1. How many clinical appointments are necessary for proper fabrication and adjustment of dentures?
7
2. The 6th and 7th appointments should be held approximately how many days after the delivery of the final denture?
6th after 24 hours; 7th after 1 week
3. This quarter, we started with the lab procedures that follow which clinical appointment?
3rd
4. After the wax trial denture try-in appointment (#4), what is the necessary lab procedure?
Process the dentures
5. Clinically, the occlusal plane is parallel to _____________ ______________. This anatomical landmark runs from the ______________ to the ________________ on the patient.
Camper’s Line; Tragus of the ear, ala of the nose
6. Clinically, the occlusal plane is determined and confirmed utilizing what?
Determined using wax occlusion rims and trial denture, confirmed by esthetics and phonetics
7. How far up the retromolar pad should the occlusal plane be positioned?
½->2/3
8. The position of the anterior teeth is dictated by what?
Esthetics and phonetics
9. What do intraoral and soft tissue landmarks serve as for tooth positioning?
Serve as guides to support esthetics and phonetics
10. How is phonetics utilized when determining the anterior tooth placement?
“Fricative F and V” sounds are used for maxillary incisor positioning when they touch the wet line; maxillary to mandibular anterior tooth relationship is determined by the “sibilant S sounds”.
11. The smile line follows what anatomic landmark clinically?
Contour of the Lower lip line
12. Which two maxillary anterior teeth touch the occlusal plane?
Central incisors and canines
13. T/F Only the mesial portion of the incisal edge of the central incisor touches the occlusal plane.
F, the entire central incisor edge touches the plane
14. What are the two planes of the maxillary canine and how are they arranged when placing the anterior teeth on the wax trial denture set up?
Mesial and Distal; Mesial is arranged in the same plane as the incisors and the distal establishes the plane for the posterior teeth
15. The long axis of the canine should be ________________when viewed from the distal.
Vertical/perpendicular to occlusal plane
1. What type of anatomic tooth form do we use and what angle are the posterior teeth at?
Pilkington-Turner 30 degree posteriors
2. Describe the acceptable deviations from ridge relationship for the maxilla and the mandible.
Maxillary posterior teeth can be slightly buccal
mandibular posteriors can be slightly lingual
3. What is the Curve of Spee and how does this relate to Hanau’s Quint?
The gradual rise in occlusion established by the maxillary posterior teeth, relates to compensating curve with Curve of Wilson, has large effect on excursive movements
4. What is the Curve of Wilson and how is it established when placing the maxillary posterior teeth?
Lingual cusps of maxillary posterior teeth should be inferior to the buccal cusps, large effect on the balancing side of excursive movements.
5. What cusps of the maxillary posterior teeth touch the occlusal plane?
Both first premolar, lingual second premolar, ML 1st molar
6. What angle is the long axis of both the maxillary first and second premolars at related to the occlusal plane?
perpendicular
7. How is the long axis of the first maxillary molar arranged? How is this achieved with the alignment of the MB and DB cusps?
Long axis inclines slightly mesially; MB aligned with facial surfaces of premolars and distal surface of canine, DB cusp aligned slightly lingual to establish the second plane of the posterior facial surfaces.
8. What is the definition of a “record base”?
provisional appliance used to record the relationship between the maxilla and the mandible
9. When are record bases fabricated during the sequence of appointments and lab procedures?
After the second appointment from the master casts
10. The facebow record and maxilla-mandibular relation record are utilized to mount the master casts. This creates a representation of what and enables the establishment of what relationships?
Creates a relationship of the patient’s jaw relationship on the articulator and allows us to establish the proper maxillary to mandibular relationship
11. What does blocking out allow you do accomplish when fabricating record bases?
Keeps them from getting stuck onto the master casts due to undercuts of the acrylic
1. What are the three characteristics of Organic Occlusion (Natural Dentition)?
Bilateral posterior centric occlusion,
anterior guidance,
mutually protective occlusion
2. What are the three characteristics of Complete Denture Occlusion and how are they similar/different from Organic occlusion?
Bilateral posterior centric occlusion,
“balanced” occlusion,
centralized forces;
both have bilateral posterior centric occlusion, but denture occlusion must be balanced and centralized in order to prevent tipping and allow for uniform forces on the residual ridges
3. What three fundamental differences of occlusion explain the inherent differences between complete denture occlusion and organic occlusion?
Retention, stability, support
4. Define Retention in terms of dislodgement of the denture base.
Resistance to dislodgement forces in a vertical direction away from bearing surfaces
5. Define Stability of a denture base.
Resistance to laterally oriented dislodgement forces
6. Define Support in terms of the denture base and anatomic structures.
Factors of the bearing surface that resist forces in a vertical direction toward them
7. T/F: An adequate denture can be made for a patient with an atrophied ridge and mobile tissues.
False: problem with support
8. What are the 5 consequences of tooth loss?
Change in intraoral structures, mastication, RRR, potential psycho-social problems, decreased facial support and muscle tone
9. Define Residual Ridge Resorption and how it differs between the mandible and maxilla.
Loss of bone structure over time;
maxilla 0.1mm/year;
mandible 0.4mm/year
10. How does the difference in RRR between the maxilla and mandible affect complete denture set-up?
Because the mandible resorbs much faster than the maxilla, have to be sure that the vertical forces are on ridge and are not putting lateral forces on the susceptible part of the ridge (being too buccal or lingual)
11. What are the 4 main goals of Complete Denture Occlusion?
Decrease trauma to supporting structures, preservation of remaining structures, enhance stability, and esthetics, mastication and speech
12. What is the single most important factor in the successful manipulation of complete dentures under function?
Neuromuscular control
13. How is tooth function biomechanical in nature?
Governs lip support, contributes to maintaining the firmness of muscle tone, scaffold for facial activity
14. The incisal edge placement is determined by what phonetic sounds?
Fricative (F and V)
15. Lou Holtz wants a new set of dentures because his current dentures make him talk with a lisp (slurring sound). What must be changed in the new set-up in order to reduce the slurring and what biological activity most likely caused this change over time (assuming she didn’t have a lisp when she first received the old set of dentures)?
Need to decrease the distance between maxillary and mandibular incisors; probably due to ridge resorption over time
16. Your next patient is on their fourth clinical appointment and you are testing the wax trial denture. When you ask them to count from sixty to seventy, you notice that they have a slight whistling sound upon annunciation of the sibilant sounds. What feature of the wax-trial denture was not accurately estimated and how do you fix this problem?
Distance between maxillary and mandibular incisors (anterior portion of the occlusal plane); increase this distance to minimize whistling sounds
17. Overtime, both ridges recede with age in edentulous patients. If a patient originally had Class I skeletal relationship, what Class would you expect 10-15 years from now? How does this affect the positioning of the teeth in the maxilla vs. the mandible?
Would expect Class III; mandibular teeth end up more anterior and maxillary teeth end up more palatal as bone resorption continues with age
18. What are the three functional determinants of denture tooth position?
Tongue function, neuromuscular control, tooth position relative to tongue
19. Your patient comes into your office for their 7th denture appointment unhappy about their new dentures. They claim that they are having a difficult time chewing their food, keeping food out of the sides of their mouth and the dentures keep tipping off. Initially, it wasn’t an issue, but now that they have had the dentures for a week, it has gotten a lot more noticeable. Where should be the first place that you evaluate on the denture that may be causing this problem and how do you fix it?
The occlusal plane is too high
20. Mr. Smith just received his first set of new dentures and is very excited to have them. At his 7th appointment, he mentions that he is having a bit of trouble keeping his tongue in a comfortable position when he is not speaking or eating and that he has noticed a bit of a difference in the way he pronounces certain words over the past week. Because you are such an astute dentist that EPR’d Dr. Hamada’s Complete Denture course, you immediately know what the problem is and how to fix it. How do you instruct the lab to fix the problem with Mr. Smith’s dentures?
The arch is too narrow in the buccal-lingual dimension; make sure that the teeth are properly on ridge especially in the mandible
21. Mary comes into your office for her annual dental visit. You inspect her dentures and ask her if she has had any problems lately. She said that ever since she got the dentures six months ago, she has noticed increased tongue biting and problems with chewing food. When you inspect the occlusal plane height, what do you expect to find and how do you instruct the lab to fix it?
Occlusal plane is probably too low; tell them to make the denture over with a lower occlusal plane height after you re-measure with the wax rim.
22. Jim Bob reports to your office complaining of his lower denture constantly tipping off. He says that he has tried everything to keep it on, but it just won’t stay in place. When he comes into your office for a realignment, you notice that he has more than expected lateral resorption on his lower arch on the right side. When you look at the lower denture, what do you expect to find on the right side regarding ridge relationship?
Mandibular posterior teeth on the right side have their central grooves too buccal causing denture tipping and rapid residual ridge loss.
23. What are the three controlling end factors that must be in harmony in order to develop a fully balanced occlusion?
right and left condylar inclinations and incisal guidance with cuspal inclination
24. How do you accomplish this harmony with placement of the teeth in a denture?
Accomplished by setting the denture with a compensating curve formed by the intersection of Curves of Spee and Wilson
25. Curve of Spee + Curve of Wilson=__________________
Sphere of Monson
1. What is the definition of Bilateral Balanced Denture Occlusion in its entirety?
The stable simultaneous contact of opposing upper and lower teeth in CR position with a smooth bilateral gliding contact to any eccentric position within the normal range of mandibular function, developed to lessen or limit tipping or rotation of the denture bases in relation to the supporting structures (CO=CR, no interferences in latrotrusion and protrusion, limited tipping and rotation)
2. In Centric relation, there is maximum __________________of the teeth.
Intercuspation
3. What is the definition of Centric Jaw Relation (CR) in its entirety?
Relation of the mandible to the maxilla when the condyles are in their most anterior/superior position in the glenoid fossa from which unstrained lateral movement can be made at the occluding vertical dimension normal for the individual
Is CR t a tooth position or a jaw position?
JAW
4. CR is attributed to the restraining action of what three anatomic features?
Ligaments, muscles, meniscus
5. Upon looking at a neighbor’s wax trial set-up, you notice that in CR there is anterior contact between the central incisors. What problem will this pose for your patient?
The pre-maxillary segment of bone is highly susceptible to resorption, want to minimize any forces on it by eliminating anterior contact in CR
6. Define Working Side and Balancing Side.
Working Side: the side you are moving the jaw towards;
Balancing Side: the side you are moving away from
7. Define VDR and VDO. How are these related to one another in terms of the length of the face?
VDR: Vertical Dimension of Rest (length of the face when the muscles of the face are not tensed;
VDO: Vertical Dimension of Occlusion (length of the face when the teeth are in Centric Occlusion)
VDO
8. What is Interocclusal Distance (Freeway Space) and how does this relate to VDO and VDR?
Distance between the occluding surfaces of the maxillary and mandibular teeth when the mandible is in its physiologic rest position VDS-VDO
10. Which two of Hanau’s quint cannot be modified effectively and why? Condylar inclination, occlusal plane;
condylar inclination is anatomically determined, occlusal plane is based on function of esthetics and phonetics and you can’t change it too much.
11. Within the confines of esthetics and phonetics, how can you minimize inclined denture tipping forces?
Minimize incisal guidance
12. What is the Christiansen Phenomenon and how does its effect differ between natural and denture occlusion?
When you go into protrusion, anterior guidance displaces the posterior teeth from occlusion; natural dention, this is part of the mutually protective system, for denture occlusion this causes tipping in the anterior direction, need bilateral balance using balancing ramps or anatomic curve of spee
13. When designing a new denture for Meg Whitman, you must adjust the incisal edge relationship to accommodate her slurring experienced with her old dentures. In order to accomplish this, should the incisal guidance be increased or decreased compared to the old denture? How must you compensate for this using cuspal inclination or compensating curve?
Increase incisal guidance, increase compensating curve or cuspal inclination
14. If your patient comes in with a steep condylar inclination, how must you adjust the other factors to compensate for this?
Decrease incisal guidance, increase cuspal inclincation or compensating curve
15. How Is retention improved by proper festooning?
Increases neuromuscular control
16. Why is there a band of more prominent tissue surrounding the cervical aspect of the facial surfaces of the teeth?
Due to increased prominence of the bone surrounding the cervical aspects of the teeth coupled with the increased thickness of attached gingiva
17. Where are the two prominent root eminences?
Incisor and canine
18. How are the papilla designed and why?
Convex, allows for better hygiene and food deflection
19. What is the purpose of the buccal prominence in the molar region? Decrease cheek biting
1. What is the purpose of the posterior palatal seal? What does it compensate for as a consequence of denture processing?
To increase the retention of the maxillary denture utilizing atmospheric pressure (suction).
Compensates for polymerization shrinkage and palate movement during mastication and swallowing
2. What type of seal does it make on the palatal portion of the denture base?
Bead seal
3. What three things make a posterior palatal seal difficult to maintain?
Area of the vestibule, a lot of muscle attachment to the soft palate, a lot of movement in the mandible
4. What is the definition of vibrating line and how it is determined clinically?
Mobile vs. non-mobile soft palate (ah-ah)
5. Mrs. Jones makes an appointment with you to get a new denture. When you are examining her palate, you notice that it is significantly vaulted and curved. What House Palatal Classification does Mrs. Jones most likely have and is this to your benefit or demise as the dentist?
Class III; demise, difficult for retention
6. In order for House Class III patients to maintain compartmentalization of the nasopharynx and oropharynx during chewing and swallowing, what must occur? Is this good or bad for denture wearers?
A lot of movement, bad for denture wearers
1. What is the 5th goal of complete denture occlusion that significantly comes into play when choosing a monoplane set-up design?
Decrease lateral forces to residual ridges
2. Monoplane teeth are considered to have what degree of cuspal inclination?
0
3. How does this change in cuspal inclination compared to anatomic denture teeth affect Hanau’s Quint and what additional features must be added in order to maintain balanced occlusion?
must minimize incisal guidance or increase compensating curve (add balancing ramp)
4. What is Neutrocentric Occlusion and where are forces centralized?
Centralized forces around 1st molar and 2nd premolar region
5. Señor Bruxer wants a new set of dentures. You notice that he had anatomic dentures before and had a lot of success with them. However, there is significant wear on the teeth indicating that he bruxes a lot. In addition, Señor Bruxer recently had a stroke that affected his neuromuscular control on the right side of his body. What type of occlusion would be best for Señor Bruxer at this point in his life?
Plastic, monoplane
6. T/F Monoplane occlusion can be used for immediate dentures even if the opposing arch is natural dentition.
F
7. What are four indications for anatomic denture teeth?
Opposing natural teeth, esthetics, good neuromuscular control, previous good experience, good residual ridges
8. What type of dentition should be used in patients with Class II or III skeletal relationship and why?
Monoplane, can still get centralized occlusion despite ridge discrepancies
9. What type of teeth should be used if Lingualized Occlusion is desired?
Ortholingual (anatomic)
10. Significant arch alignment discrepancies require what type of occlusion?
Monoplane
11. What are some disadvantages of monoplane occlusion?
esthetics, shearing, ICP feel, sloughsways absent
12. Which type of occlusion has increased horizontal force development and what is it due to?
Anatomic, cusp inclinations
13. Which type of occlusion requires more frequent follow up due to the necessity of relines?
Anatomic
1. What is the main determinant of denture tooth position?
Functional Anatomy
2. Centralization of centric forces must be over what anatomical structure?
Mandibular residual ridges
3. Name the three types of non-balanced monoplane occlusion teeth.
Hardy Cutters V-O posterior,
Monoline Zero degree,
rational zero degree posteriors,
sosin blades
4. What type of fully balanced anatomic teeth do we use?
Pilkinton-Turner 30 degree posterior
5. What is the difference between Curvilinear and Non-Curvilinear tooth forms?
Curvilinear has curve of spee
6. What type of teeth is used for Lingualized Occlusion?
Ortholingual
7. What are the advantages of lingualized occlusion?
shearing, maintain some anatomic esthetics, easier to set, centralized forces, minimizing tipping, potential bilateral balance (each posterior tooth acts as its own balancing ramp)
8. Why would you use lingualized occlusion over anatomical?
Severe mandibular ridge atrophy, Malocclusion, previous success, displaceable supporting tissues
9. Name three advantages and three disadvantages of porcelain teeth.
Esthetic, resists abrasion, less wear, maintains VDO; chip and fracture prone, may weaken denture since not bound, harder click sound, abrade opposing natural teeth
10. Name three advantages and three disadvantages of plastic teeth.
Useful with reduced space between residual ridges because easy to adjust, break and chip resistant, useful against opposing natural dentition, chemically bound to denture; less wear resistance, dull appearance, crazing and blanching if not cross linked
11. Is porcelain or plastic more natural in appearance?
porcelain
12. Does porcelain or plastic teeth abrade opposing natural dentition?
porcelain
13. What is a Gothic Arch Tracing and how does it apply to monoplane set-ups?
Working, centric, protrusion and balancing trace marks on the balancing ramp
14. How much vertical overlap should the monoplane set-up have?
