• Malocclusion • Flabby tissues • Teeth too buccal • CO ≠ CR |
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Interferences
1. Swallowing 2. Gagging 3. Clicking 4. Deafness 5. Muscle fatigue 6. general uneasy feeling |
1. • U posterior too long or thick
• L lingual too long or thick • Posteriors too lingual • Excessive VDO 2. too long or thick or moving 3. excess VDO, unstable denture 4. deficient VDO 5. excess VDO 6. malcocclusion, incorrect VDO; CO not equal to CR 4. |
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Esthetics
1. fullness under nose 2. depressed filtrum 3. sunken upper lip 4. shows too much teeth 5. artificial appearance |
1. labial border too thick or long
2. labial border too thin or short 3. upper anteriors too lingual 4. excess VDO, incisal plane too low, cuspids, laterals too prominent 5. poor set up, wear facets, lacks of custom gingiva |
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Phonetic complaints
1. whistle on S 2. lisp on S 3. indistinct T and TH |
1. anteiror palate too narrow
2. anterior palate too wide 3. inadequate interocclusal distance |
