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Tooth Selection Flashcards

1
Q

tooth selection is part of what patient visit?

A

intermaxillary records (3rd)

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2
Q

lines on rim that serve as rx for the lab? in terms of teeth?

A
  1. midline
  2. high smile line
  3. canine lines
  4. interpupillary line
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3
Q

is labial frenum a good indicator of pt midline? what about lower anterior teeth?

A

no
and
no

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4
Q

best thing to determine midline for teeth?

A

look at pt. FACE

plus incooporate patient – what they really want

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5
Q

relationship of incisal edge to teeth/ lip line?

A

it should MIMICK THE patients lip line

  • the incisal edges of the maxillary anteriors should follow the contours of the lower lip during the smile

most people have incisal edges that are contouring the lower lip

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6
Q

reversed smile?

A

when the centrals and laterals are lifted up slightly more than the canines

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7
Q

what is the guide for tooth selecton and set-up?

A

the rim

we also built the rim to form the arches of the bone

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8
Q

what are the rim guidleines for tooth selection

A
  1. midline- comes from the face
  2. high smile line - determines the length of maxillary centrals
  3. canine lines
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9
Q

high smile line indicates?

A

length of the maxillary centrals

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10
Q

what helps determine the position of the maxillary canines?

A
  1. 1/2 the ala-modiolus
  2. mid-pupillary line
  3. canine -eminence on cast – if it is prominent
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11
Q

canine eminence line should also extend where? what does this represent and what are the implications

A

onto the land of the cast – determining the height of contour of the cuspids

since this is the height of countor – we see this when we look at a patient straight on but there is still part of canine tooth distal to this point and need to account for this as well

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12
Q

in many people width of 6 anterior teeth = what?

A

width of the nose - these are about the same distance

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13
Q

what to keep in mind for canine lines

A
  1. consider each side separately – not always symmetrical

2. lines represent the M-D height of contour – so will need more space distal

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14
Q

what is your prescription??

A

YOUR RIM

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15
Q

do we add the centric lines to rim?

A

YES – so we know position is reproducible and lines on the rim are where they should be

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16
Q

what do we measure with the rulers on the rim?

A
  1. high smile line – from base of wax to the beginning of the land
  2. Midline to each canine on either side (2 measurements) – we can have some assymmtry here
  3. distal of one canine – distal to the other

this gives you a range

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17
Q

range numbers on rulers correspond to what?

A

range between 42-58 mm?

different letters – which indicate molds of teeth

represent different molds of teeth we can choose from

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18
Q

patients face falls into what 4 major categories?

what does this suggest?

A
  1. square face
  2. the swuare tapering face
  3. tapering face
  4. the ovoid face

follows the arches of persons teeth – square face? – probably a square arch of patient – square tooth

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19
Q

describe square face

+ incisal aspect of teeth

A

Sides of the face from the hairline to the levels of the condyles to the angles of the jaw are straight and parallel

+ incisal aspect of teeth– central incisors are set practically straight across with the laterals also having full labial aspect

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20
Q

describe square tapering face

+ incisal aspect of teeth

A

sides of the head are parallel from the condyles upward – from condyles downward along the sides of the face – outline tapers in to the angle of the jaw

+ incisal aspect of teeth– centrals are more prominent than the laterals and canines- which are slightly elevated – but set at softer arrangement than a typical square taper

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21
Q

describe tapering face

+ incisal aspect of teeth

A

tapered face is widest at teh hairlien and most narrow at the angles of the haw – lines converge towards the jaw

+ incisal aspect of teeth– tapering arch converges to a point midline between the two centrals – centrals start to curve even

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22
Q

describe ovoid face

+ incisal aspect of teeth

A

widest through the center at the level of the condyles it curves upward and downwards to form an oval outline

+ incisal aspect of teeth— teeth set to full curve and demonstrate the ovoid characteristics

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23
Q

long face = what in terms of tooth selection

A

long tooth

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24
Q

mold guide comes with?

A

mold chart –

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25
mold chart
lists sizes
26
first column in mold chart gives you what?
height/length of tooth / centrals
27
second column in mold chart gives you what?
width width of centrals
28
third column in mold chart gives you what?
canine to canine distance -- distance of anteriors ON A CURVE
29
once you pick maybe two different styles of teeth what do you do?
first, compare your mold choices with the guidelines you have on your occlusion rim 2. then can evaluate intra-orally via a rim selector kit
30
if first number is different but second letter is the same what is the same/ different for the tooth?
height is different width is the same
31
underneath the upper anterior molds are?
recommended mandibular anterior molds usually come in cards -- 6 teeth for
32
mold chart articulations for what type of typical patient?
Class I patient with different degrees of tapering, etc.
33
mold chart for class II or class III patient
II-- pick a smaller mold III- pick a larger mold
34
Types of posterior molds? indicating what?
CUSP height 0 degree - monoplane 10 degree 20 degree 22 degree 30 degree 33 degree 40 degree
35
posterior molds available in cards of_____
1X8 "cards"
36
12 degree means?
Functional -- anatoline posteriors next level up
37
how do we select posterior tooth width m-d?
measure from DISTAL of cuspid to RISE OF THE RAMUS on mandible available from 29-36 mm
38
available height/ length of posterior teeth?
short, medium, long, or L/S (long buccal - short lingual)
39
rule of thumb for posterior teeth selection?
the flatter the ridge the flatter the cusp
40
monoplane posterior cusp height an rational
0 degrees resorbed ridge
41
semi-anatomical posterior cusp height an rational and what is it called? used when?
12 degree, 20 degree, and 22 degree (10-20) rational -- LINGUALIZED -- lingual contact occlusion -- most often used for implant overdenture contains aesthetics of anatomical -- somewhat of a cusp but reduces lateral sheer forces
42
anatomical posterior cusp height an rational
30, 33, and 40 degree rational -- excellent rdige-- you have enough ridge
43
class II or III patient what plane tooth?
monoplane
44
list the 8 major rationals for choosing monplane posterior tooth height
1. resorbed rigde 2. class II or class III patient 3. bruxism patient 4. cross-bite 5. debilitation --pt. weak 6. interum U/L 7. when in doubt 8. when CR is difficult
45
list the 6 major rationals for choosing anatomical posterior set ups
1. excellent ridges 2. natural opposing teeth 3. bilateral balance 4. severe overbite -- so need to accomodate for anterior guidance 5. improve aesthetics 6. chewing efficiency
46
resorption on lower but upper is okay?
always resort to the lower -- so we choose what teeth will match most efficiently with the ridge so severe resorption on lower = monoplane
47
10 major analysis in the anterior for tooth selection? when should this start?
DURING INTAKE -- understand the patients expectations from the start 1. face shape 2. smile line - length 3. canine distance - width 4. gender - 5. complexio - shade 6. old dentures (likes/dislikes) 7. old photos 8. old x-rays 9. old casts 10. PATIENT OPINION /SIGNIFICANT OTHER
48
9 major patient analysis for posterior tooth selection
1. ridge status 2. arch relatonship - what class is pt. 3. cross-bites? 4. bruxism 5. coordination 6. health 7. old dentures 8. anterior overbites 9. canine- to pad distance
49
denture tooth material?
1. acrylic 2. IPN 3. Porcelain
50
porcelain drawbacks?
brittle | what is does to ridge over long term wearing
51
can porcelain teeth chemically bond to denture base?
NO | - they need tooth retention deviced for denture base acrylic
52
retention for acrylic, IPN, and porcelain teeth? - general
Acrylic and IPN teeth are CHEMICALLY retained in denture bases Porcelain teeth must be MECHANICALLY retained in denture bases
53
porcelain anterior teeth have what for retention? | porcelain posterior teeth have?
PINS = anterior Diatoric = posterior - holes in undersurface
54
opposing dentition consideration?
important because over time can ware down natural teeth example - porcelain can cause ware on the enamel
55
opposing dentition for acrylic? | best / okay / not good
acrylic and enamel are good IPN is okay --but acrylic would ware because the IPN is harder against polished porcelain -- porcelain would ware the acrylic
56
plastic = acrylic
yeah, basically
57
long term effects of porcelain anteriors and plastic posteriors?
acrylci waring at a different rate than the porcelain eventually leaving occlusion in the anterior -- and anterior would increase in pressure and increase in bone resorption
58
effects of long term use of porcelain denture tooth misuse
severe mandibular and anterior maxillary resorption pre- maxilla like gone mental foramen coming up to the occlusal table loss of the flange no premaxilla
59
loss of pre-maxilla?
bad combination of materials used
60
denture base coloring? | basic ones
1. fibered dark, light 2. lucitone 199 3. custom blends and custom shading 4. custom staining
61
sequence of monoplant tooth set up
A-B-C-D set anterior teeth first 2/3 height of pad -- because do not use curves
62
two techniques to setting teeth? | which do we use?
1. setting one side at a time 2. setting 2 pairs at a time - - we will use this one
63
what touches occlusal plane in anterior set up?
centrals and cuspids touch laterals are a little above table - about 1-2 mm above
64
canine points?
towards chin with neck outwards
65
for upper anterior set up where do we align incisal edges? where will roots diverge?
PARALLEL to the plan so the roots will all DIVERGE DISTALLY -- by desgin and canines point towards the chin and the incisal edges will give the illusion of a curved plane -- aka smile
66
steps to make room for teeth - height
1. 1st grind record base 2. make window in base (placing foil) 3. grind tooth (last resort -- we WILL NOT DO THIS IN OUR LAB)
67
ridge lapping?
reduce from lingual at SAME CURVE AS THE RIDGE - we will not do this
68
in which direction do you NOT cut to reduce height of teeth
do NOT cut horizontally -- so do not cut top or bottom
69
which lower anteriors touch plane in monoplane set up? roots diverge? canines point?
ALL touch the plane roots diverge distally and cuspids now point TOWARDS THE FOREHEAD
70
Tilt and angulation of canines?
uppers --- angle towards chine lowers -- angle towards forehead both roots diverge distally with prominent necks and distal tilt
71
do anterior teeth touch in centric?
NO -- no anterior contact
72
what is holding VDO?
wax and pin -- teeth should not touch C+D+ pin
73
cuspid lines indicate what
anterior or mesial half
74
``` with a completed anterior set up of monoplane posteriors what is the: tilt axes appearance roots incisals ```
``` tilt -- M-D tilt axes-- they converge appearance-- curved appearance roots -- diverge distally incisals -- these align ``` slight a-p tilt
75
what is the a-p tilt in anterior set up?
slight proclination slight a-p tilt so each tooth is individually angles away from the plane to reflect light and give a natural appearance
76
T/F we should treat each side of the rim separately?
YES asymmetry exists in patients -- influence on tooth arrangement
77
creating natural looks to dentures can include doiong what?
including staining, restorations, overlapping (vertical overlap), stippling, diastemas
78
*4 Major BASIC rules of denture occlusion. Include reasons for each... If change to more anatomical set up what is the big difference?
1. NO ANTERIOR CONTACT IN CO - decreases pressure 2. NO CANINE GUIDANCE IN LATERAL - decreases movement 3. NO ANTERIOR GUIDANCE IN PROTRUSION - decreases movement 4. CO=CR - decreases movement ANATOMICAL SET-UPS HAVE BALANCE
79
Bone loss will come from?
1. tooth loss 2. pressure 3. movement
80
guidance definition and implication?
any contact in anterior alone and will result in increased movement and pressure
81
group function definition and implication?
unilateral posterior contact and results in increased movement
82
balance definition and implication?
bilateral posterior contact and will DECREASE movement
83
if unsupported posterior in dentures?
resorption in the maxilla and mandible pressure in anterior so no anterior contact in CO
84
only time there can be contact in the anterior in dentures?
if there is SIMULTANEOUS CONTACT in the posterior DURING PROTRUSION NO ANTERIOR CONTACT IN OCCLUSION ALONE
85
two main denture goals
1. prevent guidance | 2. promote balance
86
fixed factors (things we cannot change on patient)
1. HINGE POSITION of condyle (CR) 2. Protrusive path of condyel --- HORIZONTAL condylar inclination 3. Lateral path of condyel --- lateral inclinations of condyle
87
what can we alter in dentures? | 4 MAIN THINGS
1. HORIZONTAL OVERLAP OF ANTERIORS (H) 2. VERTICAL OVERLAP OF ANTERIORS (V) 3. CUSP HEIGHT OF POSTERIORS 4. CURVE OF POSTERIOR PLANES
88
How to manipulate anteriors for monoplane occlusion in terms of overlap to not get contact
increase horizontal decrease vertical combination of both
89
2 main objectives of anterior denture setup in terms of occlusion
1. PREVENT anterior contact as long as possible | 2. MAINTAIN posterior contact as long as possible
90
aspects of the a-p tilt
Labial - incisal 1. root location 2. lip support 3. light reflection
91
ridge lap? will we do this?
how you can fix the vertical height if tooth too tall BY REDUCING FROM THE LINGUAL AT SAME CURVE AS THE RIDGE after base is thinned and window is made N0 -- WE WILL NOT GRIND, ADJUST, OR RIDGE LAP ANY TEETH IN EITHER SET UP
92
overlap allowed in class III patient
horizontal -- up to 3-5 mm (usually only 1-2)

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