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1
Q

Define overdentures

A

Removable prosthesis that fits over retained teeth/roots or implants beneath the fitting surface

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2
Q

Types of overdenture

A

Partial or complete
Implant-retained or both implant-supported and retained

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3
Q

4 indications for overdentures

A

Gross loss of tooth structure
Cleft palate
Hypodontia
Difficult partial dentures

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4
Q

6 advantages of overdentures

A

Preserve alveolar bone
Better force distribution due to root support
Enhanced retention via natural tooth structure or attachments
Improve stability from combined tissue and tooth support
Improve masticatory function: proprioception from periodontal ligament, higher biting force
Increase patient acceptance

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5
Q

4 disadvantages of overdentures

A

Increased risk of periodontal issues
Increased risk of caries
Greater bulk, patient tolerance compromised
Risk of denture fracture where space lacking or heavy occlusal load

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6
Q

4 considerations prior to provision of overdentures

A

Periodontal status
Potential abutment teeth: ideally 2 per quadrant, well-spaced
Inter-ridge space
Jaw relationship

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7
Q

5 potential preparations to abutment teeth for overdentures

A

None or minor smoothing of surface
Coronal reduction to dome shape
Direct or indirect restoration
Coronal reduction, endodontics and direct or indirect coverage
Coronal reduction, endodontics and indirect coping plus precision attachment

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8
Q

3 benefits of copings

A

Protect the root face
Guide the overdenture into position
Aid proprioception

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9
Q

1 benefit of precision attachments

A

Aid retention from the root

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10
Q

3 disadvantages of precision attachments

A

Expensive
Difficult to maintain
Higher loading of teeth

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11
Q

3 ways to minimise problems with overdentures

A

Careful case selection and treatment planning
OHI, dietary advice
Topical fluorides

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12
Q

Define duplication dentures

A

For patients requiring replacement complete dentures which have been well designed and previously successful to allow for good neuromuscular continuity

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13
Q

3 indications for duplication dentures

A

Replacement of previously successful dentures, with improved fit and perhaps with some other small improvements incorporated
Spare dentures
Incorporation of some denture improvements for compromised patients

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14
Q

Advantage of copy denture

A

Replication of the polished surfaces
allows for rapid neuromuscular continuity and increased denture stability

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15
Q

3 stages in the provision of copy dentures

A

Take mould of dentures
Take impressions (PVS) in trial dentures
Insert new prostheses

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16
Q

3 stages in the method for producing mould for copy dentures

A

Take mould of existing dentures in alginate, in duplicating flasks
Send to laboratory along with prescription to pour resin moulds of existing denture, mount on an articulator in centric occlusion and replace teeth with prescribed mould and shade
Return existing dentures to patient

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17
Q

7 stages in the method for taking fit surface impressions for copy dentures

A

Check correct extension of resin moulds and extend with greenstick if neccessary
Remove undercut areas from denture
Make relief holes in anterior palate
Load with zinc-oxide eugenol or polyvinylsiloxane
Take closed mouth impression in RCP
Wax record in RCP if occlusion incorrect
Send to laboratory along with prescription to process for finish

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18
Q

1 indication for denture reline or rebase

A

Improve the fit of the dentures and a moderate amount of extension

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19
Q

Define denture rebase

A

Laboratory replacement of the majority of the denture base following clinical impressions of the fit surface

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20
Q

3 indications for denture rebase

A

Residual ridges have resorbed and adaption of bases poor, other than fit surface dentures are serviceable
Immediate denture 3-6 months after insertion, initial gross alveolar resorption has occurred
Construction of new dentures may cause physical or mental stress

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21
Q

5 denture requirements to be suitable for a rebase

A

Denture base extension adequate
Aesthetics satisfactory
Occlusion correct : a-p relation
OVD satisfactory
Speech satisfactory

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22
Q

Define denture reline

A

Reshaping of the underside of a denture as a temporary solution to improve denture fit using hard or soft materials

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23
Q

3 indications for denture reline

A

Temporary solution to improve denture fit
Treat pathology: denture-induced trauma, denture-induced stomatitis, denture-induced hyperplasia
Aid to diagnosis

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24
Q

6 stages in the method of denture rebase

A

Check extension and correct with border moulding or reduce
Remove undercut areas from dentures
Make relief holes in anterior palate of upper
Load with zinc-oxide eugenol or polyvinylsiloxane
Take closed mouth impression technique to maintain occlusal relations
Send to laboratory along with prescription to process denture rebase

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25
4 ideal features of an upper complete denture
Extension to hamular notch Extension to full functional depth and width of buccal and labial sulci Extension to non-moving junction of hard and soft palate Convex buccal/labial surface
26
6 ideal features of an lower complete denture
Extension to at least 2/3 of the retromolar pad Extension to full functional depth and width of buccal, labial and lingual sulci Convex buccal/labial surface Concave lingual surface Occlusal plane below the resting level of the tongue Teeth placed on top of alveolar ridge in the neutral zone
27
Define osseo-intergration
Direct mechanical and functional contact between living bone and implant
28
Define denture-induced stomatitis
Chronic inflammatory response of the denture-bearing mucosa to harmful stimuli related to the biofilm on the denture fit surface
29
3 types of denture-induced stomatitis as per Newtons classification
Type I: pinpoint hyperaemia Type II: diffuse erythema of denture bearing area Type III: papillary hyperplasia, can be drug induced
30
6 causes of denture-induced stomatitis
Continuous denture wear Poor denture hygiene biofilm/plaque Direct trauma from fit surface Salivary gland hypofunction Candida albicans infection Allergic reactions
31
3 problems caused by untreated denture-induced stomatitis
Poor fit of dentures Tissue hyperplasia Systemic candidal involvement
32
5 treatments for denture-induced stomatitis
Leave denture out at night Denture hygiene: 1% sodium hypochlorite, Chlorhexidine Relieve trauma Tissue conditioners Antifungals: Miconazole, Fluconazole, Nystatin
33
Reason to use current dentures to rehabilitate the jaw relationship prior to making new dentures
Treatment of acquired abnormal habitual mandibular position in cases where dentures worn for many years patients may not easily accommodate to sudden increase in the OVD ( > 3/4 mm)
34
What can you do 5 features can you copy to ensure new dentures aesthetics are similar to the previous dentures
Lip support: note tooth position and tooth proclination Incisal level at rest and function Anterior and posterior occlusal planes Width and form of arch Mould and shade of tooth
35
3 methods of using previous denture as a template
Copy by eye Trim rim against denture Take an impression of old denture as template for set up
36
Describe the impact of teeth being placed lingually and how this should be corrected
Likely to be displaced by forces of the tongue Prescribe to the lab that teeth should be set on top of the lower ridge in the neutral zone
37
3 surfaces to exam when assessing a current denture assessment
Fit surface: extension, maximum functional coverage of full upper and lower denture bearing areas, good peripheral border seal Polished surface: convex buccal/labial surface, concave lingual surface, correct contoured palatal surface Teeth: aesthetics, teeth placed on top of alveolar ridge in the neutral zone and occlusion ICP = RCP at correct OVD
38
How to clinically assess freeway space
Use Willis gauge or Callipers to measure the lower face height at rest vertical dimension and occlusal vertical dimension with current dentures in situ and calculate the interocclusal space between
39
Describe the ideal freeway space
2-4mm at the incisors
40
2 factors that can contribute to retention of a denture
Acquired muscular control Physical forces of retention
41
6 features that aid muscular control and denture retention
Ability of patient to acquire necessary skill can be reduced in elderly or illness Correct extension Correctly contoured polished surfaces Lower teeth placed on top of alveolar ridge Level of lower occlusal plane below level of resting tongue Correct occlusal relationships
42
3 features that aid physical forces of denture retention
Good peripheral border seal that ensures contact between denture periphery and mucosal tissue at all time Correctly extended denture surfaces Accurate fitting surface
43
Jaw relationship to restore to for complete dentures
Retruded contact position, the relationship of the mandible to maxilla when in its most retruded position
44
3 advantages of restoring to RCP
Reproducible Patient can easily accommodate to Allows set up to bilateral balanced articulation on the articulator
45
6 advantages of using Cobalt-Chromium as a denture base material for a RPD
Good biocompatibility High tensile strength High MoE makes rigid in thin section Low density makes RPD light Allow for precision casting, resulting in a more accurate fit Less porous than acrylic, less prone to bacterial and fungal accumulation
46
Describe how the choice of lower connector is influenced by the dimensions of the lingual sulcus
If < 4mm: lingual plate If 5-7 mm: sub-lingual bar If >8mm: lingual bar
47
2 advantages of lingual bar connector
Covers minimum surface area of teeth and tissue Relatively small, minimally interferes with functions
48
2 disadvantages of lingual bar connector
Not as rigid as the lingual plate or sublingual bar Requires minimum 8mm space: 2mm clear of gingival margin, 2mm clear of floor of mouth, 4mm bar width
49
3 advantages of sub-lingual bar connector
Rigid Well tolerated Good aesthetics
50
2 disadvantages of sub-lingual bar connector
Requires border moulded impression of floor of the mouth Not compatible with prominent lingual frenal attachments
51
2 advantages of lingual plate connector
Rigid Increased patient tolerance compared to lingual bar
52
2 disadvantages of lingual plate connector
May be associated with lingual gingival inflammation Impinges on gingival margins, causing stagnation areas
53
4 tooth modifications that can be prescribed in RPD design
Rest seat preparation Guide planes Survey line reduction Undercut augmentation
54
Describe 2 benefits of rest seat preparation
Provide more suitably inclined bearing surface for the occlusal rest to direct forces down long-axis of tooth Provide space between the occlusal surface of the upper and lower teeth to allow a rest of adequate thickness and strength to be used
55
Describe how to prepare rest seats
Use round diamond bur to cut occlusal rest of about one half of the bucco-lingual cusp-cusp width and one third of the mesiodistal width of the tooth
56
Describe 3 benefits of guide planes
Improves retention and stability Provides definitive path of insertion Improves aesthetics
57
Describe how to prepare guide planes
Use straight bur about to cut guide plane of about 2mm surface area at survey line to create parallelism
58
Describe the benefit of survey line reduction
Prevents premature occlusal contact with clasp
59
Describe how to carry out survey line reduction
Remove tooth tissue at survey line using straight bur
60
Describe 2 benefits of undercut augmentation
Improves retention and stability Facilitate ideal clasp design
61
Describe how to carry out undercut augmentation
Composite addition tooth surface to augment undercut
62
Jaw relationship to restore to for complete dentures
If patient has an ICP, reproduce this and set denture teeth to harmonise with existing occlusion If patient has no ICP, make denture occlusion correspond to RCP
63
Describe the 5 stages in wax registration for partial dentures
Try in wax occlusal registration rims, look for overextension of borders and reduce if required Try in one wax rim and trim with wax knife until 2mm space apparent between wax and opposing teeth Repeat for the other wax rim Place both rims in the mouth and eliminate contacts between rims to allow maximum intercuspation of the teeth Record position of maximum intercuspation in mouth using Zinc Oxide-Eugenol impression paste
64
3 components of the RPI system
Mesial rest Distal proximal plate GAC I-bar to mid-buccal convexity
65
Indication for the RPI system
For lower distal extension saddle to reduce torque on distal abutment while still deriving support and retention
66
Explain the mechanism behind the RPI system
When saddle is under load, proximal plate and I-bar disengage from the abutment tooth
67
Which lower distal extension saddle denture design feature dictates using a vertical POI
RPI system
68
3 alternatives to the provision of RPDs
Accept shortened dental arch (10 pairs of occluding teeth) Bridges Implants

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