Complete Denture - Midterm 01

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    It is the art and science dealing with the restoration of missing one tooth/teeth and their supporting structures.
    The patient who has lost all of his teeth in one or both jaws.
    Is a dental appliance that restores the missing teeth and their supporting structures in a completely edentulous jaw.
  4. Tooth loss results in
    • • Residual Ridge Resorption (RRR)
    • • Decreased masticatory power (25%)
    • • Loss of facial support and muscle tone
    • • Psycho-social effects
  5. RRR is due to _________.
    Maxillary ridge resorption is in ______ direction (______); Mandibular ridge resorption is __________ (_____)
    • Atrophy of supporting structures
    • vertical and palatal
    • smaller
    • vertical and oriented along cross-sectional shape of mandible
    • Wider
  6. Speed of RRR
    • Maxillary loss 0.1 mm/year sustained (greater in first year but variable)
    • Mandibular bone resorption is 4x maxillary (varies)
  7. Natural Dentition vs. Complete Denture
    Units move
    Malocclusion effects
    Incising affects posteriors
    Eccentric Occlusion
    Tactile sensitivity
    • PDL / mucosa
    • independently / together
    • not immediate / immediate
    • No / Yes
    • Canine Guidance or Group Function Occlusion / bilateral balance
    • high / decreased
  8. Objectives of Complete Denture
    • Restoration of mastication
    • Restoration of speech
    • Restoration of esthetics
    • Preservation of remaining structures
  9. Steps of Complete Denture Construction
    • Preliminary Impressions -> primary casts, custom trays
    • Evaluate custom tray, Border molding, final impressions -> beading & boxing, master casts, record base, occlusion rims
    • Jaw relations (VDO, CR, facebow), teeth selection -> mounting, setting the teeth
    • Wax trial denture, confirm jaw relations, refine esthetics -> flasking & processing, finishing and polishing
    • Denture delivery
  10. two major categories of edentulous impression trays
    • Stock tray: for making initial or preliminary impression, generating a preliminary stone cast for diagnosis and construction of a custom tray.
    • Custom Tray: fabricated on preliminary stone cast out of a plastic material, usually made from acrylic.
  11. As for the materials for making the custom trays, Light cure resin, compared to _______, is _______.
    • auto cure resin
    • • Brittle and less accurate
    • • Easy to adapt but difficult to trim
    • • Predetermined thickness
    • • No odor
    • • No skin sensitivity
    • • Expensive
  12. Before making the custom tray, the cast need to be preped by ______________.
    • Blocking out undercut areas in maxilla
    • • Frenum
    • • Buccal surface of tuberosity
    • • Rugae
    • • Flabby portions of alveolar ridge
    • and in mandible
    • •  Mylohyoid ridge
    • •  Frenum
    • •  Buccal side of ridge
  13. Extra Oral Landmarks for complete denture
    • Inter pupillary line
    • Ala-Tragus Line (Camper’s Line)
    • Canthus-Tragus Line
    • Vermillion Border
    • Philtrum
    • Naso-Labial Sulcus
    • Naso-Labial Angle
    • Mento-Labial Sulcus
    • Modiolus
  14. Intra Oral Landmarks for complete denture
    • - Supporting Structures (covered by denture)
    • Primary stress bearing area:
    • Maxilla: Horizontal part of the Hard Plate, well formed Tuberosity, residual ridge
    • Mandible: Buccal shelf of bone, Retromolar pads
    • Secondary stress bearing area:
    • Maxilla: palatine Rugae area (Inclined part of the Hard Palate)
    • Mandible: Residual ridge.
    • Relief area:
    • Maxilla: Median platine raphe (C; rocking & Pain), Incisive papilla (Pain), Torus Palatinus, Fovea Palatinae (?), Tuberosity (C), Palatine Rougae (C)
    • Mandible: Knife edge residual ridge, mental foramen (C), genial tubercles (C), External Oblique Ridge (?), Internal Oblique (or Mylohyoid) Ridge (C), Torus Mandibularis.
    • - Limiting Structures (border of denture)
    • Frena (Frenum), Vestibule (Fornix)
    • Maxillar: Hamular notch, Vibrating line (Ah line), Posterior Palatal Seal Area
    • Mandibular: External Oblique Ridge (?), Lingual pouch (Retromylohyoid space)
  15. Inter pupillary line
    • Imaginary line running between the two pupils when the patient is looking straight forward.
    • Prosthetic Significance: parallel to the occlusal plane in the frontal view.
  16. Ala-Tragus Line (Camper’s Line)
    • Imaginary line, Inferior border of the Ala of the nose, the superior border of the Tragus of the ear.
    • Prosthetic Significance: parallel to the Occlusal plane in the sagittal view.
  17. Canthus-Tragus Line
    • Imaginary line running from the outer canthus of the eye to the superior border of the tragus of the ear.
    • Prosthetic Significance: Condyl’s hinge axis is 11-13 mm anterior to the Tragus of the ear along this line.
  18. Vermillion Border
    • The transitional epithelium between the mucous membrane of the lip and the skin.
    • Prosthetic Significance: becomes thinner in the upper lip after extraction; restore.
  19. Philtrum
    • Diamond-shaped area between the center of the upper lip and the base of the nose.
    • Prosthetic Significance: becomes flattened after extraction; restore.
  20. Naso-Labial Sulcus
    • Depression that extends from the ala of the nose in a downward and lateral direction to the corner of the mouth.
    • Prosthetic Significance: First sign of aging. Becomes deep after extraction; restore.
  21. Naso-Labial Angle
    • The angle between the Columella of the Nose and the Philtrum of Lip. 90 degrees in profile view.
    • Prosthetic Significance: becomes more obtuse after extraction; restore.
  22. Mento-Labial Sulcus:
    • Horizontal depression between the Lower lip and Chin.
    • Classification:
    • Angle class [I]: Normal ridge relationship.
    • Angle class [II]: Retruded mandibular position.
    • Angle class [III]: Protruded mandibular position.
  23. Modiolus
    • Situated laterally and slightly superiorly to the corner of the mouth.
    • Intersection point of 8 facial expression muscles: Buccinator, Orbicularis Oris, Platysma, Risorius, Zygomaticus Major, Levator Labii Superioris, levator Anguli Oris and Depressor Anguli Oris.
    • Prosthetic Significance: Sunken cheeks appearance and dropped angle observed by loss of maxillary teeth; restore. A forceful area which can influence the labial flange thickness of the maxillary denture.
  24. Retention, Stability, and Support
    • Resistance to the dislodging forces along the path of placement.
    • Resistance to displacement by functional horizontal or rotational stresses.
    • Resistance to the tissue-ward forces; provided by the foundation area on which the denture rests.
  25. Primary stress bearing area - characteristics
    • Supporting area:
    • Covered by keratinized mucosa
    • Supported by a compact bone (no/minimum resorption)
    • align with masticatory forces, no lateral forces formation
  26. Secondary stress bearing area:
    Area that can withstand stresses but don’t have all the 3 characters of the primary stress bearing area.
  27. Relief area:
    Any area that causes pain or instability upon pressure on it, these area should be relieved.
  28. Maxillary Residual Ridge
    • the alveolar process and its soft tissue coverage that remains after extraction, the highest part is called crest of the ridge.
    • Prosthetic significance: Primary stress bearing
  29. Maxillary ridge & Palate form shapes
    • - “U”-shape
    • - “V”-shape
    • - Flat
    • - Rounded
  30. Maxillary Tuberosity
    • prominent bulge at the maxillary ridge's distal end.
    • Prosthetic significance:
    • - Well formed tuberosity provides wide coverage with enhancement of support, stability and retention (Primary stress bearing area)
    • - Large Maxillary Tuberosity with big undercut should be relieved under the denture
    • - Surgical excision might be indicated for extremely large tuberosity that interferes with the denture space.
  31. Incisive Papilla
    • Pear-shaped elevation in the midline behind CIs.
    • Prosthetic Significance:
    • - Landmark for setting of teeth (8-10 mm lingual to the maxillary central incisors)
    • - After extraction it migrates to the crest of the ridge.
    • - It should be relieved to avoid burning sensation of the palate (Nasopalatine N.)
  32. Median Palatine Raphe
    • The mucoperiostium that covers the median palatine suture
    • Prosthetic Significance:
    • - relieved when prominent
    • - Lack of relief causes: Rocking, Tissue ulceration, Mid-line denture fracture.
  33. Palatine Rougae
    • Irregular elevations radiates from the midline of the anterior part of the palate.
    • Prosthetic Significance:
    • - 2ry stress bearing area.
    • - Prevents forward movement of the denture.
    • - should be relived if sensitive or prominent
  34. Torus Palatinus:
    • Bony prominence at both sides of the palate midline.
    • Prosthetic significance:
    • Relieved or Surgically removed
  35. Fovea Palatinae
    • Two openings of minor salivary glands on both sides of the midline, posterior to hard and soft palate junction.
    • Prosthetic Significance: determines the posterior extension of the upper complete denture (2mm posterior to Fovea Palatinae)
  36. Horizontal Part of The Palate
    • made of compact bone and covered by dense keratinized mucosa
    • Prosthetic significance: primary stress bearing area
  37. Mandibular Residual Ridge
    • The alveolar process with it's soft tissue covering that remains after extraction
    • Prosthetic Significance:
    • - 2ry stress bearing or relief area → Covered by movable fibrous connective tissue.
    • - Doesn’t Provide stability or support
  38. External Oblique Ridge
    • Bony ridge running downward and forward from the Ramus to reach Mental foramen.
    • Prosthetic Significance: The complete denture can’t extend over it
  39. Buccal Shelf of bone
    • Bordered externally by the external oblique line and internally by the slope of the residual ridge.
    • Prosthetic Significance: primary stress bearing area.
  40. Mental Foramen
    • located on the Buccal surface of the mandible between the roots of 1st and 2nd premolars
    • Prosthetic Significance: In cases of severe residual ridge resorption, the foramen occupies a more superior position and the denture base must be relieved to prevent nerve compression, numbness or pain.
  41. Retromolar Pad:
    • Pear-shaped area located distal to the lower 3rd molar.
    • Prothetic Significance:
    • - Primary Stress Bearing area
    • - contains glandular tissue, Fibres of Pterygomandibular raphe, Fibers of the Buccinator, Fibres of Superior constrictor, and Fibers of the Temporal tendon.
    • - compact bone.
    • - relatively unchanging structure; landmark to determine the level of occlusal plane
  42. Torus Mandibularis
    • Bony prominence at the inner surface of premolar area (unilateral or bilateral)
    • Prosthetic Significance: Relief or Surgical removal.
  43. Internal Oblique Ridge
    • Irregular bony ridge on the inner surface of the mandible where the mylohyoid muscle attached; influences the length of lingual flange.
    • Prosthodontic Significance: relief if prominent or sharp.
  44. Genial Tubercles
    • Bony projections at the inner surface of mandible at midline on each side of symphesis. Attachment for geniohyiod and genioglossus muscles.
    • Prosthodontic Significant: Relief in severe resorption higher than the ridge.
  45. Frena (Frenum)
    • Folds of mucous membrane; no significant muscle fibers. Labial is narrower than buccal due to the buccinator pull.
    • Prosthetic Significance: requires V- shape relief in the denture flange; surgical excision (frenectomy) when high.
  46. Vestibule (Fornix)
    • Mucosal reflection of the mucous membrane lining of the lip/cheek to join the unattached alveolar mucosa.
    • Prosthetic Significance: greatly enhances stability and retention when properly filled with the denture flange.
  47. Hamular notch
    Narrow cleft extending from the tuberosity to Hamulus.
  48. Vibrating line (Ah line)
    At the junction between the movable and the immovable part of the soft palate; runs between the Hamular noches
  49. Posterior Palatal Seal Area
    • area on the immovable part of the soft palate and posteriorly ends at the vibrating line
    • Prosthetic Significance:
    • - Critical area that provide the peripheral seal of denture, enhance the retention.
    • - Should be accurately recorded during the impression to prevent over/under extension of the denture in this area. Over-extension causes pain and difficult in swallowing; Under-extension causes lack of peripheral seal and poor retention.
  50. Lingual pouch (Retromylohyoid space)
    • The lingual vestibule posterior to the Mylohyoid muscle. Related to the distolingual end of mandibular denture.
    • Prothetic Significance: The “S” curve, as viewed from the lingual, results from the stronger intrinsic and extrinsic tongue muscles. Overextension causes pain and difficult in swallowing.
  51. Boundaries of Lingual pouch
    • -Anterior: Mylohyoid muscle
    • -Medial: Tongue
    • -Lateral: Mandible
    • -Posterolateral: Superior constrictor muscle
    • -Posteromedial: Palatoglossus muscle
Card Set:
Complete Denture - Midterm 01
2016-05-01 19:49:07
Complete Denture
Complete Denture - Midterm 01
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