Objective 1 - Use of Removable Prosthodontics Flashcards
(68 cards)
1
Q
What is Removable Prosthodontics?
A
A specialized area of dentistry that replaces missing teeth with a prosthesis that the patient can place in and take out of the mouth freely.
2
Q
When properly fabricated, the removable prosthesis can improve…
A
speech and esthetics for the patient
3
Q
2 Major Types of Removable Prosthetics
A
A removable partial denture
A removable full denture
4
Q
What is a Removable Partial Denture?
A
Replaces one or more teeth in the same arch
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Q
What is a Removable full denture?
A
Replaces all the teeth in one arch
play a crucial role in restoring both function and aesthetics for individuals who have lost all their natural teeth. They rely entirely on the underlying oral structures for support and retention.
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Q
Extraoral factors affecting the recommendation and success of removable prostheses
A
- Physical Health
- Mental Health
- Patient Motivation
- Age
- Dietary Habits
- Social and Economic Factors
- Occupation
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Q
Intraoral Factors affecting the recommendation and success of removable prostheses
A
- Musculature
- Salivay Flow
- Residual Alveolar Ridge
- Oral Mucosa
- Oral Habits
- Tori
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Q
How does Physical Heath affect recommendation/success of removable prostheses?
A
Chronic conditions like diabetes and medications influence tissue tolerance to prosthetic pressure
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Q
How does Mental Health affect recommendation/success of removable prostheses?
A
Poor Mental Health affects the patient’s comfort and ability to maintain the prosthesis
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Q
How does Patient Motivation affect recommendation/success of removable prostheses?
A
Understanding patient motives, particularily if solely aesthetic, and exploring alternatives is essential.
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Q
How does Age affect recommendation/success of removable prostheses?
A
Design considerations differ for young patients (growth accommodation ) and older patients (perception of aging)
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Q
How does Dietary Habits affect recommendation/success of removable prostheses?
A
Nutritional status influences tissue health and subsequently prostehesis tolerance
13
Q
How does Social and Economic Factors affect recommendation/success of removable prostheses?
A
Patient attitudes, affordibility, and accessibility of treatment impact decision-making.
14
Q
How does Occupation affect recommendation/success of removable prostheses?
A
Concerns about appearance changes during treatment and scheuling appointments without disruption are vital.
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Q
How does Musculature affect recommendation/success of removable prostheses?
A
Muscle tone and tongue activity affect prosthesis retention and adaptation.
16
Q
How does Salivary Flow affect recommendation/success of removable prostheses?
A
Normal or excessive saliva production and conditions like dry mouth influence comfort.
17
Q
How does Residual Alveolar Ridge affect recommendation/success of removable prostheses?
A
Ridge resorption affects prosthesis fit and requires periodic evaluation.
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Q
How does Oral Mucosa affect recommendation/success of removable prostheses?
A
Tissue alterations and poor prosthesis fit can cause friction and sore spots.
19
Q
How does Oral Habits affect recommendation/success of removable prostheses?
A
Clenching, grinding, and mouth breathing affect stress on remaining structures.
20
Q
How does Tori affect recommendation/success of removable prostheses?
A
Overgrowths like mandi or maxi tori impact prosthesis fit and may require surgical intervention.
21
Q
Advantages of Removable Partial Dentures?
A
Flexibility, ease of cleaning, and avoidance of extensive dental procedures
22
Q
Indications for prescribing removable PARTIAL dentures include..
A
- Replacing multiple teeth in the same quadrant or arch
- Temp replacement for missing teeth in children - especially during growing phases
- Preservation of tooth structure
- Suitable for patients with time constraints - patients who cannot undergo lengthy dental procedures or who have difficulty tolerating extensive dental work
- Facilitating good oral hygiene - allow for easy removal enababling patients to maintain good oral hygiene practice
- Providing support for periodontally compromised teeth - a removable partial denture can serve as a supportive splint, helping to stabilize and distribute forces evenly across the remaining teeth
23
Q
Contraindications to prescribing a removable PARTIAL dentures include:
A
- Inadequate support from remaining teeth - if not enough suitable teeth in the arch to provide adequate support, stability and retention
- Severe dental conditions - such as rampant caries or advanced periodontal disease that pose a significant risk to the remaining teeth
- Patient dissatisfaction with aesthetics - may reject patrial dentures due to concerns about their appearance
- Chronic poor oral hygiene - inadequate cleaning can lead to complications such as plaque buildup, gum disease and bad breath
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Q
Major indications for prescribing full denture include..
A
- Complete edentulism - when a patient has lost all of their natural teeth in either or both arches
- Irreparable condition of remaining teeth - if remaining teeth are severely compromised and cannot be salvaged through restorative treatments, extraction may be necessary
- Incompatibility with partial dentures - not enough remaining natural teeth to support a removable partial denture effectively
- Patient preference - in cases where alternative treatment options are available but the patient refuses or is unwilling to pursue them
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Contraindications to prescribing a full denture include..
1. Availability of alternative treatments - if other viable treatment options offer comparable or superior outcomes
2. Patient's physical or mental health - illness that may impair their ability to cooperate during the fabrication process or to accept and wear the denture properly
3. Hypersensitivity to denture materials - if allergies/sensitivities to certain denture materials. Hypoallergenic materials may be indicated or alt treatment
4. Lack of interest in tooth replacement - patient not interested or does not prioritize dental treatment unless there are compelling reasons to do so for overall health/wellbeing
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Patrial dentures fall into two categories..
Acrylic and Cast
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Characteristics of Acrylic Partial Dentures
-Appropriate for short-term replacement of one or two teeth
-Base made from tissue-coloured acrylic with artificial teeth attached
-A wire reinforcement may connect the base to the acrylic artificial teeth. Thin wire clasps partially encircle the teeth necessary to hold the acrylic patrial in place
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Characteristics of Cast Partial Dentures
-are considerably stronger than acrylic because of the metal framework under and around the artificial teeth
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The metal framework of Cast Partial Dentures has the following components:
-Retainers (clasps)
-Connectors
-Minor Connectors
-Rests
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Purpose of Retainers in Cast Partial Dentures Metal Framework
Retainers (clasps) surround the natural teeth to hold the patrial denture in place
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Purpose of Connectors in Cast Partial Dentures Metal Framework
Bars that connect the left and right sides of the partial denture
-Lingual connector - located on the mandible, inferor and lingual to the anterior teeth
-Palatal Connector - on the maxilla, may cross the palate
-Saddle or Denture Base Connector - Metal framework that supports the artificial teeth and denture base acrylic
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Purpose of Minor Connectors in Cast Partial Dentures Metal Framework
Links major connectors to other areas of the metal framework
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Purpose of Rests in Cast Partial Dentures Metal Framework
The part of the framework that extends from the retainers or connectors and limits the seating of the partial denture. The rests wsit on the occlusal or lingual surface of the teeth and help distribute the force of occlusion to the teeth, rather than the alveolar ridge
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Denture Base of a Cast Partial Denture
Tissue coloured acrylic that retains the artificial teeth and enhances the esthetics of the partial denture by covering the saddle portion of the framework and extending into the vestibular area
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Artificial Teeth of a Cast Partial Denture
These come in a variety of shades and sizes that allow the partial denture to closely match the natural teeth. Usually made of acrylic, but sometimes porcelain
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What are Complete Full Dentures held in place by?
Complete dentures are held in place by the alveolar bone and oral mucosa, surrounding tissues and palatal structures
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Components of Complete (Full) Dentures
-Base
-Flange
-Post Dam
-Denture Teeth
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The Base of Complete/Full Dentures
-Fits over the alveolar ridge and gingival tissue
-Usually made of tissue-coloured acrylic
-If additional strength is needed, a wire mesh can be embedded in the acrylic
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The Flange of Complete/Full Dentures
Part of the denture that extends into the vestibule area facially, as well as lingually or palatally
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The Post Dam of Complete/Full Dentures
-Often described as the posterior palatal seal on a maxillary complete denture
-Extends across the entire palate behind the maxillary tuberosity
-Retention of the upper denture is dependent on the suction attained with the post-dam
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The Denture Teeth of Complete/Full Dentures
-Made out of acrylic or porcelain
-Set into the acrylic base
-Full dentures has 14 teeth in an arch, as third molars are excluded
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Why is Denture Relining or Rebasing required
Without teeth, the alveolar ridge resorbs overtime. This creates space between the ridge and the dentures and they become loose.
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What is Denture Relining?
Temporary and permanent methods of filling the space created between the alveolar ridge and the dentures due to resorbtion
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What is Denture Rebasing?
A more complete method of changing the contour of the denture base
-usually not done unless the denture is several years old, broken or severely discoloured
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What to expect for a Denture rebasing or relining appointment?
The patient will usually have to be without their denture(s) for an entire day when a permanent reline or rebase is needed
-The first appointment can be booked early in the morning for the impression to be taken using the denture as the custom tray
- Denture is sent to the laboratory for acrylic repair, rebase or reline - usually returned to the dental office the same day for insertion and minor adjustments
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What are Tissue Conditioners?
Tissue conditioners are soft elastomers used to stabilize loose dentures while treating irritated mucosa supporting the denture
Tissues damaged by poorly fitting dentures must be restored to healthy condition before new dentures or a permanent reline can be done
Tissue conditioner material is mixed, placed into the denture and seated into the mouth to remain for a period of time (temporary reline/functional impression)
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What is a Temporary Reline?
A required by patients who have had all teeth extracted and an immediate denture placed
-The alveolar ridge will resorb to the extent that the denture may loosen
- Tissue conditioner can make a patient more comfortable as resporption continues until a permanent reline can be done
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Can tissue conditioners be stained?
Tissue conditioners are porous, so can become stained and flavoured by foods and beverages and should be replaced periodically
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Reparing Broken Dentures
-A denture may require repairs due to fractures of the acrylic, missing/loose teeth or chips in either the teeth or the acrylic
- Some repairs can be completed in the office lab using self-cure or light-cure acrylics
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Repairing Broken Dentures at Outside Dental Lab
-Requires patient to leave dentures for a few days and return for an insertion appointment
-proper disinfection procedures must be followed to ensure contaminated dentures are not sent to the lab
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Duplicate Dentures
Many patients have duplicate dentures made for situations where a denture must be sent away for repairs. These are created at the initial denture insert appointment and kept as spares.
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What team member is responsible for fabricating removable prosthesis?
Dental Technicians who work in the Dental Labs
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Each set of dentures or partials is unique to the patient and they must fit perfectly. If they do not...
-chewing will be painful
-discomfort will result
-infection or tissue damage may result
*skilled dental lab techs review each detail of the patient's jaw, mouth and tissue structures to ensure the dentures are a custom fit
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Dental Technicians are...
-trained in the construction of dental prostheses
-can recommend the best products or techniques to the dental team
-can provide the dental team with info or even courses in new techniques or materials that are on the market
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Appointment/Lab Steps for Partial Dentures
1.
-Impressions taken in office
-Tech uses it to create working casts
-Mounts cast on an articulator
2.
-Lab constructs metal framework according to the dentist's design
-Sets teeth into supporting wax blocks
-Returns partial denture to the dental office
3. -Lab receives the final measurment on wax blocks
-Tech fabricates tissues in wax
-Tech positions teeth according to criteria ascertained by the dentist
-Lab returns partial to dentist for wax try in
4. -When the dentist and patient are satisfied with fit/esthetics, the lab finishes the partial denture with acrylic support for denture teeth
-denture is finished and polished, then returned to the dental office in a moist, sealed container
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Appointment/Lab Steps for Complete/Full Dentures
1. - Impression taken in the office
-Tech uses it to create working casts
-Mounts casts on an articulator
2. - Lab tech makes occlusal bite rims
-These allow dentist to establish the correct vertical dimension
3. - Lab receives final measurement on occlusal rims
-Tech fabricates tissues in wax
-Tech positions teeth according to criteria ascertained by the dentist within the bite rims
-Lab returns denture to dentist for a wax try-in
4. - When dentist and patient are satisfied with fit/esthetics, the lab tech replaces wax tissues with acrylic
-Denture is finished, polished, then returned to dental office in a moist, sealed container
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What are Pre-Op instructions for Removable prosthetics?
-Dental Assistant will explain to the patient what a partial or full denture is, and discuss the sequence of appointments (6 appointments)
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Upon delivery of final denture from lab, the DA will...
-first ensure that the denture is properly disinfected before insertion
-denture is checked by dentist for proper fit and any adjustments are made as necessary
-DA will explain to patient that a follow-up appointment will be made in a few days to ensure no further adjustments are needed
-DA will advise patient that a reline may be required in the future if there are any changes in the alveolar ridge and surrounding tissues
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DA will provide these written/verbal Denture home care instructions to patient:
1. When not wearing the denture it should be stored in a moist airtight container
2. The denture needs to be brushed and cared for after eating - removing food, debris and plaque
3. Keep away from pets.
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DA responsibilities before Patient Final Denture Appointment
-confirm the date of the case to arrive, adding a day or more before the patient's scheduled appointment
-ensure dentures are disinfected before try in patients mouth
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Laboratory Steps for Fabrication of Prosthesis
1. Transportation: Most dental labs have their own courier to come to your office to pick up the “case.”
2. Computer recording of case details: The reception personnel create a computer record for tracking and billing of the case.
3. Pouring of models: Specialized technicians pour up the working casts required to fabricate the fixed prosthetic. The models are poured in a very different way than in a dental office in order for the “die” of the prepared tooth to be removed from the rest of the cast.
4. Setting of the articulator: The bite registration is used to properly set the casts onto an articulator. This enables the technicians to simulate the patient’s occlusion during the construction of the prosthetic restoration.
5. Waxing of the prosthetic: The laboratory technicians create any portion of the prosthetic that is to be made of metal alloy in wax on the die. This wax will eventually be melted away and replaced with the molten metal alloy of choice.
6. Finishing and polishing of the metal structure or substructure.
7. Porcelain work: Many fixed prosthetics have porcelain faces or may even be fully fabricated from porcelain. The technicians have great skill in fabricating the porcelain in a manner that is both functional and esthetic.
8. Final finishing and polishing.
9. Final computer entry and billing.
10. Transportation: The courier will deliver the finished case back to the dental office for delivery to the patient.
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How long does it take for Lab to fabricate removable prosthesis?
The amount of time required by the dental laboratory to complete these steps varies. Usually 3-7 working days, unless the case is very complicated or the lab is extremely busy.
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What are Immediate Dentures?
An immediate denture is placed into the patient's mouth during the same appointment as extraction of teeth. The new denture acts as a bandage during the healing phase. NOTE: the try-in and evaluation of appearance appointments are NOT possible in this situation
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When are teeth extracted for an immediate denture?
Usually most of the posterior teeth are extracted prior to fabrication of an immediate denture.
Anterior teeth are left for aesthetic reasons and extracted just before insertion of the immediate denture
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Post-Op Instructions for Immediate Dentures:
* Keep denture(s) in place for first 24 hours. If removed, bleeding may not stop and there
may be swelling that will not allow reinsertion.
* Return to dental office the day after surgery. Denture(s) will be briefly removed for
cleaning and assessment of healing ridge.
* After the second day, denture may be removed briefly to facilitate cleaning and rinsing of
the oral cavity. Saline solution or mild antiseptic are acceptable rinses.
* Sutures need to be removed in 3-5 days. Dentist will make necessary adjustments to
denture(s) then.
* Frequent visits may be necessary for adjustments as alveolar ridge heals.
* When alveolar ridge is completely healed, the denture(s) will require permanent relining
with acrylic to customize the fit and enable retention.
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At Home Care Instructions for Dentures:
* Remove denture and thoroughly rinse oral cavity at least once a day.
* Clean denture daily with denture brush and running water or specialized denture paste,
or use an effervescent denture-cleaning preparation. Avoid regular toothpaste, as it is
too abrasive.
* If cleaning denture by hand, hold it over a sink containing cool water or a towel in case it
is dropped.
* Do not soak denture in hot water, bleach or any other chemical not specifically
formulated for denture cleaning.
* Do not wear dentures at night. This allows oral tissues to hydrate and oxygenate.
* When dentures are out of the mouth, they must be kept in a moist, airtight container to
prevent drying, warping and damage.
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How often should denture wearing patients see the dentist?
All patients wearing dentures should be seen by their dentist at least once a year, for
examination of the oral cavity and evaluation of the denture.
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