thompsonleslie0 D2 | Complete Denture | Second Visit: Final Impressions

in what appt do final impressions take place?

second

- border molding as well

what is the process of creating border?

The shaping of the peripheral areas of an impression tray by the functional or manual manipulation of the tissues adjacent to the edges of the tray

why do we create border molding?

in order to duplicate the contours, the varying heights and the widths of the patient's peripheral rolls

anatomy captured in the border molding process is called what?

anatomy in function rather than descriptive anatomy

what are the principles of border molding?

- Extend the impression to cover the maximum area possible to maximize support within the limits of the health and function of the tissues of the basal seat.

OR

- The denture should cover all the available basal seat tissues without causing soreness at the denture borders and without interfering with the action of any of the structures they contact or that surround the denture

what should be done in patient's mouth before border molding material sets?

all the border molding movements should beperformed by the patient to "shape" the impression material.

what are the five objectives of an final impression?

to provide retention, stability, support for the denture, provide esthetics for the lips and at the same time maintain the health of the oral tissues

what is is the resistance to vertical components of mastication and occlusal forces applied in the direction of the basal seat?

support

______ of a denture is its resistance to removal in a direction opposite that of its insertion

retention

________ of a denture is the quality of a denture to be firm, steady, and constantin position when forces are applied to it. Refers especially to resistance against horizontal forces

stability

what is the only way to efficiently capture a peripheral seal?

border molding

what are the primary and secondary areas of support?

primary:

- horizontal segment of the hard palate

- buccal shelf

secondary:

- crest of the ridges

what is the only factor of stability that is related to the impression making phase?

good retention

- All other factors of stability are either ineffective or minimal if retention is lacking

The more extended the base of the future denture,....

the more stable it will be

The more extended the base of the future denture, the more stable it will be, however,...

the base should not over-extend, aka get in the way of the muscles when they contract as it would lead to dislodgment of the denture

shat would happen in the case of over-extension of the base of the future denture?

it would get in the way of the muscles when they contract and lead to dislodgment of the denture

what is the addition of an impression material to the peripheral borders of the custom tray in order to capture the height, thickness, and contour of the patient's peripheral rolls?

border molding

In the clinic, ______ are used for border molding

compound sticks

- VPS is used in class

The ______ _______ of the denture should be just wide enough and just deep enough to allow the frenum to pass through it without manipulation of the lip

labial notch

what muscle's tone depends on the support it receives from the thickness of the labial flange and the position of the teeth on the arch?

orbicularis oris

what type of manipulation should be done to the border wax by the patient/clinician in the car of the labial vestibule area?

Lip is elevated and extended outwards, downwards, inwards for orbicularis oris

how is functional border molding achieved in the labial vestibule area?

ask the patient to overtly move the lips by saying Ouh!, Ah!, E!

compare functional border molding and manual manipulation of the muscles in the labial vestibule area

With functional border molding, the base is more extended as the muscles are not as stretched so potentially provides more support. However, in extreme movements of the patients like sneezing, the denture may be dislodged.

manual manipulation is the only possible method for border wax manipulation under which circumstances?

1 - Patient cannot understand instructions:

- mental impairment or language barrier.

2 - Muscular disability:

- Parkinson’s disease or tardive dyskinesia (uncontrolled movements of the face and body induced by long-term use of some psychiatric drugs)

what is often the highest point of the flange?

buccal flange

in what order are border molding movements completed in the maxilla?

1- Labial vestibule

2- Buccal vestibule (one side then the other)

3- Posterior Palatal seal

in what order are border molding movements completed in the mandible?

1- The sublingual crescent area

2- The mylohyoid area (one side then theother)

3- Retromylohyoid area (one side then theother)

4- Buccal vestibule (one side then theother)

5- Labial vestibule

what type of manual manipulation should be done to the border wax by the patient/clinician in the case of the buccal vestibule?

Cheek is:

- Elevated

- Pulled downward

- Pulled outward

- Pulled inward

- Pulled forward for the action of the orbicularis oris

- Pulled backward for the action of the buccinator

Coronoid process:

Ask the patient to move the mandible side to side

how is functional border molding achieved in the cheek?

ask the patient to do the fish face

what type of manual manipulation should be done to the border wax by the patient/clinician in the case of the posterior palatal seal?

- Ask the patient to open as wide as possible (Related to the pterygo-mandibular raphe)

- Ask the patient to say ah

- Valsalva maneuver

Related to muscles of the soft palate (mostly due to the action the tensor veli palatini muscle, other muscles of the palate are: elevator veli palatini, palatoglossus and palatopharyngeus muscles)

what has been described as "an area of soft tissue along the junction of the hard and soft palate on which pressure, within physical limits of the tissues, can be applied by a denture to aid in its retention"?

posterior palatal seal area

what are goals of the posterior palatal seal area?

- compensate for acrylic shrinkage during processing

- Make the interface between the acrylic plate and the patient soft tissue less noticeable which helps decrease gagging reflex

- Avoid food being trapped under the denture

indentations near the midline of the palate that are formed by a coalescence of several mucous gland ducts. Landmark as the vibrating line is often anterior to the fovea palatine

Fovae palatinae

Vibrating line movement for border molding:

Two options:

- Ask the patient to say a long ah

- Valsava maneuver

The alveololingual sulcus (space between the tongue and the ridge) extends from the _____ _____ to the _______ _____

lingual frenum; retromylohyoid curtain

The sublingual crescent area contains:

- The lingual frenum

- The sublingual gland.

Movement for border molding of the sublingual crest area:

- Anterior Lingual Flange length: ask patient to protrude the tongue out as it activates the genioglossus muscle, which raises sublingual fold.

- Anterior lingual flange thickness: push the tongue against the front part of the palate

Movement for border molding of the mylohyoid area:

Move the tongue to the opposite cheek and push the tongue against the front part of palate. It activates mylohyoid muscle

Movement for border molding of the retromylohyoid area:

- Open wide for pterygomandibular raphe to be brought forward

- Thrust tongue out so that the superior constrictor of the pharynx pushes themylohyoid muscle.

- Ask patient to close the mouth: the downward pressure on the mandible activates the medial pterygoids push that against the retromylohyoid curtains distal end of the lingual flange

Summary of movements for border molding for the clinic: