Removable Prosthodontics Final Exam Review

 

Exam will consist of 50 multiple choice questions. 

 

Know the 6 appointments involved in delivering a completed denture

 

1. Initial exam                                                                          
2. Final Impression                                                       
3. Occlusal Record and Tooth Selection       
4. Initial Try-In
5. Delivery/Insertion
6. Post-Insertion

 

[Appointments 1-5 are completed at 1 week intervals.  Appointment 6 is a follow-up and may be the next day]

 

Initial Exam

Take preliminary impressions

Instruct the patient on tissue conditioning

                        Rest à no wearing current denture at night and not at all 2 days prior to Final Impression appointment

                        Keep current denture clean

                        Keep oral cavity clean

                        Massage oral tissues

                        Use antifungal medications as needed

 

Final Impression

Standard Protocols

            Use of polysulfide impression material

                        Should be poured up within 24 hours

                        Can be transported (unlike alginate impressions)

                        This material offers only one chance

            Tray design employs the selected pressure technique à dentist selects areas of the tray that will apply

pressure ([P]) and areas that are relieved ([R]) of pressure

	Maxilla	Mandible
[P]	Posterior ridges Hard palate	Buccal Shelf Posterior ridge Pear-shaped pad (covered but no pressure)
[R]	Incisive papillae Anterior ridge	Internal oblique ridge Spiny ridge

 

Anatomical Considerations

            Know the location and relation of hamular notch, vibrating line, fovea palatinus to the forming the tray

            Know the class types for soft palate (Class I, II, and III) à Class I is best for adapting a denture

           

Anatomic Landmark	Significance
Buccinator muscle	Affects border mold in anterior 2/3 of vestibule
Coronoid process	Affects border mold at posterior buccal area on maxilla
Masseteric notch	Affects border bold at lower posterior area on mandible lateral to retromolar pad
Zygoma	Apply no pressure here
Mylohyoid ridge	Apply no pressure here
Retromylohyoid fossa	In edentulous patients, ridges can resorb to this level Mold border mold (slightly cooler, but still soft) material into fossa

 

 

Occlusal Record and Tooth Selection

Face-Bow Transfer

            Important to transfer VDR and VDO from patient to articulator

            Whip-Mix is actually an ear-bow transfer device, not a true face-bow à it is NOT a hinge axis

            It is possible to alter the articulator a few mm w/o losing centric relation

                        If the articulator was set w/o a face-bow, then changes should include a new occlusal record

 

Measurements

            VDR à vertical dimension or rest; measured with external reference points (chin to nose); pts lips are closed but not biting

            VDO à vertical dimension of occlusion; subtract 2-4 mm from VDR for an edentulous pt

            FS à freeway space; the 2-4 mm opening between incisal edges; also known as the interocclusal dimension

       IAD à interarch distance;space between arches

 

            ñVDO = òFS             ñVDO = ñIAD

 

            CR à centric relation; the most superior-anterior position of condyle

                        In edentulous patients this is the only reproducible position

                        Initiates the hinge motion

                        In edentulous patients there is not CO

 

Tooth Selection

            Use pre-extraction records (casts, pictures, etc.) à the most important

            Use existing denture

            Use marked rim

            Use facial shape, facial size, arch size

                        1:16 ratio of maxillary central incisors size to face size

            Gender – male teeth generally have different characteristics than female teeth

 

Hanau’s Quint

            This includes the five factors that affect occlusion

1.       Condylar angle (obtained from protrusive record, NOT from a face-bow)

2.      Occlusal plane angle

3.      Incisal guide

4.      Compensating curve

5.      Cusp midline

 

A steep incisal guide can be compensated for by ñ compensating curve or ñ cusp incline

            Changes in condylar angle call for similar changes in compensating curve (ñ with ñ, or ò with ò)

 

            Review the BULL rule and other occlusal rules

 

Edentulous Classifications (review the handout)

            Radiographic à measured from a panographic x-ray; mandible is measured at its least thickest point

            Class I à mandible measurement ≥21 mm

            Class IV à mandible measurement ≤10 mm

 

Mandibular Movements

Excursion	Right Side	Left Side
Right Lateral	Working	Non-working or Balancing
Left Lateral	Non-working or Balancing	Working

 

            Working Condyle à rotation and slight lateral (Bennett) movement

            Non-working Condyle à downward, forward, and medial movement (Bennett Angle)

 

 

There was not much said about these last three appointments

Initial Try-In

            The point we are at with our lab exercise

 

Delivery/Insertion

 

Post-Insertion

            This appointment can be the next day, or ad-lib (as needed)

 

There was also a handout at the review on Denture Factors, and it was suggested to review the lecture material on Blackboard