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46 Cards in this Set
- Front
- Back
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For immediate dentures, what is the secondary impression border molded with?
What must the final cast include? |
Made using light bodied rubber base.
Final cast must include all folds, teeth, and land |
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What is a challenge of seating the record base?
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May fall, will not be retentive.
Ways to manage this: 1. wire 2. adhesive -In the posterior, need to identify AVL and trim it. |
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What is made on the record base?
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Occlusion rim. Occlusion rim
extends to beginning of tuberosity Occlusion rim made parallel to ridge Posterior plane is determined by retromolar pad if no teeth present Centric relation is used if there are Extraoral positioning of casts in CR |
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What is the upper posterior set up related to?
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Upper posterior set-up
is based on lower plane of occlusion which in turn is based on RMP as a reference. |
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After patient likes the cast, what is done? Describe how teeth are replaced. What are done to the canines and laterals?
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-Replacement of missing central #8.
-tooth is luted directly to cast. -surgerizing the cast: make sure the ridge is convex. Create convexity to force ridge to heal with concavity. Must be careful to avoid concavities. -"ridge lapping" of canine: lingual of tooth is recontoured to fit against convex ridge. -socket shape is concave (overreduced) -lateral is luted + central removed. Contour of socket is convex (correctly contoured) |
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What does surgerizing the cast do?
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Surgerizing the cast
correctly helps us to estimate the topography of the ridge which is an unknown. |
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What is stent?
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Made out of clear acryilc by lab and is a duplicate of the final cast.
Purpose: used in order to recontour the soft and hard tissue by viewing the blanchingof tissue when its placed over the post extraction site to ensure adequate trimming of bone and tissue. Use this for tori removal, etc. -transperent so surgeon can easily visualize inspect areas of stress. 2 mm thick for rigidity. |
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Stage 1 extractions?
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Stage 1 : root tips, no aesthetic value. Extract teeth that arent holding the vertical.
-this is another way to help predict what the ridge will look like. |
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Stage 2 extractions?
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Patient may want to keep for aesthetics. Must have one vertical stop (such as tooth #1 over #32).
Immediate denture is placed over extraction site. Don't use pastes in areas of extraction sites. |
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After teh immediate denture is placed, what are 2 things you must look for?
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1. bilateral posterior contact
2. no anterior contact Prostheses will be relined as needed, most likely initially with a soft chairside liner to take up the space as the ridge resorbs |
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Case 2: ICU, cast partial lower
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Lower posteriors set to pad, and then upper posteriors are set.
Upper anteriors set to cast and upper posteriors set to record base. This allows for split try of upper and lower posteriors. A split try-in is done with the trial denture that includes the posterior teeth and any other tooth that can be tried in to verify VDO, CR, and phonetics. • This step is done prior to extracting the remaining teeth (known as stage 2 extractions). The teeth that cannot be tried in are those that were set directly to the cast, hence the term ‘split’. • The patient can view the final aesthetics on the articulator to give their approval |
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Name the 4 steps invovled in ICU, cast partial lower
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1. extract posteriors
2. replace posteriors 3. Try in posteriors 4. replace anteriors |
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Immediate denture steps
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• Extract posteriors (leaving 1 stop to hold vertical)
stage 1 • Replace posteriors with base & rim • Set posteriors on rim • Try-in posteriors • Set anteriors on cast • Process denture • Extract anteriors (and posterior stop) stage 2 - apply stent/osseus recontouring appliance -Insert dentures |
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Compare and contrast Complete and Immediate denture visits
1. primary impression 2. Seconary impression 3. CR methods 4. Try in 5. Insertion 6. Adjustment |
Complete
1. compound 2. rubber base 3. notch and wax 4. anterior and posterior 5. known 6. 24-48 hrs. Immediate dentures 1. aliginate 2. rubber base 3. teeth and wax 4. posterior only (split) 5. unknown 6. 24 hours |
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Advantages + disadvantages for immediate dentures
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Advantages:
• Esthetics • Surgical dressing • Ridge formation • Maintains Chewing • Maintains tongue • Maintains muscles • Maintains speech • Maintains VDO Disadvantages • Esthetics • Healing w/ ill patients • Accuracy • Occlusion • Overbites • No anterior try-in • Cost • Time |
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impressions + healing
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• Allow 6-8 months for ideal healing
• Allow approximately 4-6 weeks before impression of a wound (primary closure) • No minimum required for tissue conditioner |
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What are treatment dentures for?
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Medicate soft tissues. Use a tissue conditioner called COE comfort.
-must lubricate the intaglio surface where you want to medicate. Lubricate it below the retention of the TC on extent surfaces to facilitate removal of extruded TC flash. |
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What can happen with the tissue conditioner?
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-Can become desiccated when it has become colonized. Can cause tissue injury also by virtue of the fact that it has been hardened.
When you relign, must do this against an oppoising prosthesis as a reference. |
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Uses for tissue conditioner?
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• To condition tissues
Red Redundant • To retain dentures Immediates Ill-fitting • To impress tissues Relines Rebases • To diagnose problems Retention Pressure VDO |
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Rules for tissue conditioner (3)
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• Use opposing occlusion during
impression to maintain CO and VDO. • If doing both U and L, do one impression at a time, relining against the more stable prosthesis first. • Replace every 2 weeks. Otherwise... -can get epulis fissuratum on mandible -colonization |
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Overlay dentures are placed where?
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-Placed over retained roots.
Standard of care is an overdentures . Bone is preserved when teeth are preservedl -Presence of teeth preserve bone. |
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Abutment preparation for overlay enures?
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max height for abutment s is 3mm
-space analysis is critical too. Abutments should contact only during occlusion and only in their center |
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What is used for a chairside relin?
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Lubricant is added to denture prior to reline of wells.
-Can do chairside reline for the acrylic. |
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1. Overdenture purpose?
2. Where must you have contact between denture + abutment 3. What are 3 causes for abutment failture? 4. How do you conduct abutment failure follow up? 5. Abutment protection? |
• Purpose:
Bone retention • Contact between denture & abutment: Only during occlusion • Abutment failure causes: 1st Perio 2nd Caries 3rd Endo • Abutment failure follow-up: Extract roots Reline denture wells • Abutment protection: Coping Fluoride drops (Gel-Kam) |
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Define relines and rebases
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• Relines – replaces the inner 1mm of the. tissue surface only.
denture base • Rebases – replaces the entire denture. base |
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What is different about the relines and bases procedure?
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Clinically, the steps to
perform both a reline and a rebase are the same. What differs, are the laboratory steps. |
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What are 4 things you must do in evaluating the denture?
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• Check age of the denture
– See materials list • Contours of the denture – RELINE vs REBASE Immediate denture Older complete denture Rebase: Porosities (lab error) Shade (clinician or lab error) Midline fracture (not resolvable by simple repair) • Check occlusion – Adjust CO=CR • Check VDO – Maintain VDO? – Increase VDO? |
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For soft consistency, what are 2 types of curing methods, length of service of each? What procedure is done?
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1. Self cured - 1 mo, reline
2. Heat cured - 1 year, reline |
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What are 3 types of curing methods of hard consistency? Length of service of each? What type of procedures?
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1. Self cured, 1 yr, reline
2. Pressure cured, 3 yr, reline 3. Heat cured, 7 yr, rebase |
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Assessment of VDO
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• You must decide prior to final impression if
VDO will be maintained or increased – Maintain : if the VDO is still acceptable – Increase : if the occlusion shows signs of wear and loss of vertical, but is still serviceable. The increase will only be 1-2 mm maximum. |
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What position is required when seating the impression?
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Functional or closed mouth position is required. Seat impression for reline or rebase in good occlusion.
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What must be removed from the denture base? What is done to maintain VDO?
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conditioner or old
reline material & freshen up the denture base. Reduce all interior acrylic by 1mm except for 3 tissue stops at the CURRENT VDO. Use Boley gauge. Location of tissue stops: One in Anterior-but not on incisive papilla Two in Posterior-in front of tuberosities or RMP’s |
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What must be added to increase VDO?
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VDOAdd
compound tissue stops to the appropriate vertical. Maximum 1-2 mm. Stops in same location as previously described. |
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AFter you check for VDO, what is next?
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1. Treat the patient’s
existing denture like a custom tray… 2. …border mold functionally and place rubber base adhesive and let it cure before taking impression 3. Make a final impression using a mucostatic impression material such as light bodied rubber base. 4. Take CR |
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What if you have small, well circumscribed voids in the final impression? What line is marked on the final impression material?
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-Small voids can be filled with disclosing wax.
-Post dam is drawn on impression since cast doesn't exist. Mechanical post dam technique. Compressive tissue depths documented in record so cast can be scored after flasking. Alternatively, functional post dam technique can be employed using Kerr wax |
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After beading, boxing, when is the post dam cut into the cast?
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The Post Dam will be cut into the cast after flasking and boil out and
before the new acrylic is packed. The outline is transferred from the impression to the cast and now the cast can be scored using the depths docuented in the record. |
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Describe the flasking procedure for relining and rebase
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• Initially all 3 elements (impression, denture
and cast) are embedded in plaster in the lower half of the flask. • The edge of the flask holds the vertical in the same way that a pin does. • AFTER an occlusal index is made then the cast may be separated from the denture and impression between the upper and lower flasks. Here, the LAND acts as a vertical stop. Do not separate. |
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What is a Jig reline?
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Temporary solution with a pressure pot. Without an incisal pin or leveling screw, there's no way to maintin VDO after impression material is removed.
Level screw also you to maintain the VDO. Both flask and jig require an occlusal index. |
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Describe the chairside silicone reline
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• Soft Silicone denture liner (such as
Permasoft by Dentsply) is indicated for patients with severely resorbed and sensitive ridges, especially lower. • Provides durability of a laboratory processed soft liner in a chairside soft cured reline. -can be challening to adjust. Wide fluted burr will grabs onto silicone better w/o pulling or tearing. The material can also be cut w/ scalpel blade. -Shade is either clear or very pink. |
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Describe repair - why is this done? (3 reasons)
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1. replacement of teeth
2. addition of borders (incl PPS) 3. reposition of broken denture base segments |
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Describe tooth replacement repair
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1. select same size or larger tooth
2. residual portion of borken tooth is ground away 3. Tooth is luted on facial Space is created on lingual for repair acrylic Repair site using salt and pper technique |
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Describe incipient midline fracture repair
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Cause: weak repair site that is liable to refracture is indication for rebase.
Weak repair site with additional horizontal barbell cut placed perpendicular to fracture and widened cut on polished facial side. Weak repair site with additional horizontal barbell cut placed perpendicular to fracture and widened on polished palatal side. Repair site is NOT widened on intaglio Reinforcement pin used to stabilize site TMS pin or metal mesh reinforcement placed in groove prior to acrylic placement |
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How do you repair a fractured border?
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Missing
border replaced w/ Compound intra-orally. Block out undercuts; Cast poured to support denture & repair site/ = compound removed from denture and reseated |
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Denture base fracture at overlay abutment site
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Very Common
Be sure to check occlusion and proper height of abutments before addressing the repair. Parts splinted on temporary cast. Temporary Repair Cast can be made of dental stone or silicone putty Overdenture repair site likely to re-fracture & will need a Rebase as a follow-up for definitive treatment |
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Post dam augmentation
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Compound added intra-orally
and functionally to postdam area and to distobuccal areas bilaterally. |
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Pick up impression
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Adding teeth and base to a prosthesis
or Conversion of a provisional to an interim denture Depending on the repair, you must first create a cast with the denture in place. Pouring the cast with the prosthesis still embedded in the alginate produces a cast with a precise fit. DO NOT attempt to seat the prosthesis on a cast made without a pickup |
