12. Remount procedure Flashcards
1
Q
Desired articulation for complete dentures?
A
Balanced articulation
2
Q
During flasking there is a contraction of..
A
3-14 % in the acrylic resin
3
Q
When does deformation of the denture occur in the process of constructing it? What deforms?
A
- Flasking and deflasking
- changes in teeth positions
4
Q
Accurate occlusal adjustments are difficult to achieve if…
A
preformed in the patient’s mouth
5
Q
What cast is used for the remount procedure?
A
When taking a denture out of the flask, cast usually breaks. We make a new cast from the complete denture by putting the plaster into it directly
6
Q
Remount procedure: To achieve balanced articulation extraorally, dentures must be transferred and mounted in a semi-adjustable articulator with…? (2)
A
- Facebow transfer
- Centric relation occlusal records
7
Q
Remount procedure: PCPI?
A
Must be customized
8
Q
How many times must casts be mounted in the articulator for CDs?
A
- Teeth arrangement
2. Remounting procedure
9
Q
Who makes the remount casts?
A
Dental lab
10
Q
What happens to the working cast during manufacturing?
A
Usually destroyed while deflasking dentures
11
Q
Final dentures have a VD that is…
A
Increased by 0.5-1mm because the cast is not in the fossa directly
12
Q
Inadequate occlusal contacts lead to…? (2)
A
- Unsuitable load transfer to supporting tissues
(gingiva sores and bone resorption). - Reduction in retention and stability.
13
Q
Remounting: Back cuts/ retentitve areas of the inner surface of both dentures should..
A
Be blocked ( with wax or other materials )
14
Q
Remounting: _____ shaped wax plate is placed _____
A
- U shaped
- At lingual area
15
Q
What is poured on top of dentures for the remounting ? (2)
A
- Separating fluid is laid over inner surface.
* Type IV plaster is poured into the inner surface of the dentures.
16
Q
How do we get casts from dentures? (2)
A
- Dentures are centered in the base formers
- Before plaster fully sets: notches to ease removal of denture from plaster.
17
Q
Remount facebow transfer: PCPI/Bennet/Incisal pin?
A
- PCPI of 45o.
- Bennet angle of 15o.
- Incisal pin at 0 mm.
18
Q
Remount: facebow? (2)
A
- Ideally with a kinematic facebow.
* It’s difficult with edentulous patients, so arbitrary facebows are the ones most commonly used.
19
Q
Remount intermaxillary transfer: How is the aluwax heated?
A
45 degrees for 30s
20
Q
Remount intermaxilarry transfer: how thick is the aluwax?
A
1mm
21
Q
Remount intermaxillary transfer: Incisal pin? why?
A
+2mm to compensate the increased VD while flasking and aluwax
22
Q
Remount intermaxillary trasnfer: records must be taken at what VD?
A
almost the final occlusal VD
23
Q
Remount PCPI customization: wax record?
A
3mm thick hard wax
24
Q
Remount PCPI customization: steps? (6)
A
• At the articulator, make a protrusion of 3mm or
until front teeth are at edge-to-edge relation.
• Guide the patient to reach that position with his/ her dentures on.
• Heat the record, put it in place at take the PCPI record.
• Cool it down.
• Take it to the articulator to adjust PCPI value.
• Fix value for Bennet angle at 15 degrees
25
What are the occlusal equilibration goals? (2)
- MI at CR
| - Balanced articulation
26
Occlusal equilibration MI @ CR (3)
* MI happens at the desired OVD and with the condyles at centric relation.
* Simultaneous and equally intense occlusal contacts between all active cusps and their corresponding fossae.
* No occlusal contacts at the anterior teeth.
27
Occlusal equilibration Balanced articulation: at lateral mandibular position?
- Simultaneous contacts at both working and non-working sides.
28
Occlusal equilibration Balanced articulation: at lateral mandibular position WORKING SIDE? (2)
- Working side: contacts between homonymous cusps:
| ◦ Upper buccal against lower & same with linguals
29
Occlusal equilibration Balanced articulation: at lateral mandibular position NON WORKING SIDE? (2)
◦ Upper palatal cusps against lower buccal cusps
30
Occlusal equilibration: cusps engage ... (2)
Fossae or marginal ridges
31
Occlusal equilibration: cusps engagement should not be ...
- not strong - freedom to allow eccentric movements
| - Should not be flat occlusal surfaces to preserve masticatory efficiency
32
Ideal occlusal relationships: Upper palatal cusps contact?
corresponding lower fossae or marginal ridges (upper functional cusps)
33
Ideal occlusal relationships: Upper buccal cusps inclination?
have an antero-posterior inclination of 33 degrees
34
Ideal occlusal relationships: lower buccal cusps?
contact corresponding upper fossae or marginal ridges (lower functional cusps)
35
Ideal occlusal relationships: distance between cusps?
decreases from front to back
36
Occlusal reshaping: transversely at working side? (2)
- Upper teeth: the opposing tooth moves buccally. - Lower teeth: the opposing tooth moves lingually.
37
Occlusal reshaping: diagonally at non-working side? (2)
- Upper teeth: mesio-palatal direction.
| - Lower teeth: disto-buccal direction.
38
Occlusal equilibration: location of grinding for eccentric movements? (2)
- Always at cusp inclines.
| - Never at cusp tips.
39
Occlusal equilibration: which denture do we prefer to grind?
Lower to preserve esthetics
40
Occlusal equilibriation: Contacts with eccentric movements?
Must get maximum number of contacts
41
Occlusal equilibriation: Contacts with eccentric movements- working side? (3)
(homonymous cusps):
- Buccal cusps: upper inner inclines against lower external inclines.
- Lingual cusps: upper external inclines against lower inner inclines.
42
Occlusal equilibriation: Contacts with eccentric movements- nonworking side? (2)
- Upper palatal cusps: inner
inclines.
- Lower buccal cusps: inner inclines.
43
Occlusal equilibriation: Contacts with eccentric movements- protrusion? (2)
- Upper cusps: distal inclines.
| - Lower cusps: mesial inclines.
44
Occlusal equilibration: VD and grinding?
- Must be preserved
| - Grinding done preferably at nonfunctional cusps
45
Occlusal equilibration: preserving VD grinding exception?
Grinding must be done preferably at non- functional cusps (except for non-working side contacts and some CR contacts)
46
Occlusal equilibration: preserving VD- adjusting CR?
its better to grind bottom of fossae or marginal ridges than tip of cusps
47
Occlusal equilibration: preserving VD - prematurities in sagittal plane? (2)
◦ Upper cusps: mesial inclines.
| ◦ Lower cusps: distal inclines.
48
Occlusal equilibration: preserving VD - prematurities in frontal plane? (3)
◦ Between inner inclines of upper palatal and inner inclines of lower buccal.
◦ Between inner inclines of upper buccal and external inclines of lower buccal .
◦ Less likely between external inclines of upper palatal cusps and inner inclines of lower lingual cusps.
49
Occlusal equilibration procedure: steps? (3)
1. Lateral movements.
2. Protrusion.
3. Maximal intercuspation/centric relation.
50
What is the occlusal equilibration procedure with an atriculator with micrometrical screws?
equilibration is performed at condylar movements of 1, 2 and 3 mm
51
What is the occlusal equilibration procedure with an atriculator without micrometrical screws?
(like Artex/Kavo), the whole movement from CR to
| maximal lateral position or maximal protrusion is performed
52
What type of articulating paper do we use to assess if there are prematurities?
Thin articulating paper (4-8 μm)
53
What tools do we use to reduce pre maturities?
With high speed handpiece (turbine) or contra- angled handpiece with rugby ball burs (fine grit size – red band).
54
What colors do we use for lateral movements occlusal equilibration? (2)
- Blue articulating paper for working side.
| - Red articulating paper for non-working side.
55
lateral movements occlusal equilibration working side: There are only NWS contacts, that prevent WS
teeth to contact? (4)
```
◦ Least common possibility.
◦ Trim until getting contacts at WS.
◦ Diagonal trimming (mesially at upper/distally at
lower).
◦ Inner inclines of functional cusps.
```
56
Lateral movements occlusal equilibration working side: There are only anterior WS contacts (2)
◦ Canine guidance impedes posterior WS contacts.
| ◦ Trim labial surface of lower canine or incisors.
57
Lateral movements occlusal equilibration working side: There are only posterior WS contacts - general? (4)
◦ They impede NWS contacts.
◦ Most frequent possibility.
◦ Trim non-functional cusps transversely.
◦ Usually inner inclines buccal upper cusps are the ones that have to be trimmed. - inner inclines of buccal cusps
58
Lateral movements occlusal equilibration working side: There are only posterior WS contacts - buccal cusp contacts?
◦ Inner inclines of upper buccal cusps
| ◦ Or external inclines of lower buccal cusps, because of esthetics (even being functional cusps)
59
Lateral movements occlusal equilibration working side: There are only posterior WS contacts - Contact between upper palatal and lower lingual cusps?
Trim inner inclines of lower lingual cusps
60
Lateral movements occlusal equilibration working side: What do you check when you're done equilibrating? (3)
- Check that there are NWS contacts when
finishing with WS adjustment.
- If there are NWS contacts, they must be at the inner inclines of functional cusps, up to the 2nd molar.
- If not, continue trimming WS until there are NWS contacts up to the 2nd molar.
61
Lateral movements occlusal equilibration non-working side: Where should there be contacts?
between inner inclines of functional cusps
62
Lateral movements occlusal equilibration non-working side: If there aren’t contacts up to the 2nd molar, what are the two possibilities? (2)
- Any NSW that implies a prematurity
| - No NWS contact implies a prematurity
63
Lateral movements occlusal equilibration non-working side: there aren’t contacts up to the 2nd molar: Any NSW contacts that implies a prematurity? (4)
Trim diagonally:
- Distally for lower cusps
- Mesially for upper cusps
- Inner inclines of upper palatal cusps
- Inner inclines of lower buccal cusps
64
Lateral movements occlusal equilibration non-working side: there aren’t contacts up to the 2nd molar: No NSW contacts that implies a prematurity?
Trim diagonally:
- Distally for lower cusps
- Mesially for upper cusps
- Inner inclines of buccal cusps only
65
Occlusal equilibration protrusion: At the beginning of the movement (first 1-2mm) contacts should be... (4)
At both sides:
- Between upper functional cusps and lower fossae/marginal ridge
- Between lower functional cusps and upper fossae/marginal ridge
- No contacts at the front teeth yet
66
Occlusal equilibration protrusion: At 3mm contacts should be... (4)
- At distal inclines of upper cusps.
- At mesial inclines of lower cusps.
- At palatal surface of upper front teeth.
- At labial surface of lower front teeth.
67
Occlusal equilibration protrusion: Undesired contacts between upper and lower buccal cusps?
Trim distal inclines of upper buccal cusps (mesially)
68
Occlusal equilibration protrusion: Undesired contacts between upper palatal and lower lingual cusps?
Trim mesial inclines of lower lingual cusps (distally)
69
Occlusal equilibration protrusion: Undesired contacts between functional cusps and opposing fossae/marginal ridges?
Trim at fossae/marginal ridges mesially at upper teeth and distally at lower teeth
70
Occlusal equilibration protrusion: Undesired contacts at front teeth? (2)
- Trim at labial surface of lower front teeth and palatal surface of upper front teeth.
- Don’t trim incisal edges, especially upper ones.
71
Occlusal equilibration protrusion: Undesired contacts at both anterior and
posterior teeth? (2)
- Trim as previously stated if at 3 mm protrusion
| - At 1-2 mm of protrusion there should be no anterior occlusal contact
72
Occlusal equilibration centric relation?
* While closing the articulator there should be maximum number of contacts (MI).
* If there are only few contacts, one or both cusps can be trimmed.
73
Occlusal equilibration centric relation: MIOP? (3)
- Usually located at functional cusps.
- Mesial inclines of upper palatal cusps.
- Distal inclines of lower buccal cusps (better trimming place).
74
Occlusal equilibration centric relation: LIOP possibile location 1? (2)
Between:
◦ Mesial inner inclines of upper buccal cusps
(choice trimming).
◦ Distal external inclines of lower buccal cusps
75
Occlusal equilibration centric relation: LIOP possibile location 2? (2)
Between:
◦ Mesial inner inclines of upper palatal cusps
◦ Distal inner inclines of lower buccal cusps (better trimming place)
76
Occlusal equilibration centric relation: achieving maximum number of contacts, what are the two possibilities?
- There are only a few contacts at MI
| - There are many occlusal contacts but not of the same intensity
77
Occlusal equilibration centric relation: achieving maximum number of contacts - There are only a few contacts at MI (3)
- Trim that contacts until getting contacts at all
functional cusps/marginal ridges.
- Deepening fossae or trimming marginal ridges.
- Never trim tip of functional cusp.
78
Occlusal equilibration centric relation: achieving maximum number of contacts - Many occlusal contacts but not same intensity? (3)
- Trim stronger contacts until all have the same intensity.
- Deepening fossae or trimming marginal ridges.
- Never trim tip of functional cusp.
79
Occlusal equilibration final evaluation? (3)
• Look at general occlusal anatomy.
- If occlusal surfaces are flat, reshape them deepening fossae and sulci without altering balanced articulation.
• When everything is correct, polish with stones and diamond paste.
