Removable Exam 1

What is the function of the Retromylohyoid Fossa?
1. Retention 2. Support 3.Stability 4. Comfort

Retention and Stability

What is the intaglio surface?

Inferior portion of a denture determined by impression

What are the House Denture Patient Personalities Classifications? (4)

Which is the hardest pt to have?

Physiological: calm, rational, cooperative

Exacting: demanding, precise, skeptical

Hysterical: unstable, can’t adapt to denture, exaggerate pain

Indifferent: lack of care, interest, and motivation (hardest pt to have)

Esthetic consequences of tooth loss (5)

Narrowing of lips

Decreased mental-labial angle

Increased Naso-labial angle

Deep Facial Sulcus

Prognathic appearance

Why should the impression include all the denture-bearing surface area?

Maximize distribution of functional forces

1. Retention

2. Support

3. Stability

What does the Border Molding help with?

1. Retention

2. Support

3. Stability

4. Comfort

Retention and Comfort

What are sources of distortion of an impression?

How to remove this distortion?

Impression must be dimensionally stable

Sources of distortion: removal from mouth + handling

Achieved by: material selection and handling

What positions the stock tray in a primary impression in the mandible and maxilla?

Maxilla: frenum + palatal vault + hamular notch

Mandible: retromolar pad + frenum

What is mucostatic impression technique? Anatomic or Functional? When is it used? What are some examples?

Anatomic with NO MOVEMENT

Not moving tissues

Holes let material flow out so tissue isn’t being pushed (overextended)

Used: when there is reduced supporting tissues, mobile tissue, or metal dentures

Examples: PVS + Polysulfide + POP + ZOE

What is mucodisplacing impression technique? Anatomic or Functional? When is it used? What are some examples?

Functional (movement is present)

Selective pressure records anatomy in functional state

Used: excellent supporting tissue remain, firm + resilient mucosa, tori present (press on non-tori areas)

Examples: alginate + wax + High Viscosity elastomers

Selective pressure provides support and relief

What is the working time of final impression material?

How long before you should remove it from the mouth?

Working time: 1 minute

Remove from mouth: 2.5 minutes

What should be done after taking the final impression?

Transfer the post-palatal seal location

How to get the occlusal plane? (3 things)

1. Transfer midline to the Maxillary occlusal rim by using the middle of the face

   1. Line from the glabella through the filtrum of the maxillary lip

2. High Smile Line: important to know the amount of FGM showing

3. Canine Line: important to know the size of the teeth

   1. Inner canthus of eye to ala of nose to inner part of canine

What are the 3 things that Occlusal Rims dictate?

1. Lip Volume = re-establishes naso-labial angle

2. Corridors = space between buccal surface of the posterior teeth and inner mucosa of cheek

3. Occlusal Rim Height

Match each letter you should use to sound something out with what it is related to:

m, s, f/v

M = Rest Vertical Dimension

S = Speaking Space

F/V = Incisal Height

What is the Facial Proportional Method to measure vertical dimension?

When is it used?

What are you measuring?

Used in patients with NMJ problems

Measured by comparing:

• Distance from corner of eye —> middle of lip = bottom of nose —> bottom of chin

• Width of lips = Height from top of lip to bottom of chin

What is the Phonetic Method to measure vertical dimension?

When is it not used?

What are you measuring?

Pronouncement of S sounds and observing jaw movement

• MISSISSIPPI

Looks at Speaking Space

Contraindications = Deaf, Mute, Brain Injuries

What is the Aesthetic Method to measure vertical dimension?

When is it used?

What are you measuring?

Turner Fox Plane

• Inter maxillary distance analyzed via external appearance of face

• Indications: soft tissue is intact and capable of being aesthetically related

  • Doesn’t work for flabby people

What is the Swallowing Method to measure vertical dimension?

When is it used?

When is it not used?

Swallowing —> muscles raise mandible from the resting position to OVD

Indications: pts with adequate NMJ control and able to swallow normally

Contraindications: Muscle injuries, CNS injuries, Sclerosis, Feeble-minded

What are the Physiological ways to measure horizontal position of the mandible? (3)

How do they each work?

1. Swallowing

   1. Swallowing —> muscles raise the mandible from RVD to OVD 

   2. Saliva forced back —> jaw retrudes to CR

2. Contraction of Temporalis

   1. Contract posterior bundles = condyles in posterior position in glenoid cavity

3. Tongue lift and mouth closure

   1. Tongue elevation —> posterior superior position

   2. Done via elevators and retrusors

   3. Jaw driven into CR position

What position are you trying to get into?

How can you guide a patient into the horizontal position of the mandible?

What are some problems that can arise? (8)

1. Guide to most retrusive position = able to record CR

2. Perform fast opening and closing movements

   1. Achieve muscle relaxation

   2. Alter proprioceptive memory

   3. Avoid protrusive jaw reflexes

3. Can cause Incorrect balance = problems

   1. Trauma to supporting tissues

   2. Resorption of alveolar process

   3. Loss of retention

   4. Discomfort

   5. Joint imbalance

   6. Cusp sliding

   7. Lack of intercuspation

   8. Unbalanced vertical contact

When is the greatest source of error in edentulous record?

After record has been made

Due to:

• Wax distorts

• Carless cast articulation

When trying on trial bases, what do you want to make sure they have?

1. Retention 2. Support 3. Stability 4. Comfort

Retention

Stable

Accurate extensions (support)

What are the 3 scenarios in which the incisal position is evaluated in?

Smiling

Speaking

At rest (normal)

What teeth are we looking at if we want to make sure the horizontal plane of the occlusal plane is flat?

Distal of the canines

Where does the Curve of Spee start from?

Where does it end?

Start: Canine

End: 2nd Molars = 2/3 up the retromolar pad

The position of ______ tooth is most critical to the incisal edge position?

Why (3 reasons)

Maxillary Central Incisor

• Midline centered

• Level

• Determines the amount of display?

When should you show MORE wax?

Young

Short upper lip

Hypermobile lip

When should you show LESS wax?

Older

Longer upper lip

Stiff lip

What type of occlusal relationship do we want between the teeth? Thing broad? Anteiror and Posterior

Anterior open bite

Posterior even and simultaneous contact

Bilateral contact during excursive movements

In the curve of spee, what cusps are we looking at?

Buccal cusps from the canine to the 2nd molar

What bone does the Curve of Spee relate to?

Curvature of the temporal bone eminance

What does the Curve of Spee help with?

No posterior contact during protrusion

Due to the Christensen Phenomenon

What determines the posterior limit for positioning the last tooth in the lower arch?

Where should the last tooth be in relation to it?

Retromolar Pad

Cusps are 2-3 mm below retromolar pad

What is Mutually Protected Occlusion?

When the anterior teeth (Canine guidance) limits contact on the RPD

• Can cause interference

What is Unilateral Balance?

Group Function

Multiple posterior teeth are involved in function

What happens in static and dynamic moments in dentures that aren’t in normal occlusion?

Static: Anterior Open Bite

Dynamic: Bilateral Balanced Occlusion

How do you achieve balance in Monoplane Occlusion?

Compensating Curve (ramp)

Balancing Ramp (neutrocentric)

What jaw relationsihps are used for Bilateral Balanced, Lingualized, and Monoplane occlusion?

BB: Class 1

Lingual: Class 1-3

Mono: Class 1-3

What is the most important goal of denture treatment? 

What is the 2nd most important?

1. Psychological comfort —> can’t have success without pt accepting denture

2. Esthetics

3. Function —> limited improvements can be made

What is more important, impression material or technique?

Technique

• Material rarely determines success/failure

What is support?

Resistance to downwards forces on the occlusal table

What is retention?

Resistance to from pulling the denture off the alveolar ridge

What is stability?

Resistance to horizontal forces

What are the important landmarks to maxillary posterior extension?

1. Hamular Notch

2. Fovea Palatine

3. Posterior Vibrating Line

What is the important anatomical landmark for mandibular occlusal position?

Retromolar pad

What is the most distal portion of the maxillary residual alveolar ridge?

Maxillary Tuberosity

Where can you find the palatal vault?

Deepest and most superior part of the hard palate (don’t skip this card unless I said superior)

What do you measure when you classify the maxillary and mandibular residual ridges?

Maxillary: residual ridge is the most objective criteria

• Measure of bone height radiographically isn’t reliable

Mandibular: muscle attachments are used to classify

The interarch distance measured from the occlusal rims are uniform contact with what?

a. RVD b. OVD c. Christensen’s Space

OVD

What is another name for freeway space?

Speaking Space

Facebow is the caliper-like instrument to record the spatial relationship of the mandibular and maxillary arch: True or false

False

• Relationship between maxillary arch and some skull landmark

Three uses of occlusion rims:

a. Take the primary impression, fabricate primary cast and make diagnosis and treatment plan

b. Orientation of occlusal plane, Determination of shape of arch, determination of jaw relation

c. Take the final impression, fabricate master cast and for fabricate complete denture

d. Constrict special tray, carried and control impassion material

Orientation of occlusal plane

Determine shape of arch

Determine jaw relation

One of the following is not a feature of reduced OVD:

a. Commissural lesions

b. Reduction of chewing efficiency

c. Exaggerated increase in SS

d. Premature occlusal contact

Premature Occlusal Contact

When evaluating a custom tray for border molding, which findings indicate the tray should be adjusted before proceeding? -Select all that apply

a. Tray impinges on labial frenum

b. Tray is stable against retromolar pad reference

c. Tray lifts on seating due to overextension

d. Tray borders extend 2 mm short of sulcus depth

e. Tray lacks coverage of hamular notch region

A, C, E

For individuals utilizing removable complete dentures, the incisal edge of the denture teeth should make contact when the patient repeats the letter "S."

a. True

b. False

False

Which of the following conditions may directly compromise the accuracy of a final impression, and require tissue management before proceeding

a. Flabby anterior ridge after extraction

b. Severe palatal torus

c. Shallow vestibule with healthy mucosa

d. Deep palatal vault

Flabby Anterior Ridge after Extraction

What is the Curve of Wilson?

What plane is it in?

What cusps does it run across? What arch?

What does it do?

Exists in the Mesio-Distal Plane

Contacts the M and D cusps of mandibular teeth

Helps with proper alignment of teeth and proper mastication

What are the 3 parameters in the Lip Dynamics Theory?

High Smile Line

Midline

Commissure Line

In complete dentures, the inclination of the cusps of the posterior teeth directly impacts:

a. Support b. Retention c. Stability d. Chewing e. Esthetics

Retention

Stability

Chewing

Greater the condyle angle, the greater the cusp angle? True or False

True

What is the Christenson Phenomenon?

Gap between upper and loewr posterior teeth when the mandible protrudes

What is the function of the Monson’s Sphere?

Maintaining balanced occlusion in DYNAMIC movement

In the classification of edentulous pts, what does it mean to overall be Class 1, 2, 3, and 4?

1: ideal or minimally compromised

2: moderately compromised

3. substantially compromised

4. severely compromised

What is the function of the incisal height in relation to wax rim? (2 fxns)

Why do we care to make F and V sounds?

Helps check the anterior length and labial position of the maxillary wax rim

What are the 3 functions of Camper’s Plane?

Ensures parallelism in te occlusal plane

Provides esthetics in the smile

Directs masticatory forces perpendicularily

After doing what 3 things do you not change the maxillary rim position?

After finding the midline, canine line, and high smile line

What determines the height of the incisal edge?

Age

Extraoral Musculature

Phonetics

When looking at the Occlusal Plane in 3D, what are you looking at? (3 things)

1. Arch dimensions —> rim contour

2. Length + Height

3. Orientation —> parallel rim

Is a short lip 1-2 mm below or above the incisal height?

Below (SB = son of a bitch)

When do you check incisal height?

Before recording jaw relation (MMRR)

What happens in the first appointment of denture making?

1. Rapport

2. Exam and diagnosis

3. Eliminate prior disease

4. Preliminary Impression + Cast

What happens in the second appointment of denture making?

1. Make custom tray

2. Border Molding

3. Final Impression + Cast

What happens in the third appointment of denture making?

1. Evaluate trial base retention and extension

2. Occlusal Plane

3. Occlusal Vertical Dimension

4. Facebow

5. MMRR

6. Teeth Selection

What happens in the fourth appointment of denture making?

1. Confirm that pt likes tooth shape, anatomy, and position

2. Confirm MMRR

How many appointments does it take for a full denture process?

6 apts

What are modifying factors of denture placement?

Systemic disease

Psychosocial considerations (are they crazy)

TMD

Large Tongue

Hyperactive gag reflex (are they gonna choke on that thang)

In a primary impression, are we using mucostatic or mucodisplacing technnique?

Mucostatic (anatomic)

When selecting size of the tray, what is our extension of the impression? Max and Mand

Max: hamular notch

Mand: retromolar pad

Are you supposed to put alginate intraorally or just on the tray?

Put it intraorally AND on tray

Where does overextension in primary impressions normally occur?

Facial and lingual vestibules

What is a disadvantage of thin saliva?

Poor retention and lubriction

What determines success/failure of a denture psychologically?

The ability of the dentist to manage expectations

How to achieve patient comfort? (5)

1. patient management

2. patient education

3. lowering expectations

4. high quality work

5. patient involvement