denture teeth selection

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denture teeth selection
2013-05-02 10:49:22
denture teeth selection

denture teeth selection
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  1. Overclosed vertical dimension of occlusion-Clinical Consequences 
    • Loss of muscular tone
    • Reduced biting  force 
    •  Fatigue of facial muscles
    • TMJ problems
    • Esthetics compromises
    • Angular cheilitis
    • Interference with ear function
    • Reduction of the tongue space
  2. Excessive vertical dimension of occlusion
    • Bone resorption
    • Continued ridge soreness
    • Gagging
    • Muscular fatigue and discomfort
    • Decreased masticatory efficiency
    • TMJ problems
    • Clicking of teeth during speech
    • Difficulty swallowing
  3. Methods of assessing the vertical dimension of occlusion
    • Physiologic rest position 
    • Phonetics and esthetics
    • Swallowing
    • Comparison with the old denture
  4. Delicate
    • Rounded arch form
    • Rounded corners
    • Anteriors closely follow the lower lip
    • Laterals overlap centrals
    • Smaller laterals and cuspids
    • Sharp canines
  5. Rugged characteristics
    • Angular outlines
    • Larger laterals and canines
    • Square arch form
    • Centrals overlap laterals
    • Blunt canines
  6. Monoplane Occlusion Indications
    • Poor Residual Ridges
    • Poor Neuromuscular control (Bruxers, CP etc.)
    • Previously successful with Monoplane Dentures or Severely worn occlusion on previous denture
    • Arch discrepancies
    • Class II or III or Cross-bite
    • Immediate Dentures
    • except when opposing natural dentition
    • Potential poor follow-up
  7. Anatomic Denture Teeth Indications
    • Good Residual Ridges
    • Well Coordinated Patient
    • Previously successful with anatomic dentures
    • Denture opposes natural dentition
    • When “Lingualized” occlusion is desired
  8. Monoplane Occlusion Advantages/Disadvantages
    • Advantages:
    • Reduction of horizontal forces
    • CR can be developed as an area instead of a point
    • Freedom of movement
    • Can develop solid occlusion despite arch alignment discrepancies
    • Easily adapted to situations prone to denture base shifting
    • Easy to set and adjust teeth
    • Disadvantages:
    • No vertical component to aid in shearing during mastication
    • Occlusal adjustment impairs efficiency unless spillways and cutting edges restored
    • Patients may complain of lack of positive intercuspation position
    • Somewhat esthetically limited (don’t look like natural teeth)
  9. Anatomic advantages
    • Definite point of positive intercuspation may be developed
    • Esthetically similar to natural dentition
    • Tooth-to-tooth and cusp-to-cusp balanced occlusion can be achieved
    • Maintains some shearing ability after moderate wear
  10. Anatomic disadvantages
    • Difficult to set
    • Less adaptable to arch relation discrepancies
    • Horizontal force development due to cusp inclinations
    • Harmonious balanced occlusion is lost with denture base settling
    • Requires frequent follow-up and may require more frequent relines to maintain proper occlusion
  11. Lab tasks for 4th appt
    • Mount maxillary cast with facebow record
    • Mount mandibular cast with centric relation record
    • Arrange anterior and posterior teeth
  12. Square Tooth Molds (ivoclar):
    With this angular shape, the central incisor is dominant and the gingivo-incisal curvature is moderate. The square facial shape offers maximum light deflection and creates a bold effect.
  13. Tapering (ivoclar):
    • Characterized by rounded contours which taper towards
    • the cervical ridge. Moderate gingivo-incisal curvature.
    • Large triangular incisor slightly triangular in shape.
  14. Ovoid (ivoclar)
    • Ovoid:
    • The teeth have a
    • pronounced gingivo-incisal curvature, which tends to disperse the light reflection and create a softened appearance.
  15. anterior teeth size
    • In the majority of pts., a relationship exists
    • between the inner canthus measurement
    • and the distance between distals of the
    • maxillary laterals. This measurement can
    • then be carried directly to select the proper
    • maxillary anterior teeth.
    • Determined by:
    • Evaluation of existing denture
    • Old photographs
    • Width of the six anterior teeth with a flexible ruler
    • Trubyte tooth selector