Exam, Diagnosis and Treatment Planning for Edentulous Patients

Question 1

3 DENTURE OCCLUSION

ARRANGEMENTS

Answer 1

1. BALANCED
2. NON-BALANCED
3. LINGUALIZED (can be used with 1,2)

Question 2

Balanced occlusion (Balanced articulation)

Answer 2

“the bilateral, simultaneous, anterior and posterior occlusal contact of
teeth in centric and eccentric positions” GPT

Question 3

anatomic, balanced occlusion indications (2)

Answer 3

young, healthy alveolar ridges

good neuromuscular control

Question 4

hanaus quint (5)

Answer 4

incisal guidance- anterior influence 
condylar guidance- posterior influence 
cusp hight (0, 20, 30 degrees)
plane of occlusion
compensating curve

Question 5

Condylar guidance is determined

by

Answer 5

the patient’s anatomy

Question 6

monoplane occlusion: indications (5)

Answer 6

excessive inter-ridge distance
skeletal class 2, class3, crossbones 
successful previous F/F were monoplane 
limited oral dexterity 
severely resorbed ridges

Question 7

Complete edentulism has differing

degrees of —

Answer 7

severity

Question 8

patient psychological classification (4)

Answer 8

philosophical
extracting/critical
hysterical
indifferent

Question 9

philosophical (4)

Answer 9

rational, calm, sensible, confident
“you make them, ill wear them”
the majority of patients
prognosis is good

Question 10

extracting/critical patient (5)

Answer 10

methodical, precise
somewhat difficult to please 
may try to dictate treatment 
may demand a written guarantee 
should make a special effort to be neat and organized when treating

Question 11

hysterical patient (5)

Answer 11

generally in poor health
oral conditions neglected
may blame dentist for poor oral condition
dont make promises

Question 12

indifferent patients (4)

Answer 12

unconcerned with appearance and chewing
often persuaded by relatives to seek treatment
diet often poor
prognosis poor unless education successful

Question 13

Make — of the mouth
as the patient presents! Measure
existing —.

Answer 13

impressions

VDO

Question 14

dental history (2)

Answer 14

chief concerns or why the patient is in the chair

history of previous treatment

Question 15

medical history (2)

Answer 15

overall health and current medications

interactions causing xerostomia

Question 16

Radiographic Exam (3)

Answer 16

Panoramic preferred
Evaluate pathosis : root tips, foreign bodies, impacted teeth
Evaluate mucosal thickness, foramen location

Question 17

“the relationship of oral examination to dental diagnosis” (3)

Answer 17

MM House
a 12 page article describing a classification system of the biologic conditions found in edentulous mouths
13 intra oral items classified

Question 18

MM House, 1958 (2)

Answer 18

classified biological conditions of inter arch space, muscle tone, arch size, arch form, ridge relations, ridge contours, border tissue attachments, muscles and frenum attachments, palatal throat form, saliva, tongue form, sensitivity of palate, and condition of mucosa 
class 1, 2, 3

Question 19

oral exam: ideal to unfavorable (3)

Answer 19

class 1: ideal
class2 
class 3: unfavorable

Question 20

oral exam: ridge size

Ideal

Answer 20

large enough for denture stability, small enough to leave room for denture bases and teeth

Question 21

oral exam: ridge size

unfavorable

Answer 21

too large for positioning of teeth, too small for any stability or support

Question 22

Small ridge size

House Class —

Answer 22

III

Question 23

Large ridge size

House Class —

Answer 23

III

Question 24

oral exam: inter arch space

ideal

Answer 24

space accommodates teeth and bases with esthetic result

Question 25

oral exam: inter arch space | unfavorable

Answer 25

too little space or too much space (torque lever is applied to denture bases)

Question 26

oral exam: ridge form | ideal

Answer 26

square to gently rounded

Question 27

oral exam: ridge form | unfavorable

Answer 27

tall, thin, undercut

Question 28

Tuberosities (5)

Answer 28

``` Space ? Dental mirror thickness –a guide Dental mirror handle –2 denture bases Ideal = 5-6 mm (Choy E., General Dentistry, May-June, 1977) Minimum = 4 mm ```

Question 29

Tuberosity/ridge exam | Look and Feel! (2)

Answer 29

Use your gloved first finger to feel the buccal and lingual ridge contours Mark (draw on) the diagnostic casts for communication with the patient and surgeon

Question 30

bony undercuts: unilateral

Answer 30

may be ok

Question 31

bony undercuts: bilateral

Answer 31

may need surgical correction

Question 32

sharp area of ridge: --- needed

Answer 32

surgery

Question 33

Palatal Torus (4)

Answer 33

Bony enlargement at midline of hard palate 20 - 25% of population More prevalent in women Maximum size in 3rd or 4th decade

Question 34

Palatal torus | surgical removal when: (4)

Answer 34

Large and fills palatal vault Is undercut Encroaches on vibrating line Pnt is concerned that it is cancer

Question 35

mandibular tori (3)

Answer 35

dense cortical bone covered by a. very thin later of mucous membrane extremely susceptible to irritation from denture base best treatment is surgical removal

Question 36

Palatal vault form | Ideal is

Answer 36

medium depth with well-formed rugae

Question 37

Palatal vault form | Flat =

Answer 37

poor resistance to horizontal movement of denture

Question 38

Palatal vault form | High, narrow, deep =

Answer 38

rapid break of peripheral seal and poor retention

Question 39

Soft Palate Class I = Class II Class III =

Answer 39

ideal (5 –12 mm available) -------- (3 - 5 mm tissue available) unfavorable(< 3 mm available)

Question 40

Border attachments: | Ideal =

Answer 40

muscle/ frenum attachments are 10 mm or | more from crest of ridge

Question 41

Border attachments: | Unfavorable =

Answer 41

attachments near crest of ridge and | may interfere with peripheral seal

Question 42

The tongue and complete dentures | major impact areas: (3)

Answer 42

Border seal Tooth placement Speech

Question 43

Normal tongue position (3)

Answer 43

Fills floor of mouth Lateral borders lie on post. alveolar ridge Apex approximates ant. alveolar ridge

Question 44

Retruded tongue (4)

Answer 44

25% of edentulous pnts Border seal is absent Stabilizing influence of tongue is absent Retention/ function of mandib. CD difficult

Question 45

tongue size | enlarged tongue- (2)

Answer 45

exerts constant dislodging force on mandibular denture | adaptation to denture may require months of dedicated effort

Question 46

saliva (4)

Answer 46

plays important role in denture retention quantity and quality important xerostomia from meds and systemic diseases xerostomia patients- prognosis for CD success is guarded to poor

Question 47

denture history (5)

Answer 47

``` years edentulous? previous dentures/current dentures successful? expectations? attainable? multiple sets of dentures made in a short time- not a good sign ```

Question 48

Evaluate existing dentures and make | impressions of them as reference (6)

Answer 48

``` Phonetics, esthetics, stability, retention, lip support, OVD ```

Question 49

prognosis (3)

Answer 49

advise patient of findings and discuss the prognosis: good, fair, poor educate patient about his/her role in mastering the use of dentures chewing efficiency: 20-25% natural teeth

Question 50

Complete edentulism has differing | degrees of ---.

Answer 50

severity

Question 51

``` Classification system for complete edentulism Class I --- Class II -- Class III -- Class IV – ```

Answer 51

straightforward denture-supporting anatomy degraded anatomy degraded; surgical revision needed; additional factors present most debilitated edentulous condition

Question 52

Classification system for complete edentulism | Diagnostic criteria are organized by their

Answer 52

objective nature and not in their rank of significance.

Question 53

Bone height –

Answer 53

mandibular only

Question 54

Residual ridge morphology –

Answer 54

maxillary only

Question 55

Muscle attachments –

Answer 55

mandibular only

Question 56

classification system for complete edentulism

Answer 56

``` in those instances when a patients diagnostic criteria are mixed between two or more classes, any single criterion of a more complex class places the patient into the more complex class ACP 1 ACP 2 ACP 3 ACP 4 ```