1 - 3/4: The Trial Placement

Question 1

What relationship must the denture function in?

Answer 1

Harmonious relationship between the mechanical and the biologic

Question 2

What stage is a critical phase of complete denture care when evaluating the relationship between mechanical and biologic?

Answer 2

The wax trial denture stage

Question 3

What is a significant appointment for successful complete denture treatment?

Answer 3

Trial placement

Question 4

What attitude should a dentist approach the trial placement appointment?

Answer 4

Errors may exist in all areas

Question 5

The steps that convert dentures to acrylic resin may do what?

Answer 5

Limit the possibility of further corrections

Question 6

What is the trial denture?

Answer 6

A preliminary arrangement of denture teeth that has been prepared for placement into the patient’s mouth to evaluate esthetics and maxillomandibular relationships

Question 7

What is trial placement?

Answer 7

process of placing a trial denture into the patient’s mouth for evaluation

Question 8

What are waxs occlusion rims?

Answer 8

Crude approximations of positions of artificial teeth

Question 9

What are contours?

Answer 9

Arbitrary

Question 10

How are shapes and size of teeth selected?

Answer 10

Based on anatomic averages (are estimates)

Question 11

What is important to patient and dentist?

Answer 11

Trial denture evaluation

Question 12

What question does the trial denture evaluation help answer?

Answer 12

“Do we have the correct teeth in the correct locations?”

Question 13

What might be necessary during a clinical evaluation?

Answer 13

A checklist for the steps

Question 14

What should you use inside the trial bases?

Answer 14

Denture adhesive powder

Question 15

What should you clinically evaluate in trial dentures?

Answer 15

• occlusal vertical dimension
• centric occlusion
• midline, vertical and horizontal overlap
• occlusal plane
• buccal corridor
• phonetics
• overall esthetics

Question 16

How should you assess occlusal vertical dimension?

Answer 16

• numerous methods suggested
• all methods are unscientific
• should assess using a combination of methods for more accuracy

Question 17

What is the OVD assessment in physiologic rest position?

Answer 17

Normally 2-4mm space between teeth when mandible is in physiologic rest position

Question 18

What is the OVD assessment in stretch-relax method?

Answer 18

• dot on nose and chin. Open wide and hold for 20 seconds
• slowly close until lips first touch. Measure distance between dots
• after 10-15 more seconds, close until teeth touch. Measure dots again

Question 19

What are the difference in measurements in OVD during the stretch-relax method?

Answer 19

“interocclusal distance”
2-4mm average

Question 20

What is the swallow relax method in OVD assessment?

Answer 20

• Pnt is asked to swallow then relax. Teeth contact while swallowing, then separate upon relaxing
  Note: teeth should not be in contact at physiologic rest position

Question 21

How to determine the closest speaking space?

Answer 21

• rapid speech of sibilant sounds “sixty six, san francisco, kansas city chiefs, salt lake city, cincinnati”
• should be no contact of max. and mandib. teeth when speaking

Question 22

How should you perform the OVD assessment?

Answer 22

“Just look at it”

Question 23

What should you verify to determine centric occlusion?

Answer 23

Must verify that the casts are mounted correctly on the articulator

Question 24

How should you verify centric relation mounting?

Answer 24

• make new interocclusal record in mouth and check it on the articulator
• remember: either record base can move on soft tissue and the resulting occlusion may seem acceptable when its not
• REMOUNT CAST IF NEEDED

Question 25

How should you check centric position contacts?

Answer 25

- with articulating paper - stabilize the mandibular denture - new centric relation record - minimal amount of recording medium

Question 26

What does accurate mounting entail?

Answer 26

- teeth interdigitate perfectly (no space around the cusps) - condylar ball should contact fossae wall - if either criteria not met, remake record

Question 27

What is used to confirm inaccurate mounting?

Answer 27

- second record - mandibular cast removed from mounting ring - mounting plaster ground thinner - cast remounted, using the new record

Question 28

What is the level of occlusal plane in the anterior determined by?

Answer 28

Esthetics/phonetics

Question 29

How much of the incisor teeth are visible when the upper lip is resting?

Answer 29

1-2mm

Question 30

What is displayed when smiling?

Answer 30

Most of teeth length, but minimal amount of denture base "The white things look better than the pink stuff"

Question 31

What contact must the maxillary incisors have?

Answer 31

Positive contact with lower lip when fricative sounds "F, V, "very funny", are made

Question 32

What should be visible at the lower lip?

Answer 32

Mandibular incisors, slightly

Question 33

What should the occlusal plane be like in the posterior?

Answer 33

- mandibular molars at height 2/3 up RM pads - plane should be 2-3mm below dorsal surface of resting tongue - plane should parallel the two residual ridges and (usually) bisects the space between the ridges

Question 34

What are the maxillary posterior teeth parallel to?

Answer 34

Ala-tragus plane (camper's plane) - should not appear to descend posteriorly

Question 35

What are phonetics?

Answer 35

-easier to assess (Teeth have replaced bulky rims) - crowded tongue space can adversely affect phonetics

Question 36

How do specific sounds affect phonetics?

Answer 36

Sibilant sounds - "S", "CH" --OVD Fricative sounds - "F", "V" -- incisors hit wet/dry line of lip

Question 37

What are fricative sounds?

Answer 37

F, V, 'fifty five' Ask patient to count from 50-60 Maxillary incisal edges should just touch the posterior one third of the lower lip

Question 38

What are the five components of speech?

Answer 38

Respiration - lungs Phonation - vocal cords Resonance - pharynx, mouth, nasal cavity Articulation Neurologic integration - a learned activity

Question 39

What converts sound into meaningful speech?

Answer 39

Mandible, tongue, lips, soft and hard palates, alveolar ridge and teeth convert sound

Question 40

What happens if teeth touch when speaking "S" sounds?

Answer 40

OVD is too far open

Question 41

What happens if the speaking space is excessive?

Answer 41

More than approx. 3mm - OVD likely overclosed

Question 42

What does it mean if a pnt whistles or lisps on sibilant sounds?

Answer 42

Whistles - contour of anterior palate may be too narrow Lisps - anterior palate may be too braod

Question 43

What should the incisors approach in sibilant sounds?

Answer 43

End to end relationship

Question 44

What is lisping?

Answer 44

- non uniform overjet of the anterior teeth - diastemas between teeth - palatal contours - diamond shaped openings between incisors

Question 45

What should the incisal plane parallel?

Answer 45

Interpupillary line

Question 46

What should you evaluate when assessing esthetics/appearance?

Answer 46

Various harmonies of tooth size, form, position, arrangement, shade

Question 47

Where should posterior teeth be centered?

Answer 47

Mesiolaterally centered over denture-bearing area

Question 48

What is the checklist when evaluating how dentures fit on a patient?

Answer 48

- centric record verified with recording medium - vertical dimension verified: a. 2-3mm between lip closure and teeth touching b. phonetics tests "50s-60s" or "mississippi" - space between rims c. lips appear and feel unstrained - tooth form, arrangement and shade verified - phonetics verified "S", "F", and "M" sounds

Question 49

What does a protrusive record record?

Answer 49

Condylar inclinations of pnt

Question 50

What is a protrusive record used to adjust?

Answer 50

Articulator condylar angles - recird is made approx. 6mm protruded

Question 51

What schemes should a protrusive record be used for?

Answer 51

Balanced occlusion schemes only - is not needed for non-balanced schemes

Question 52

What is VERY IMPORTANT?

Answer 52

Patient approval - pt, family, friends - look in a large mirror, alone for a few minutes

Question 53

What do denture base contours affect?

Answer 53

Phonetics, comfort, and retention Should **not** be slightly convex in shape

Question 54

What do denture base contours ensure?

Answer 54

That the denture base is not unduly thick or thin - excess bulk impair comfort (feel between index finger and thumb) - base that is too thin will be weakened (should not be able to see through

Question 55

What should you request in a labaratory prescription?

Answer 55

- processing, finishing and polishing - lab remount of the dentures - adjustment of occlusion to compensate for processing changes