Study

Question 1

border moulding:

Answer 1

• on tray borders
• in secondary impression
• first ensure correct border extension
• incrementally add greenstick compound
• to obtain peripheral seal between the mucosa and the denture
• to record sulcus depth and width accurately
• both for CD and RPD
• for RPD is done in the mandibular anterior lingual sulcus and free end saddles bc we aim full extension of the flange -> to allow major connector fabrication in abutment teeth and gingival approaching clasps

-custom tray with ZOE

Question 2

RPD Design steps:

Answer 2

mark teeth to be replaced
POI
support - rests/saddles
retention - clasps
stability - bracing arms
major connector
indirect retention
undercuts
modify if needed

Question 3

RPD construction steps:

Answer 3

examine
primary impression
study casts
occlusal rims and wax bases
preliminary JRR
mount primary casts on articulator
survey primary casts
RPD design
custom trays
tooth preps
secondary impression
working casts
metal framework fabrication
metal framework insertion
definitive JRR
mount secondary casts
tooth mould and shade
tooth setup
trial insertion
finish
placement

Question 4

CD construction steps:

Answer 4

examine

primary impression

• to create the study casts
• mucostatic tech
• to record all tissues and sulci
• with stock tray

study/diagnostic casts

• for diagnosis
• to study the occlusion
• to fabricate the custom trays

custom trays
-to carry out 2ry impressions with border molding

secondary impressions

• to carry out border moulding to achieve peripheral seal
• mucocompressive tech
• ZOE
• with custom tray

working casts
-to create denture base which are stable, well supported and retentive

permanent denture base

• to ensure early that they are R,S,S
• to carry out JRR

occlusal wax rims
-to carry out JRR

JRR

• to find OVD, FWS and occlusal plane
• to find the position of the mandible relative to maxilla -record the H maxillomandibular relationship in RP of mandible at the selected OVD

mount casts on articulator (using facebow record)

tooth mould and shade

tooth setup

trial insertion

placement

check record

• to assess the occlusion
• carry out any occlusal adjustments
• to confirm the OVD

Question 5

JRR =

Answer 5

= any positional relationship of the mandible relative to the maxilla
-vertical, horizontal or lateral (ex: CR, MIP, RP)

For ICP cases: MIP
For non-ICP cases: RP

Question 6

Perforations on custom tray:

reason:
material:

Answer 6

• so that there is no detachment of impression material during impression removal
• for alginate only

Question 7

tissue stops on the rims of custom tray fabrication:

Answer 7

• to have adequate space b/w tray and teeth, so that when loading the material we will know where to stop
• to repeat position of tray as many times we want
• to do border molding

Question 8

why do we prepare teeth?

Answer 8

to ensure V loading
to avoid H forces
to avoid occlusal interferences

Question 9

fitting surface of tray

non-fitting surface of tray

Answer 9

fitting surface of tray -> rough -> to enhance material retention during tray removal

non-fitting surface of tray -> smooth -> to avoid gag reflex

Question 10

alginate vs silicone:

Answer 10

alginate:
ADV: non-toxic, cheap, pleasant taste, hydrophilic, elastic
DISADV: less surface detail, low tear strength, low dimensional stability

silicone:
ADV: high tear strength, high dimensional stability, high dimensional accuracy
DISADV: expensive, if undercuts then it locks

Question 11

RPD lab prescription:

Answer 11

patient and student names
type of RPD (acrylic or metal)
material (PMMA or CoCr)
teeth to be replaced
design components (rests, clasps, major connector, bracing arms)
tooth mold and shade
confirm disinfection
date and time work is required (1 day before app)

Question 12

Trial insertion purpose:

Answer 12

occlusion, aesthetics, flanges waxing, gumline, polished surfaces

Question 13

RPD

Finishing purpose:

Answer 13

check if the laboratory didn’t overtrim or overpolished the borders in free end saddles (no sharp edges)

Question 14

Placement purpose:

Answer 14

comfort first thing to assess -> pressure indicating paste
then occlusion
then ensure placement/removal, satisfactory retention, support, stability and correct occlusion and aesthetics

Question 15

CD
permanent base: (instead of temporary base)

ADV:
DISADV:

Answer 15

ADV:

• all adjustments are carried out on the permanent base at an early stage
• support, stability and retention can be assessed early on so there is time for corrections
• JRR is much easier
• at placement the denture base and borders will hardly need any adjustment
• at placement excessive trimming of base and borders can be avoided

DISADV:
-extra work for lab and extra costs

Question 16

CD

occlusal wax rims measurements:

Answer 16

upper jaw:
labially to extend 7-8 mm anterior to center of incisive papilla
doesn’t extend beyond M2
height: 10 mm anteriorly, slopping down 0.8 posteriorly
width: M 8-10 mm, P 5-7 mm, I 3-4 mm

lower jaw:
extends slightly anterior to the crest anteriorly (on the crest of the ridge)
doesn’t extend beyond M2
height: 2/3rds of retromolar pad posteriorly, slopping up to 8-10 mm anteriorly
width: M 8-10 mm, P 5-7 mm, I 3-4 mm (same)

Question 17

JRR steps:

Answer 17

• maxillary rim placed inside the mouth
• > occlusal plane based on aesthetics and anteroposterior position based on lip support
• > angle between columella and philtrum 90 degrees
• > laterally the wax rim should be parallel to ala-tragal line
• > Fox bite plane to help establish occlusal plane

-measure the RVD

• mandibular rim placed inside the mouth
• > ensure even contact

-measure OVD

• measure freeway space (should be 2-4 mm)
• > RVD-OVD
• > 2 dots placed with a skin marker and measure with dividers and ruler
• > if not enough space for FWS start reducing from mandibular rim

JRR:

• retention grooves
• vaseline on one of the two rims
• registration material (ZOE/wax/PVS)
• mark canine tip
• RP

Question 18

components for:

support:
stability:
retention:
indirect retention:

Answer 18

support: rests, saddles, mucosa, base
stability: bracing arms, flange, minor connector, base, sufficient height and width of alveolar ridge
retention: saliva, clasps, correct border extension, good base adaptation, sufficient border seal

indirect retention: flange, cingulum bars

Question 19

Anatomical structures of maxilla and mandible:

Answer 19

maxilla:
labial sulcus - labial frenum, orbicularis oris m
buccal sulcus - buccal frenum, buccinator m
incisive papilla - position of incisors, canines and midline
palatine raphe
palatal gingival remnant - palatal tooth surfaces
vibrating line - posterior palatal border
hamular notch - tensor veli palatine, coronoid process, masseter m

mandible:

• labial sulcus - labial frenum, orbicularis oris m, mentalis m
• buccal sulcus - buccal frenum, buccal shelf, buccinator m, mental foramen
• retromolar pad - masseteric m
• anterior lingual sulcus - lingual frenum, genioglossus m
• posterior lingual sulcus -mylohyoid m, retromylohyoid fossa

Question 20

review appointment for:

RPD or CD:
immediate dentures:

Answer 20

RPD or CD: 1 week after placement

immediate dentures: next day

then review after 6m

Question 21

why immediate dentures cannot be considered a predictable tx option:
/
limitations of immediate dentures:

Answer 21

• JRR may be incorrect due to condition of remaining teeth
• presence of deep soft tissue undercuts
• placed while the patient is under LA effect
• placed in patients who haven’t accepted the fact that they are edentulous
• can be their first denture wearing experience and can also be a negative one
• impression procedures are suboptimal

Question 22

Immediate denture construction steps:

Answer 22

examine
primary impressions
study casts
survey
IPD design
custom trays
secondary impressions
working casts
record base and occlusal rims
JRR
mount casts on articulator
tooth mold and shade
tooth setup
trial
finish
placement

Question 23

main concerns with Kennedy Class:

1:
2:
3:
4:

Answer 23

1:
free end saddles support
-especially on the mandible
-prevent saddles movement towards tissues
-wider residual ridge coverage
-rpi clasp system (protects abutment tooth from pulling forces)

2:
free end saddles support and RPD extension
-cross arch stabilization needed
-consider implants
-avoid unilateral design so that patient doesn’t swallow/inhale it

3:
occlusal interferences and RPD extension
-cross arch stabilization needed
-consider implants
-avoid unilateral design so that patient doesn't swallow/inhale it

4:
POI, aesthetics, type of major connector, black triangles, big enough denture so that patient doesn’t swallow/inhale it
-labial flange needed (posterior tilt and then rotating posterior denture part)
-clasps placed on molars, not on anteriors

Question 24

Semi-adjustable articulator:

Answer 24

• easier to understand mandibular movements
• facilitates CD construction
• allows more adjustments
• accepts facebow transfer
• works for both fixed and removable

Question 25

how can a RPD cause damage to the remaining teeth?

Answer 25

- plaque accumulation resulting in caries and perio disease - creating occlusal interferences which may cause excessive wear of opposing teeth - transferring H forces to abutment teeth - causing crown fracture if occlusal rests are not designed correctly - damage of mucosa, non-abutment teeth and ridge if RPD design is incorrect

Question 26

steps done in the lab - examples:

Answer 26

fabrication of custom trays fabrication of metal framework tooth set up finishing

Question 27

Relining: indication: how to assess clinically:

Answer 27

indication: - loss of support of free end saddles - food trapping - patient reported discomfort - aesthetics -assess what happens if you press the free end saddle

Question 28

tooth preps:

Answer 28

- thin layer on enamel - no LA needed -guide planes: done to establish POI and avoid path of withdrawal 3 mm height remove < 0,5 mm and follow tooth circumference for reciprocation

Question 29

why do we prepare rest seats on teeth?

Answer 29

- to avoid food trapping - to avoid occlusal interferences - to avoid H forces - to achieve the most favorable distribution of occlusal forces

Question 30

major connectors: maxillary: mandibular:

Answer 30

maxillary - palatal strap (single or anterior/posterior) - >single: K class iii - >anterior/posterior: all K classes - > rigid, little interference w/ tongue - palatal plate - > covers more than half of the plate - u-shaped (for torus) - palatal bar mandibular - lingual bar - > hygienic, good aesthetics, no interference w/ tongue - > needs 7-8mm height, issues w/ tooth additions - lingual plate - > needs less than 7-8 mm height, easier future teeth additions - > not as hygienic, visible, interference w/ tongue - sublingual bar - cingulum bar - lingual bar with cingulum bar - labial bar - > for retroclined teeth

Question 31

What will happen if the free end saddle is not well supported?

Answer 31

* The RPD will ‘sink’ towards the tissues * Denture teeth will not be in occlusion any more * Pain and discomfort * Increased rate of residual ridge resorption * Tilting forces applied on distal abutment tooth * Excessive forces applied on the other teeth * Anterior components of the RPD will tend to ‘lift’ away from the tissues * Further damage soft and hard tissues

Question 32

study cast vs working casts:

Answer 32

study casts: - primary - diagnostic reasons and tx planning - dental stone III working casts: - secondary - metal framework fabrication - dental stone IV

Question 33

primary impression steps:

Answer 33

- stock tray - modify tray with wax - adhesive - putty (only on edentulous areas) - place in mouth - cut 2-3 mm when out of mouth to create space for alginate - adhesive - alginate - place in mouth

Question 34

RPD: JRR: preliminary: Vs definitive:

Answer 34

preliminary JRR: - to mount the primary/study casts - before tx plan finished - occlusal wax rims with record bases - to check whether and how we can fabricate an RPD Vs definitive JRR: - to mount the secondary/working casts - occlusal wax rims with metal framework instead of record bases - to set up the artificial teeth - during RPD fabrication

Question 35

surveyor =

Answer 35

paralleling instrument for prosthesis reconstruction | -for abutment teeth and associated structures position

Question 36

custom tray:

Answer 36

- needed instead of stock tray due to specific material thickness - if locked is easy to be cut in half instead of using a stock tray - you can reduce potential errors in depth and sulcus during impression by controlling extension and shape of tray borders - for border molding

Question 37

check record:

Answer 37

OVD confirmation JRR confirmation occlusal adjustments - premature interferences

Question 38

dentures left overnight:

Answer 38

``` bacterial overgrowth bone loss cracks -> soaked in liquid all night colds/illnesses due to bacteria gum inflammation looser dentures bone resorption -vely affects saliva -> denture stomatitis ```

Question 39

‘My dentures are loose’ may refer to:

Answer 39

* Lack of effective border seal * Lack of close contact between denture bearing tissues and denture base * Underextension * Overextension * Lack of stability * Lack of support * Premature occlusal contacts

Question 40

‘I can’t eat with these dentures’ may refer to:

Answer 40

* Lack of support * Lack of stability * Pain due to overextension * Pain due to premature occlusal contacts * Insufficient interdigitation * Significantly reduced OVD * Increased OVD * Incorrect occlusal plane level

Question 41

‘These dentures don’t look right’ may refer to:

Answer 41

* Incorrect anterior tooth setup vertically, e.g. maxillary anterior teeth set up too high or too low * Incorrect anterior tooth setup horizontally, e.g. maxillary anterior teeth set up too far labially or palatally * Incorrect tooth mould * Incorrect tooth shade * Asymmetrical tooth setup * Midline mismatch * Incorrect occlusal plane orientation * Excessive labial flange thickness * Insufficient lip support * Overextension of the mandibular buccal flange

Question 42

‘My dentures are too big’ may refer to:

Answer 42

* Excessive OVD -> decreased FWS - megalo stoma * Excessive denture base thickness * Excessive polished surfaces thickness * Overextension * Incorrect tooth mould (size) -> poli megala dontia

Question 43

for severe gagging reflex patients:

Answer 43

- choice of trays that don't extend excessively - choice of impression materials that don't easily flow backwards - choice of the right amount of this material so you don't end up with excess flowing backwards.

Question 44

pain only during removal/insertion of denture:

Answer 44

insufficient relief from undercuts

Question 45

localized pain/discomfort:

Answer 45

due to poor impression technique

Question 46

posterior overextension:

Answer 46

difficulty in swallowing

Question 47

generalized pain/discomfort:

Answer 47

underextended denture base | increased OVD

Question 48

``` lip biting: Vs cheek biting: Vs tongue biting: ```

Answer 48

lip biting: - insufficient lip support - decreased OVD - insufficient overjet - upper anteriors set too palatally cheek biting: -posterior teeth placed too palatally tongue biting: - posterior teeth placed too lingually - occlusal plane set too low

Question 49

8 common reasons an RPD would suddenly become unretentive after years of it being successful:

Answer 49

- periodontal condition of abutment teeth - fracture of clasps - resorption of alveolar ridge - denture stomatitis - allergic reactions causing irritation of the tissues - xerostomia (medications) - broken rests providing indirect retention - teeth loss

Question 50

4 ways to confirm the OVD in CD clinically:

Answer 50

- check record - phonetics - incisors height measurement - previous photographs - patient relaxation

Question 51

mucostatic technique: mucocompressive technique: selective-mucocompressive technique:

Answer 51

mucostatic technique: -primary impressions of RPD or CD mucocompressive technique: - records an impression with all tissues in function - in CD 2ry impression selective-mucocompressive technique: - records an impression with some tissues in function and others at rest - in RPD 2ry impression - you select where you will have space (1 sheet for mucosa and 2 sheets for teeth)

Question 52

bracing arm: clasps:

Answer 52

bracing arm: above undercut clasps: below undercut

Question 53

polished surfaces affect:

Answer 53

retention and stability

Question 54

``` speech considerations: bilabial: labiodental: linguodental: linguoalveolar: linguopalatal and linguovelar: ```

Answer 54

bilabial: lips labiodental: lips and teeth linguodental: tongue and teeth linguoalveolar: tongue and anterior palate linguopalatal and linguovelar: tongue and palate

Question 55

increased OVD: Vs decreased OVD:

Answer 55

increased OVD: - lack of FWS - decreased stability - loss of retention in function - dentures look too big as well as teeth - lips unable to seal - difficulty eating and swallowing - PAIN along the periphery or on ridge crest - pain worsens as the day progresses Vs decreased OVD: - excess FWS - stability, support and retention not directly affected - cheek/lips/tongue biting - insufficient lip support - muscular tenderness (tired pt) - eating difficulty

Question 56

SOS a patient comes with a CD done from a different dentist complaining they are loose - what are you going to evaluate?

Answer 56

``` let the patient tell you the problem - most important interview history IOE EOE dentures in situ dentures out of mouth ``` - when did dentures become loose - are they loose all the time - did they become loose gradually or suddenly - on both sides - specific sounds produced may refer to: - lack of border seal - lack of contact b//w denture base and denture bearing tissues - underextension - overextension - lack of support - lack of stability - premature occlusal contacts

Question 57

SOS you did a CD to a patient and reports a problem. what are you going to check?

Answer 57

occlusion -> any occlusal interferences frenum -> not to displace the denture or be overextended undercuts -> if pain upon removal/insertion cheeks -> if teeth placed too palatally polishing surfaces -> if pain upon on mouth opening due to excessive thickness Regardless the case we need to check: - retention, stability, support - fitting surface of base - check the border extension - occlusion - speech

Question 58

SOS RPD survey steps:

Answer 58

survey cast tilt -> find poi, minimize black triangle, avoid interferences, maximize retention 1. visual assessment 2. initial survey: horizontal 3. tilting the cast: anteriorly or posteriorly 4. final survey at selected tilt: ensure undercuts present both at tilted and horizontal positions 5. mark the selected tilt