Midterm 1 Flashcards
(153 cards)
1
Q
the estimated prevalence of complete edentulism in US patients between the ages of __-__ years is approximately __% (approx. __ million)
A
65-74 years
26%
23 million
2
Q
What is residual ridge resorption?
A
- life long remodel of alveolar bone
- chronic, progressive and irreversible
3
Q
what is one of the goals in CD therapy?
A
to mitigate the pressures exerted on the residual ridge to prevent further resorption
4
Q
What movement and resistance is lateral displacement and rotation during function?
A
horizontal movement and stability is the resistance for lateral displacement and rotation during function
5
Q
what is the movement and resistance for vertical displacement?
A
movement is going up and retention is the resistance for vertical displacement
6
Q
what is the movement and resistance for vertical placement?
A
movement is going down and support is the resistance for vertical placement
7
Q
what is the CD workflow?
A
- oral examination (clinical step)
- preliminary impressions (clinical step)
- diagnostic casts (lab step)
- custom trays (lab step)
- definitive impressions (clinical step)
- record bases and occlusion wax rims (lab step)
- maxillomandibular records (clinical step)
- artificial tooth arrangement (lab step)
- esthetic try-in (clinical step)
- processing (lab step)
- delivery (clinical step)
- remount (lab step)
- 24 hr post insertion adjustment (clinical step)
- 48-72 hour check (clinical step)
8
Q
what do you put for the medical history of the patient?
A
- what conditions may influence or contraindicate dental treatment?
- follow-up significant responses (uncontrolled HTN, DM II)
- note systemic conditions that may impact on therapy (e.g. sjogren’s syndrome, Bell’s palsy, diabetes)
- obtain physician consultations
- if debilitating disease present (e.g. Parkinson’s, dyskenisias): discuss with instructor, ensure acceptability as a student patient
9
Q
_____ patients with complex ___ are common
A
multi-morbid
polypharmacy
10
Q
what do anti-hypertensive meds cause?
A
dryness and postural hypotension
11
Q
what do corticosteroids and anti-parkinson agents cause?
A
dryness, confusion and behavioral changes
12
Q
what meds can affect CD therapy?
A
diuretics, antihistamines and atropine
13
Q
Therapies leading to _____ compromise the overall prognosis of ______
A
xerostomia
complete denture therapy
14
Q
what do you put in the dental history of the patient?
A
- what is the chief complaint with the current denture?
- how long has the patient been edentulous?
- history of tooth loss; caries, perio, trauma, finances?
- how many sets of dentures has the patient worn?
- satisfaction with dentures?
- what patient likes and what they want changed
- pre-extraction records: photos, previous casts
15
Q
in a radiograph, ____ roots lying close to the surface of the mucosa should be ___
A
fractured
extracted
16
Q
____ or ____ embedded in ____ may be left if they are ____
A
retained teeth
root fragments
bone
asymptomatic
17
Q
what to look for when doing an extra oral examination?
A
general appearance facial symmetry eyes and skin: color, complete, texture lips and smile line: length, thickness, symmetry and mobility palpation of head and neck muscle tonus TMJ examination: crepitus, clicking, popping, discomfort, deviations neuromuscular coordination
18
Q
what are the classifications of frontal facial forms?
A
square
tapering
square tapering
ovoid
19
Q
what are the classifications of profile facial forms?
A
normal - class I retrognathic - class II prognathic - class III
20
Q
what to look for in intraoral examination?
A
mucosa cheeks tongue floor of mouth maxillary tuberosities hard palate soft palate arch form and relationship residual ridge form quantity and quality of saliva presence of undercuts CHECK ONE ARCH AT A TIME
21
Q
what to look for in general tissue health
A
mucosa thickness mucosa condition - healthy, irritated or pathologic (which requires tissue conditioning) - inflammatory papillary hyperplasia keratinized attached mucosa mucogingival junction density color displaceability
22
Q
what to use to treat angular cheilitis?
A
an anti-fungal - diflucan
23
Q
what can you remove if it gets in the way of dentures?
A
epulis fissuratum ( denture epulis) aka inflammatory fibrous hyperplasia - a benign tumor of the connective tissue
24
Q
what to check for in the intraoral examination of the buccal mucosa
A
- draping of the cheeks over the buccal flanges essential for peripheral seal
- loss of muscle tonicity and overlapping is common
- common location for lesions (fibromas, cheek biting)
25
what to check for in the intraoral examination of the tongue
1) size - normal or large
| 2) position - normal, retracted/retruded (35% - happens with no dentures)
26
what to check for in the intraoral examination of the floor of the mouth?
- if FOM is near the level of the ridge crest, retention and stability of the denture is severely compromised
- hyperactive FOM also reduces retention and stability
- if great ridge resorption, FOM in sublingual and mylohyoid regions spill over the ridge
27
what are the residual ridge arch forms (house)?
```
class I - square (normal)
class II - tapered
class III- ovoid
```
28
What are the residual ridge forms (cross sectional contours) ?
u - shaped : most favorable for retention and stability
v-shaped: unfavorable
flat or shallow/knife edge: unfavorable, accompanied by resorbed ridges, poor resistance to lateral forces
flat
29
if maxillary tuberosities are _____ , it allows denture movement
hypermobile
30
____, _____ tissues are desired for maxillary tuberosities
firm
| non-moveable
31
if maxillary tuberosities are enlarged with fibrous tissue, the maxillary occlusal plane may be placed too ___ and surgical ____ may be necessary to create adequate ______ for denture bases and teeth
low
reduction
interocclusal space
32
what is necessary for accommodation of CD reduction in pressure ulcers?
ridge alveoplasty (alveolectomy)
33
what are the classes of the soft palate (palatal throat form)
```
class I: large and and normal in form; with a relatively immovable band of resilient tissue 5-12 mm distal to a line drawn across the distal edge of the tuberosities
class II: medium size and normal in form, with a relatively immovable resilient band of tissue 3-5 mm distal to a line drawn across the distal edge of the tuberosites
class III: the curtain of soft tissue turns down abruptly 3 to 5 mm anterior to a line dine across the palate at the distal edge of the tuberosities
```
34
what are the hamular notches?
- max posterior extent of the maxillary denture
| - forms the distal limit of the buccal vestibule
35
what does over extension of hamular notches cause
inflammation and pain
36
what does under extension of the hamular notches cause
non-retentive denture
37
another name for vibrating line
posterior vibratin line ?
38
where is the vibrating line located
at hard-soft palate junction
| ends are at the hamular notches
39
the mandibular ridge form has __ surface area for retention
less
40
the ___ and __ of the mouth in the mandibular ridge form interfere with retention
tongue
| floor
41
in the mandibular ridge form , the ___ of keratinized attached mucosa is confined to the ____
narrow zone
| alveolar ridge
42
in the mandibular ridge form, ___ will occur if denture is overextended
displacement
43
in the mandible , resorption occurs at a rate _____ than the maxilla
4x faster
44
what are the buccal shelves
consists of dense cortical bone
| are at 90 deg
45
as ___ of the ridge occurs, the buccal shelf ____ resorb because of it's muscle attachment
resorption
| doesn't
46
if mandibular frenum are ___ they may affect denture extensions, particularly the _____
prominent
| lingual frenum
47
what are the retromolar pads?
triangular pad of tissue at the distal end of the residual ridge
creates peripheral seal
48
in the retromolar pads, the underlying bone is _____ because of the muscle attachments and is ___ to resorption
dense cortical bone
| resistant
49
the retromolar pads must be covered by the ___ for support and lack of long term _____
denture
| cortical bone resorption
50
what are the primary and secondary bearing areas of the maxilla?
p: crest of the residual ridge
s: lateral aspects of hard palate
r: mid palatal raphe
51
what are the primary and secondary bearing areas of the mandible?
p: buccal shelves
s: crest of residual ridge
52
what does the retromylohyoid space (lateral throat form) determine?
this space determines the posterior extension of the mandibular denture lingual flange. this amount of available space will influence denture stability and retention
- have a type I, II, and III of this with I allowing for the most extension/space
53
____ and ___ are affected by the shape of the residual ridge
support
| retention
54
what is prognosis based upon?
```
bearing surface anatomy
ability to reproduce CR
tongue position
floor of mouth posture
neuromuscular control
dental history
psychological classical
```
55
what is the preliminary impression?
an accurate representation of all anatomical landmarks that permits fabrication of a properly extended custom tray that will facilitate a quality definitive impression
56
how to make a quality preliminary impression?
- center and extend your stock tray to cover all the necessary stress bearing areas and all the important anatomical landmarks
- dont' exert too much pressure during impression making to prevent any tray show through
- make sure you have a smooth, negative replica free of large voids
- must have a well-formed peripheral roll
- must have a reasonable accuracy of fine details
57
the goal of the preliminary impressions is to ___ the tissues and obtain and _____ impression that will facilitate the fabrication of custom impression trays
displace
| overextended
58
preliminary impression is poured using ___ and ___ dental stone (microstore)
vacuum spatulation
| type III
59
what are the measurements of the land area, base and depth of peripheral roll of the diagnostic casts?
land area: 4-5 mm
depth of peripheral roll: 2-3 mm
base: 15 mm
60
what are the steps to take a preliminary impression?
- lightly coat edentualous surface with petroleum jelly
- blue periphery wax is placed to help capture all relevant anatomical landmarks
- maxillary stock tray should extend from the labial vestibule to the hamular notches and slightly beyond the vibrating line
- mandible stock trays should be extended slightly posterior to the retromolar pads
- mix the powder and water according to instructions
- apply alginate to the vestibules and the palatal area of the typodont with your fingers in order to avoid incorporating air bubbles into the impression
- load the trays and allow the alginate to fully set before carefully separating the impression tray from the typodont
* a thick and creamy mixture will displace the edentulous tissues and produce an overextended impression
- setting time is 3-4 min
- make sure you have a well- made maxillary and mandibular impression with proper border extensions and anatomical details
- trim excess alginate with a bard Parker red handle and #25 blade to remove tongue space while preserving the peripheral rolls
- once the initial pour of stone has achieved in its initial set, invert the impression into a second pour of stone using pink base formers to form a base for the diagnostic cast
61
what's an ideal maxillary ridge?
```
abundant keratinized attached tissue
square arch form
firm, broad and tall residual ridges
moderate palatal vault
low frena attachments
```
62
whats an ideal mandibular ridge?
```
well-defined retromolar pad
abundant attached keratinized mucosa
firm, broad, and tall residual ridges
deep retromylohyoid space
low frena attachments
```
63
for the maxillary impression, the tray must extend beyond the ___ and ___ onto the soft palate
pterygomaxillary (hamular) notch
| vibrating line
64
for the mandibular impression, the tray must completely cover the ____ and extend to capture the _____
retromolar pads
| retromylohyoid fossa
65
to take the maxillary impression, direct the patient to ___ and ____ after seating the tray and alienation. instruct the patient to ___ while material sets
pucker
smile
relax
66
for the mandibular impressions, have patient ___ tongue and touch ___ while the material sets
protrude
| upper lip
67
a well made preliminary impression must have proper ___ and all relevant ___ captured
border extensions
| anatomy
68
what are custom impression tray?
individualized trays specific to each patient used for final impression purposes
69
the objective of custom impression trays are to fabricate a rigid tray of ___ thickness adapted to the ____ of the preliminary cast with borders approximating the ___ of the complete denture
uniform
contours
outline
70
the purpose of custom impression trays are to accurately record the ___, ___ and ___ of the ___ and of the _____.
```
shape
depth
width
peripheral roll
soft tissues
```
71
- purpose of the custom trays are to ___ impression material distortion b/c ___ thickness = accuracy
- ____ tissue distortion b/c ___ vicious material = ____ accurately adapted tray
- allow for accuracy by molding the borders resulting in improved ____
```
minimize
uniform
prevent
less
more
retention
```
72
what other trays can you use for CD fabrication?
thermoplastic trays (warner trays) - are low temp edentulous trays where you just put them in hot water, put em in the patients mouth and mold it according to their anatomy
73
requirements of custom impression tray design:
- made __ -__ mm short of the depth of the ___ of the diagnostic casts
- must be well adapted with ___ baseplate wax blockout of ___ to allow for ____ and ____ seating
- uniform __ -___ mm tray thickness
- ___ deg handle design should not impinge on the ___ nor interfere/distort the ____
- properly positioned finger rests on the ___ molar and ___ premolar region so the fingers don't distort the ___ when _____ and making the mandibular impression
```
2-3 mm
vestibule
minimum
undercuts
consistent
repeatable
2-3 mm
45
vestibule
lips
first
second
vestibule
border molding
```
74
what is outlined on the diagnostic casts with red and blue pencil?
- the greatest depth of vestibule is outline in blue
- a second line of red is drawn 2-3 mm short of depth of vestibule for the border molding material
- red line will determine initial tray extension and may reduce chair side adjustment time
- the labial and buccal frena and obvious muscle attachments must be relived/ allow clearance for them
75
need to soften and uniformly adapt __ thickenss/layer of baseplate wax ___ of the depth of the ____
one
short
vestibule
76
purpose of the wax spacer is to provide ___ for the impression material and ensure a consistently _____ during tray placement
space
| repeatable positioning
77
alternate method of providing tray relief/space is by....
incorporating evenly distributed tissue stops within the custom tray material
78
in the maxilla, tissue stops are placed on ___ alveolar ridge
posterior
79
in the mandible, tissue stops are placed on ____ and ___ alveolar ridge
buccal shelves
| posterior
80
size of the tissue stops are
4 x 4 mm
81
__ layer of triad trutray custom impression material is adapted to the ___ and trimmed at the line drawn __- __ mm short of the depth of the ____ (red line)
one
wax space
2-3 mm
vestibule
82
on the maxillary a ___ handle is shaped by placing a small rod of material over the ____ and shaping it into a ____ handle about ___ mm in height and ___ mm wide.
the tray handle should be at a ___ deg angle to the ____ of the ridge and should not interfere with the patient's ___
```
vertical
incisive papilla region
vertical
9 mm
10 mm
45 deg
crest
lips
```
83
in the mandible, __ finger rests are placed on the ___ segment of the tray. these stops hold the mandible tray in place when ___ and making the final impression. the handles should be ___ mm wide ____ in the ___ area and ___ mm wide _____.
These should be placed ___ from the ____.
```
2
posterior
bordering molding
20 mm
mesiodistally
molar
10 mm
anteriorly
vertically
alveolar ridge
```
84
each cast is placed in the triad curing unit for ___ min.
the cast is removed from the unit and allowed to ___.
the tray is___ from the cast and is placed in the ____ for ___ additional minutes facing ____.
case is taken to not ____ the wax spacer.
```
2 min
cool
teased
curing unit
2 min
upwards
melt
```
85
using an ____ bur, any ___ along the tray borders to the edge of the ______ are removed
acrylic rising trimming
excess
wax spacer
86
what are the advantages of the tissue stops and wax spacers?
- creates adequate tissue relief for the impression material
- help center and stabilize the tray on the edentulous residual ridge
- provide the clinician with a predictable position on tray reinsertion, helping to prevent over-seating the tray during functional border molding
87
- an additional __ mm of wax is ___ from the inside of tray to allow for ____ to overlap the edge of the tray and form a ____ shaped joint.
- the joint will be ___ enough to firmly ___ the impression material on the tray
```
2 mm
removed
border molding material
U
strong
retain
```
88
how should the custom tray look on the inside (intaglio)?
no sharp edges
custom tray must be stable on preliminary cast
flat edges of tray
uniform tray and wax spacer thickness
89
if border molder material extends ___ the wax spacer, then __ of the wax ___ to the impression ____ the border molding
onto
removal
prior
disrupts
90
What are some clinical adjustments that can be made to the custom tray impressions?
adjust extensions and receive arena for proper tray adaptation
91
The definition of border molding is to shape an impression material by ____ or ____ of the tissues to duplicate/record the _____, _____, _____ and ____ if the vestibule
```
functional
manual manipulation
contours
height
width
depth
```
92
what is the objective of border molding?
to determine the contours, height, and width of the borders of the complete denture
93
why is border molding necessary?
- to gain maximum bearing area for the denture, correct clearance for frenum and physiologic function of muscle and membranous attachments
- to obtain a peripheral seal for maximum stability and retention of the final denture
94
if border molding material ___ onto the _____ then the removal of ____ prior to the impression ____ the border molding
extends
wax spacer
wax
disrups
95
prior to border molding and making final impression, instruct the patient to ____ their dentures for ____ hours prior to the final impression appointment. This allows _____ and ____ of the edentulous mucosa.
leave out
24 hours
tissue recovery
keratinization
96
what are some characteristics of the Polyvinyl Siloxanes (PVS) (addition reaction silicone)?
- ease of mixing and dispensing
- good dimensional stability and accuracy (up to a week)
- excellent elastic recovery
- excellent dimensional accuracy
97
what are some characteristics of Polyether Rubber (PR)?
- stiffest of all elastomeric impression materials
- optimal recording of the functional periphery seal
- good dimensional stability (up to a week)
- hydrophilic
- excellent soft tissue detail
- bitter taste?
98
What are the elastic recovery, flexibility, tear strength (g-cm) and shrinkage (24 hr) of the non-aquaous elastomers?
```
poly ether rubber:
- elastic recovery: 98-99%
- flexibility: 2-3%
- tear strength: 1,700-4,800
- shrinkage (24hr): 0.3%
Addition silicone:
- elastic recovery: 99%
- flexibility: 1-5%
- tear strength: 1,600-5,200
- shrinkage (24hr): 0.001-0.2%
```
99
- the ___ are the key to successful impressions
- knowing which ___ and ___ produce the borders is a prerequisite to ____ impression making.
- knowledge of how to ____ the muscles and ___ the structures is also needed.
```
borders
muscles
structures
successful
activate
locate
```
100
wax spacer ___ during border molding.
| adequate ____ is key in edentulous final impression.
remains
| retraction
101
What are the 4 key actions for obtaining a good functional maxillary impression?
1) ask the patient to create suction around a finger and the impression tray handle
2) ask the patient to create suction around a finger, pucker or pooch their lips and produce a maximal smile line
3) ask the patient to open their mouth wide and then move their mandible side to side to stretch the ptergyomandibular raphe and allow the coronoid processes to shape the impression
- note: the 2 posterior areas are different due to more impact of the coronoid process movement on the right side. when you see this, repeat the border molding to verify the differences.
- impingement of the coronoid process in lateral excursive movements may cause pain and dislodging of the denture
4) pinch the patient's nostrils closed and ask the patient to attempt to blow air through their nose. make sure that the tongue is heard down using a mouth mirror. mark the hard-soft-palate junction. Have the patient pronounce the word "aah" or cough to locate the vibrating line so it can be marked, thereby identifying the area between the vibrating line and hard palate-soft palate junction.
102
what are the 5 key actions for obtaining a good functional mandibular impression?
* * locate the retromolar pads and buccal shelves (ensure the structures are covered by your custom tray)
1) ask the patient to create suction around a finger and the impression tray handle
2) pucker or smooch their lips and produce a maximal smile line
3) produce the word "Christmas" and the letters "Q" and "U" and pull the lower lip and cheek superiorly over the impression tray.
4) place a finger on the top of each side of the impression tray and ask the patient to close the mandible against resistance using one second intervals of applied force
5) ask the patient to raise their tongue to the roof of the mouth, then anterior to vermilion border, and then to the corners of their mouth. Ask patient to swallow (if possible)
103
After border molding is completed, the wax spacer is ____.
| care is taken to ___ dislodge the border molding achieved.
removed
| not
104
how to load the custom trays?
- enough material (2-3 mm thick) to replace wax spacer
- load quickly - viscosity increases rapidly
- avoid bubbles when loading
- bring material over peripheries
105
ill-effects of recording tissues in an excessively displaced position include:
1) when tissues are held in a displaced position, the pressure ___ the normal blood flow. when normal tissue are deprived of their blood supply, ____ of bone may occur.
2) space is provided inside the tray so the shape of the tissues covering the denture bearing area may be recored with ____ pressure or displacement.
limits
resorption
minimal
106
what doe a completed maxillary impression look like?
- smooth, well-defined peripheries
- adequate flange extensions
- soft tissue details
- maximum extension
- even pressure distribution (There should be no areas where the underlying tray or compound shows through)
- there should be intimate tissue contact
107
what does a completed mandibular impression look like?
- smooth, well defined peripheries
- maximum extension
- even pressure distribution (there should be no areas where the underlying tray or compound shows through)
- there should be intimate tissue contact
108
border molding determines the ___ of a prosthesis by using _____ or ____ of the peripheral limiting structures by duplicating the ___ and ___ of the vestibule
```
extension
tissue function
manual manipulation
contour
size
```
109
border molding occurs at the junction of the ____ and ____
attached mucosa
| unattached mucosa
110
the borders of the denture must accommodate the ____ of the frenums and ____
physiological movement
| muscles
111
when do you know you are done with border molding in maxilla?
- when you grab the border molded tray by the handle and pull downward, you should feel retention (Resistance to removal in a vertical direction)
- this means you have obtained a border seal (patients will actually get excited)
112
when do you know you are done with border molding in mandible?
- when completely border molded tray is in patients mouth, instruct patient to lick upper lip and the tray should remain stable
- if tray lifts upwards, the extensions are too long (over extension), material is carefully removed and reassessment of tray is essential.
113
what is the rationale in boxing the impressions?
- provides superior hardness of master cast surface
- provides land area that strengthens the periphery of the master cast
- maintains the thickness and contours of the border-lodes periphery
- minimizes cast trimming
114
what's the purpose of boxing the impressions?
- ultimately defines the borders of the final denture (These are important because they form the seal which keeps the denture in place)
- loss of border, either in the impression, in the cast, or by over polishing the denture borders will result in inadequate retention and stability
- controls dimensions of the master cast (must fit in processing flasks)
- produces a dense cast resistant to the high temps and pressures of acrylic polymerization
115
What are the steps for boxing and pouring and fabrication of master casts?
1) trim the excess impression material that extends the depth of the vestibule
- the edentulous typodont already had land area but patients don't have land area- there is a peripheral roll so remove all land areas from your impression to simulate a real patient before boxing.
2) measure and mark with a fine sharpie pen 3-4 mm below the borders of the maxillary and mandibular definite impressions. This line will represent how much to embed the impressions into the plaster-pumice mixture.
3) enclose the definite impression using one strip of red boxing wax over a clear plastic slab
- be sure to keep 4-5 mm circumferential space between the red boxing wax and the definite impression (this forms the LAND AREA of the master cast)
4) make a mixture by volume of lab plaster (100g) and pumice (100 g) and stir thoroughly while dry to assure uniformity. Add enough water to obtain a mix with a smooth, stiff and creamy consistency.
5) pour the mixture of plaster and pumice on a plastic slab in the preformed boxing wax strip
6) keeping the ridge portion of the impression parallel to the bench top, carefully settle the impression (tissue surface up) into the plastic pumice mixture
- use a spatula to draw the plaster pumice mix to the height of 3-4 mm below the border of the impression
7) after the plaster pumice has set, remove the base from the plastic slab and trim it on the cast trimmer until the land area is 5 mm wide.
8) leave the land areas approx. 4-5 mm circumferentially. smooth the land area with a sharp buffalo knife below the established borders of the maxillary impression. trim the pumice plate base using the model trimmer after setting to establish to boxing edge of 4-5 mm wide.
9) adapt the boxing wax to the invested impression so that the wax extends at least 15 mm above the highest point on the impression
* * you can also use rubber bands to keep the red boxing strip in place
10) seal the gap between the pumice base and boxing wax using a hot # 7 spatula and baseplate wax
11) using a bendabrush, paint the plaster-pumice surface with operating medium (SupraSep or vaseline)
12) vacuum mixed ISO type III yellow dental stone (buff stone) is vibrated onto the residual ridges and then allowed to fill the boxing waxed peripheries.
13) being by introducing small amounts of stone onto the impression. flow the stone laterally into the alveolar ridge portion. this will prevent entrapment of air bubbles. fill the boxed impression with the remainder of stone so it is flush with the boxing wax.
* ** allow 45 minutes setting time
14) once the stone is set, remove the boxing wax from the poured impression. carefully pry the base from the master cast using a sharp buffalo knife.
116
what are the specifications of the master cast?
- the land area must be smooth and 405 mm wide.
- the base of the cast should be 15 mm at the mid-palatal area (maxillary) and at the disto-lingual area (mandibular).
- the residual alveolar ridges of the cast should be parallel to the base of the cast and with the bench top
- in the mandibular cast, the tongue space should be smooth and open at the posterior for access.
- no voids should exist on the tissue surfaces of the master casts
- the walls and base of the master cast should be smooth and neat
117
What is the purpose of the posterior palatal seal?
a raised acrylic resin area at the posterior border of the maxillary denture that enhances retention and maintains the peripheral seal by compensating for:
1) polymerization shrinkage
2) minor denture base functional movements
118
the vibrating line (posterior border) is the junction between the ____ and ____ portions of the ____ palate
mobile
non-mobile
soft
119
the primary reason for a posterior palatal seal is to compensate for the ____ of the acrylic resin ( __%) that occurs during _____ procedures
shrinkage
7%
denture processing
120
retention of the denture ___ be maintained without ___ contact of the denture on the _____
cannot
tissue
PPS surface
121
the PPS is a raised area that will maintain ___ contact
intimate
122
it is imperative that the master cast fit in ____.
| cast guidelines must be followed to produce a ___ cast that can withstand the ______ and _____ of acres resin ______
```
processing flasks
dense
high temperatures
pressures
polymerization
```
123
record bases and wax rims establish ___ , record the ____ relationship and guide tooth position
VDO
| maxillo-mandibular
124
what is the purpose of maxillo-mandibular relations?
- determine the relation of the maxilla to the mandible
| - determine the position and arrangement of denture teeth
125
in order to establish a balance denture ____, we must transfer our patient's ____ relationship to the ____.
occlusion
maxillo-mandibular
articulator
126
what are record bases?
an interim denture based used to support the record rim material for recording maxillo-mandibular records
127
what are occlusion wax rims?
occluding surfaces fabricated on record bases for purposes of making MMR and arranging denture teeth
128
what is the purpose of record bases and occlusion wax rims?
- they establish facial contours by providing proper support of the lips and cheeks
- aid in orientation of the occlusal plane
- aid in tooth selection/arrangement and anterior tooth placement
- establish and maintain the vertical dimension of occlusion
- serve as a means of transfer of the face bow record
- temporary form representing the base of a CD
- determines the relation maxilla:mandible
- NECESSARY FOR MAKING STABLE INTEROCCLUSAL RECORDS
129
When making the record base fabrication, block out using minimal baseplate wax undercut areas to protect the master cast:
maxilla:
- labial surfaces of anterior ridge
- frenum areas
- rugae
- lateral areas of tuberosites
mandible:
- retromylohyoid fossa
- frenum areas
- facial aspect of anterior ridge
- buccal and lingual regions of residual ridge
130
what are the steps for record base fabrication?
1) wax block out
2) a thin layer of vaseline is applied to the master casts
3) place one layer of triad denture base material and adapt it to the master cast using light finger pressure
- extend to all vestibular areas
- the depth of the vestibules must be completely filled in to enhance the peripheral seal of the record base and improve retention
- use the red blade to carefully trim off excess material
* the record bases are not trimmed back as was done with the custom impression tray
- ensure that the border of the record base are smooth and rounded
4) place each master cast individually in triad curing unit and allow for 2 min of polymerization time
5) gently and carefully pry the record base off the master cast. place only the record base back in the triad unit (intaglio surface) for an additional 2 minutes.
6) trim and smooth the record base to obtain rounded borders.
* try not to shorten border extension areas or alter the intaglio surface of the record base
131
the completed record bases should stimulate the ___ and ___ base of the definite prosthesis. the borders fully extend into the depth of the ____ without any ___.
borders
denture
vestibule
voids
132
what is the function of occlusion wax rims
- to establish and maintain VDO
- to serve as a means of transferring jaw relations from the patient to the semi-adjustable articulator
- to serve as trial denture base
133
materials needed for occlusion wax rims
7A spatula + baseplate wax/preformed wax rims/ + flat spatula
134
what are the steps for wax occlusion rim fabrication?
1) clean the occlusal surface of the record bases where the occlusion wax rims are to be added (no vaseline)
roughen the areas to receive the occlusion wax rims (residual alveolar ridges)
2) mark the anatomical landmarks for occlusal plane determination and tooth position
3) uniformly soften two sheets of baseplate wax using the Bunsen burner. roll one sheet into another lengthwise to form a cylinder shape. Form the occlusal wax rim following the shape of the dental arch centering it over the residual ridge posteriorly and over the labial flange anteriorly. seal the wax to the record base with a hot was spatula. fill in voids with additional wax.
4) heat the flat spatula carefully and flatten the occlusal aspect of the rim. form the buccal and labial contours with the flat plate n a similar manner. any voids must be filled with wax.
135
what are the anatomical landmarks for occlusal plane determine and tooth position
1) crest of ridge
- aligns with central fossa of denture teeth
2) retromolar pad
- 1/2-2/3 the height of the pad dictates occlusal plane
- mark a line on the land area that bisects the middle of the RMP and is continuous with the center of the residual ridge
- mark a line of the land area that represents the mandibular occlusal plane which should be placed at the 1/2 to 2/3 the height of the RMP
136
what are the measurements of the occlusal wax rim
the occlusal portion of the rim should have the following width
a) molar region: 8-10 mm
b) premolar region: 5-7 mm
c) anterior region: 3-5 mm
- as viewed from the lateral perspective, the rim should project anterior to just beyond the outer edge of the land area of the cast
- the rim should be centered over the crest of the ridge to maximize denture STABILITY
- lingual contours must no impinge on the tongue space
maxillary:
- frontal view: height of the occlusal rim from the anterior labial to the incisal edge is 22 mm, 15 deg
- posterior view: 8 mm/12 mm??? and 45 deg
* posterior ends of the occlusal wax rim terminate at a 45 deg angle and end 8-10 mm short of hauler notch
mandible:
- frontal view: height of the occlusal rim is 18 mm, from the anterior labial flange to the incised edge 15 deg
- lateral view: 2/3 height of the RMP
- posterior: posterior ends of the occlusal wax rim terminate at one half to 2/3 the height of the retromolar pads or 1-2 mm below the top of the RMP
137
Posterior occlusion rim height of the mandibular wax occlusion
posteriorly, the occlusion rim intersects 1/2-2/3 up (height of) the retromolar pad
138
what are the requirements of satisfactory record bases and occlusion wax rims?
- maxillary record base must be retentive
- stable (no rocking)
- rigid
- accurately adapted to the master cast
- fully extend to the depth of the vestibule
- peripheries must be smooth and rounded
- be comfortable to the patient
- should stimulate the borders and denture base of the definitive/final prosthesis
139
what must be correct for the record base retention?
- must be stable for accurate interocclusal recordings
- inaccurate if loose:
* poor adaptation to cast
* excessive block out
* over or under extension
- use denture adhesive if slightly loose
- if pronounce looseness - REMAKE record base
140
place the maxillary record bas and wax rim in the patient's mouth and contour for proper ___, ___, ___, and ____
phonetics
esthetics
lip support
occlusal plane
141
what are some esthetic determinants?
```
wax display
lip support
facial midline
position of high lip line
smile line
interalar width/canine lines
incisal edge position of maxillary
anterior teeth
```
142
how much of the maxillary base record should be in the mouth when at rest?
women: average 1-3 mm
men: average 0-1 mm
with the lips at rest, wax rim should project 1-2 mm below the lip line depending on age and sex of the patient
-as you get older, the amount of space decreases and you show less of the maxillary
143
wax rim/tooth display can be adjusted according to __, ___, and ___.
with the lips at ___, a youthful appearance of an unworn dentition may display between __ and __ mm of the ____ incisors
```
sex
age
lip length
rest
2 mm
4 mm
central
```
144
with adequate lip support the angle between the lips and the nose should be
90-115 deg
145
the midline is marked by bisecting the ___ of the face and scoring a notch on the ___ wax rim. This must not coincide with the patient's ____ ignoring any deviation of the ____
long axis
maxillary
facial midline
146
what do you use to bisect the long axis of the face?
a 7 wax spatula and floss
147
how to determine the high lip line?
patient is asked to give an exaggerated smile line and a horizontal line is scribed on the wax rim to record maximum elevation or retraction of the upper lip
148
when the patient it smiling, the incisal edges follow the contour of the ____
lower lip
149
how do you determine the location of the canines?
canine lines are transferred to the occlusion rim as lines through the pupils of the eyes or as lines extending from the Ala of the nose. the distal aspects of the canines will fall approximately on either of these lines
150
how do you determine the incisal edge position
edge of maxillary rim must touch "wet-dry" junction of lower lip during pronounce of F or V sounds.
anterior portion of the maxillary rim is adjusted for phonetics and esthetics.
clinically determined by the assessment of the dynamic position of the anterior denture teeth during speech.
151
how do you establish the occlusal plane?
mediolateral orientation of the occlusal plane parallels the pupils. anterior portion of rim must be parallel to inter pupillary line.
goal is to parallel the occlusal plane with an esthetic reference plane - usually the interpupillary line.
152
what helps establish occlusal plane anteriorly and posteriorly?
trubyte Fox occlusal plane plate
153
occlusal plane is parallel to the ___ line also know as ____. ( __ border of Ala of nose to the ___ border of the tragus of the ear)
ala-tragus
camper's line
inferior
superior
