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4 - misc > nae teeth > Flashcards

nae teeth Flashcards

1
Q

What are the options for replacing missing teeth?

A

No tx
Removable prosthesis
Fixed prosthesis
Implants
Orthodontic space closure

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2
Q

What are the pros and cons of no tx?

A

+ conservative and not destructive
- poor aesthetics
- loss of speech and masticatory function
- deterioration of occlusion

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3
Q

What are the criteria for SDA?

A

Dental problems limited to posterior teeth
Good prognosis for approx 8-10 pairs of anterior and premolar teeth
Pt limitations preventing extensive restorative care - finances, ill-health
Absence of parafunction or mandibular dysfunction
When biological cost of fitting an RPD will be too high

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4
Q

What is an SDA?

A

The retention throughout life of a functional, aesthetic, natural dentition of not less than 20 teeth and not requiring a prosthesis

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5
Q

What are the advantages of an RPD?

A

Appearance
Conservative - no/minimal tooth prep
Additions possible
Maintains masticatory function
Less expensive
Can be removed for cleaning
Good if multiple edentulous regions

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6
Q

What are the disadvantages of RPDs?

A

May be bulky and adaptation can be difficult
Multiple appointments required
May cause gagging or retching
Retention and stability may be a problem
Soft tissue coverage may result in plaque retention
Clasps may be unattractive

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7
Q

What are the advantages of bridges?

A

Better pt acceptance
Superior stability with chewing hard foods
Minimal soft tissue coverage
Easier plaque control
More natural appearance
RBB cantilever - minimally invasive

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8
Q

What are the disadvantages of replacing an edentulous gap with bridgework?

A

Less conservative - tooth prep may be required
With conventional bridges - 5-10% of preparations will result in pulp necrosis if crown prep is required
Abutments must be in good alignment and functionally adequate
More difficult to repair if damaged
More expensive

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9
Q

What are the advantages of replacing an edentulous gap with an implant?

A

Excellent aesthetics
No prep of adjacent teeth
Good maintenance of supporting bone
Simplified plaque control
Good restoration of speech, function and aesthetics
High long term survival

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10
Q

What are the disadvantages of replacing an edentulous gap with an implant?

A

Expensive
Needs long term maintenance care or risk of peri-implantitis
Not indicated in all pts - bone levels, MH
Risk of perforation into nasal cavity, maxillary sinus
Lengthy tx time
Technique dependent
Surgical procedures required

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11
Q

What are the advantages of restoring an edentulous gap with orthodontic space closure?

A

No tooth prep required
Aids in plaque control once space closure has been achieved

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12
Q

What are the disadvantages of restoring an edentulous gap with orthodontic space closure?

A

Movement is slow - long tx time
Requires good compliance and stable perio condition
May require tooth prep/restoration/indirect work following repositioning teeth
May not provide aesthetic appearance
Risk of root resorption
Can be expensive

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13
Q

Why would you use an RPD over a fixed prosthesis?

A

Replacing multiple missing teeth
Restoring long edentulous spans
Restoring free-end saddles
Managing alveolar resorption - RPD can provide lip support, teeth can be set ahead of the ridge to provide better support

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14
Q

What are the advantages of CoCr RPDs?

A

Stronger material
Better tolerance and taste sensation
More hygienic
Better retention potential

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15
Q

What are the disadvantages of CoCr RPDs?

A

Poorer aesthetics
Difficult to add to, repair and adjust
More expensive and involves more stages to make

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16
Q

What are the advantages of PMMA RPDs?

A

Good aesthetics
Easier to add to, repair and adjust
Has low density
Cheaper to process and requires less stages to make

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17
Q

What are the disadvantages of PMMA RPDs?

A

Brittle and susceptible to distortion
Must make them in bigger bulk to overcome brittleness
Less hygienic
Less strong
Less tolerable for some pts

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18
Q

What are the aims of surveying?

A

Establish path of insertion
Identify undercuts which may be used to retain denture
Identify undercuts to be blocked out prior to finish
Informs decision making on position, type and material of clasp

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19
Q

What instruments are used in surveving?

A

Analysing rod
Graphite marker
Undercut gauge
Wax trimmer

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20
Q

Where are rests placed in bounded saddles?

A

At equal distance on either side of the bounded ssaddle, so load is distributed evenly

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21
Q

Where should rests be placed on free-end saddles and why is this?

A

Further away from saddle ie - mesial of tooth
Reduces torque on the abutment so denture sinks into mucosa less, giving even compression of soft tissue distally

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22
Q

How large should CoCr rests seats be?

A

At least 1mm wide with 0.5mm depth

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23
Q

When is tooth support often used?

A

In bounded saddles

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24
Q

When is mucosal support considered?

A

Inadequate teeth available to support number of teeth being replaced
Teeth available in poor condition or if denture is transitional or immediate

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25
Q

When is tooth and mucosal support considered?

A

Free-end saddles
When inadequate teeth for tooth borne support only
There is a lower free-end saddle present - prevents last tooth from potentially tipping

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26
Q

What is support?

A

Resistance to a vertical displacing force directed towards teeth and mucosa

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27
Q

What is retention?

A

Resistance to vertical displacement of the denture

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28
Q

What are the types of retention?

A

Direct - keeps denture in place during function and at rest
Indirect - the ability of the denture to resist rotational movements

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29
Q

What gives a denture direct retention?

A

Neuromuscular forces
Physical forces - adhesion/cohesion to denture surface - comes with experience
Guide surfaces - parallel guide planes
Mechanically - clasps

30
Q

What depth of undercut is needed for each clasp material?

A

0.2mm - CoCr
0.5mm - SS
0.75mm - to deep

31
Q

What provides indirect retention?

A

Major and minor connectors
Rest seats
Saddles
Denture bases

32
Q

What is an RPI system?

A

Stress relieving system used for free-end saddles on lower arches
Includes:
- mesial occlusal Rest
- distal proximal Plate
- gingivally-approaching I-bar clasp

33
Q

How does each component of the RPI system work?

A

Rest prevents distal tipping of the premolar when occlusal forces act on the posterior saddle
I-bar clasp provides retention and disengages from the tooth when occlusal forces are places on the free-end saddle
The distal proximal plate provides retention. An undercut below it allows it to slide into the undercut, relieving pressure from the tooth during masticatory forces

34
Q

What is reciprocation?

A

Resistance against horizontal displacing forces on abutment teeth caused by clasp removal from undercuts

35
Q

How is reciprocation achieved?

A

Opposing clasp arm
By the connector - plate makes continuous contact with the tooth as the retentive arm moves through its retention distance

36
Q

What are minor connectors?

A

Join small components (rests, clasps) to the saddle or to the major connector
May contribute to bracing and reciprocation

37
Q

What is a major connector?

A

Links the saddles and minor connectors
Contributes to support, retention, reciprocation and bracing

38
Q

When are anterior plate/horseshoe connectors used and what are their drawbacks?

A

When several anterior teeth to be replaced
If maxillary tori present
Pt tolerance may be limited due to highly innervated rugae and mucosa

39
Q

When are mid palatal plates used and what are their drawbacks?

A

Leaves most gingival margins uncovered and well tolerated as allows sensation to uncovered mucosa
Contraindicated if maxillary torus

40
Q

When are full palatal plates used?

A

To distribute forces between teeth and mucosa
Can leave gingival margins uncovered but may act as food trap

41
Q

When is a ring design used?

A

Good if multiple saddles around arch
Well tolerated as increased sensation to uncovered mucosa
Good if torus would contraindicate a mid palatal plate or full palate

42
Q

What are the requirements for a lingual bar?

A

Space required - 8mm:
- 3mm away from gingival margin
- 4mm height for lingual bar
- 1mm above raised functional depth of FoM

43
Q

What are the pros and cons of a lingual bar?

A

+ well tolerated
+ less of a plaque trap
- cannot be used when inadequate space of prominent lingual frenum/torus

44
Q

What are the requirements of a sublingual bar?

A

Space required - 5mm:
- 3mm away from gingival margin
- 2mm height for actual bar
4mm thickness for rigidity

45
Q

What is used if there is insufficient space for a sublingual bar?

A

Dental bar or lingual plate

46
Q

List 3 non-elastic impression materials

A

Plaster
Impression compound
Zinc-oxide eugenol

47
Q

What are the different types of elastic impression materials?

A

Hydrocolloids:
- agar (reversible)
- alginate (irreversible)
Synthetic elastomers:
- polysulphide
- polyether
- addition silicone
- condensation silicone

48
Q

When is impression compound used?

A

Primary imps for complete dentures (Red IC)
Border moulding and tray extension (Greenstick)

49
Q

When is zinc-oxide eugenol used?

A

Master imps for complete dentures

50
Q

What are the components of alginate and what is their significance?

A

Trisodium phosphate - controls setting time
Polysaccharide - allows for irreversible setting
Calcium salts - causes the setting reaction by reacting with sodium
Filler - increases viscosity to increase handling

51
Q

What are the advantages of alginate?

A

Non toxic and non irritant
Good surface detail
Ease of use and mix
Cheap and good shelf life
Setting time can be controlled by water temp

52
Q

What are the disadvantages of alginate?

A

Poor dimensional stability
Poor tear strength
Can distord if unsupported
Incompatible with some dental stones
Setting time very dependent on operator handling
Messy
Needs good mixing so no air bubbles

53
Q

What happens if an alginate imp is left out in the open?

A

Syneresis - loss of moisture causing shrinkage leading to an inaccurate impression

54
Q

What happens if an alginate imp is stored in wet conditions?

A

Imbibition - water absorbed causing localised expansion where it has contracted water leading to an inaccurate impression

55
Q

What is the post dam and where is it anatomically?

A

The posterior extension of a maxillary acrylic denture that aims to enhance retention and maintain peripheral seal
Lies on the junction of the hard and soft palate - the vibrating line
Can be identifies using finger - vibrating line moves when the pt says ahhh

56
Q

What may occur if the post dam is placed in the wrong position?

A

Too deep - pain
Too anterior - lack of posterior seal and retention
Too posterior - poor pt tolerance, triggers gag reflex

57
Q

What are the advantages of replica dentures?

A

Increased success as able to reproduce successful features that pt is already accustomed to
Tooth position is already given to lab
Able to accurately alter undesirable features
Simplified occlusal registration
Reduced number of visits

58
Q

What are the disadvantages of replica dentures?

A

Cannot be done for RPDs
Cannot be done if major problems with old denture

59
Q

What are the indications for replica dentures?

A

Pt has successful denture but:
- is losing retention
- has difficulty when eating
- wants a spare
Following successful immediate replacement denture that requires replacement
To renew old, deteriorated and stained denture base material
For physically or psychologically impaired pts who cannot adapt to new dentures (utilises same neuromuscular control)

60
Q

What is an immediate denture?

A

A denture that is made prior to the extraction of the natural teeth and which is inserted into the mouth immediately after the extraction of those teeth

61
Q

What are the advantages of immediate dentures?

A

Maintenance of soft tissue contour of face
Maintaining appearance and mental well-being
Duplication of existing teeth and jaw relationship
Aids function
Prevention of tongue spread
Reduction in alveolar bone resorption
Protection of extraction site

62
Q

What are the disadvantages of immediate dentures?

A

Discomfort
Increased cost and number of visits
No trial denture stage possible - unable to assess aesthetics

63
Q

What is relining?

A

The addition of material to resurface the fit surface of a denture producing an accurate adaptation to the denture bearing area
Will increase the thickness of the denture

64
Q

What is an overdenture?

A

A denture that lies above one or more natural teeth or implants which gives it additional support

65
Q

What are the indications for overdentures?

A

Motivated pt with good OH
RCT treated teeth with significant tooth wear
If MH suggests avoiding extractions
To mask cleft lip and palate
Severe toothwear

66
Q

What are the advantages of overdentures?

A

Alveolar bone maintained
Improved retention, stability and support
Preservation of proprioception
Enhanced masticatory force
Additional retention possible using precision attachments
Psychologically aids transition from partial to complete dentures
Ridge preservation
Good pt tolerance

67
Q

What are the disadvantages of overdentures?

A

RCT usually required on natural abutments
Increased maintenance for patient
Needs meticulous OHI
Roots prone to caries
Higher cost and surgical risk if opting for implant-supported

68
Q

What denture hygiene instructions should be given?

A

Rinse denture after every meal
Remove debris by brushing with soft toothbrush, soap and cold water
Clean over basin full of water to avoid breakage if dropped
Soak in appropriate denture cleaning solution for recommended time
Rinse thoroughly with cold water then soak overnight in cold/room temp water
Do not sleep with dentures in
Do not use effervescent peroxides for long periods

69
Q

How should CoCr dentures be cleaned?

A

Do not use acid cleaners as metal will corrode
Soak in effervescent cleansers (alkaline peroxide) for 15 minutes
Or soak in alkaline hypochlorite for 10 minutes
Rinse and soak in cool water overnight

70
Q

How should acrylic dentures be cleaned?

A

Use alkaline hypochlorite for 20 minutes in evening if necessary
Alkaline peroxides fine to use
Rinse and soak in cool water overnight

71
Q

What is candida-associated denture stomatitis?

A

Secondary candidal infection of tissue modified by the continual wearing of an ill-fitting denture and poor denture hygiene

72
Q

What are the predisposing factors to candida-associated denture stomatitis?

A

High carbohydrate diet
Poor denture hygiene
Denture appliance wearing at night
Dry mouth and denture wearing
Diabetes

4 - misc (10 decks)

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