Prosthodontics III: The Edentulous State

A comprehensive set of 200 flashcards based on lecture notes for Prosthodontics III focusing on the edentulous state, biomechanical support, residual ridge resorption, patient classifications, and sequelae of wearing dentures.

What does the face embody in terms of interpersonal communication and social identity?

Social identities and one of the major vehicles for interpersonal communication.

List four types of negative changes associated with the edentulous state.

1. Anatomic changes, 2. Esthetic changes, 3. Biomechanical changes, 4. Speech problem.

Success in treating edentulous patients requires technical expertise and what other ability?

The ability to empathize with the patient's fears and aspiration.

What causes edentulism according to the lecture notes?

Various combinations of dental disease, cultural, financial, and attitudinal determinants, and previous dental treatment.

What does the edentulous state represent regarding the masticatory system?

A loss of the integrity of the masticatory system.

What supports the teeth in the natural dentition to ensure they function properly?

The periodontium.

What occurs to the total face height as a result of resorption of the residual ridges?

A decrease in total face height.

What is the resultant facial appearance caused by the reduction in the vertical dimension of occlusion?

Mandibular prognathism.

When should a dentist seek to maintain or restore the basic physiological relations between condyles, disks, and glenoid fossae?

When treating a patient with complete dentures.

Which age group is the edentulous state typically associated with in most cultures?

Old age.

What happens to the nasolabial groove in the edentulous state?

It deepens (deepening of nasolabial groove).

What happens to the labiodental angle during the morphologic changes of edentulism?

Loss of labiodental angle.

What morphological change occurs to the lips when a patient becomes edentulous?

Narrowing of the lips.

What change occurs to the columella philtral angle in the edentulous state?

It increases.

Success of prostheses ultimately depends on the patient's acceptance and what other factor?

Learning to use them.

What are the two principal functions of the periodontium?

1. Support and positional adjustment of the tooth, 2. Sensory perception.

What is the approximate surface area of the periodontal ligament (PDL) on each arch?

$$45\,cm^2$$

List three properties of the PDL that allow the dentition to cope with occlusal loading.

Viscoelastic properties, sophisticated sensory mechanisms, and potential for bone remodeling.

What are the functional and esthetic consequences of edentulism called?

Sequelae.

What compromised system replaces the natural support mechanism when a patient becomes edentulous?

The residual ridge.

What is the mean area of mucosa available for denture support in the edentulous maxilla?

$22.96\,cm^2$ ($3.559\,in^2$)

What is the mean area of mucosa available for denture support in an edentulous mandible?

$12.25\,cm^2$ ($1.899\,in^2$)

How do vertical forces and horizontal forces differ in their acting targets in the dentulous state?

Vertical forces act on the teeth; horizontal forces act on teeth during mastication and deglutition.

Which muscles create linguolabial or linguobuccal horizontal forces on the teeth?

The tongue.

Which structures create labiolingual or labiobuccal horizontal forces on the teeth?

Lips and cheeks.

List the four components that make up the residual ridge.

1. Denture-bearing mucosa, 2. Submucosa, 3. Periosteum, 4. Underlying bone.

What term describes the new bone formed in the alveoli after the alveolar process becomes edentulous?

Residual alveolar processes.

What process does the residual bony architecture of the jaws undergo throughout life?

Life-long catabolic remodeling.

When is the rate of reduction in size of the residual ridge at its maximum?

In the first $3\text{ to }6\text{ months}$.

What does the continuation of bone resorption throughout life ultimately leave the patient as?

A 'dental cripple'.

What are the two coupled processes involved in bone remodeling?

1. Bone deposition by osteoblasts, 2. Bone resorption by osteoclasts.

What percentage of bone mass is recycled weekly?

$$5\text{ to }7\% \text{ of bone mass}$$

How often is all spongy bone replaced?

Every $3\text{ to }4\text{ years}$.

How often is all compact bone replaced?

Every $10\text{ years}$.

List five factors that influence the rate and amount of bone loss.

Gender, hormones, metabolism, parafunction, and facial type (brachiocephalic vs. dolichocephalic).

What is Order 1 in Atwood's pattern of bone formation?

Pre-extraction.

What is Order 2 in Atwood's pattern of bone formation?

Post-extraction.

What is Order 3 in Atwood's pattern of bone formation?

High, well rounded.

What is Order 4 in Atwood's pattern of bone formation?

Knife-edge.

What is Order 5 in Atwood's pattern of bone formation?

Low, well rounded.

What is Order 6 in Atwood's pattern of bone formation?

Depressed.

In which direction does the maxilla resorb?

Upward and inward.

In which direction does the mandible resorb?

Outward.

What happens to the size of the maxilla as it resorbs?

It becomes progressively smaller.

What happens to the size of the mandible as it resorbs?

It becomes progressively wider.

What is the term for the direction of residual ridge resorption in the maxilla?

Centripetal.

What is the term for the direction of residual ridge resorption in the mandible?

Centrifugal.

Where does a large proportion of bone loss occur in the anterior residual ridge of the mandible?

The labial side.

Where does bone loss occur in the molar region of the mandible?

Lingually.

On which aspect does bone loss primarily occur in the maxilla?

Labial or buccal aspect.

What is the reduction in residual ridge height in the maxilla during the first year after extraction?

$$2\text{ to }3\,mm$$

What is the reduction in residual ridge height in the mandible during the first year after extraction?

$$4\text{ to }5\,mm$$

What is the annual rate of reduction in mandible height after the first year?

$$0.1\text{ to }0.2\,mm$$

How many times less is the annual rate of height reduction in the maxilla compared to the mandible?

$$4\text{ times less}$$

On which four components does the functional equilibrium of the masticatory system depend?

1. Occlusion's components, 2. The dentition, 3. Neuromuscular system, 4. Craniofacial structures.

Why must teeth be placed within a zone defined by the functional balance of musculature in complete dentures?

To ensure the denture is minimally displaced and the food bolus is positioned between occlusal surfaces.

How does the maximal bite force of denture wearers compare to dentate subjects?

It is five to six times less than that in dentate subjects.

What can be the result of nonfunctional or parafunctional habits on the masticatory system?

They can be harmful to the teeth or other components of the system.

Why was the idea of linking dental prostheses to the facial skeleton via an implanted device conceived?

To overcome the manifest disadvantages of conventional removable prostheses.

What happens at the interfaces between prostheses and their supporting tissues over time?

Time-dependent changes occur.

What are the two categories of sequelae caused by wearing complete dentures?

Direct sequelae and Indirect sequelae.

What are direct sequelae of wearing complete dentures?

Changes in local mucosal morphology.

List six examples of direct sequelae from the transcript.

1. Traumatic ulcers, 2. Cheek biting, 3. Denture irritation hyperplasia, 4. Denture stomatitis, 5. Flabby ridge, 6. Residual ridge reduction.

Describe the appearance of a traumatic ulcer or sore spot.

Small, painful lesions covered by a gray necrotic membrane and surrounded by an inflammatory halo with firm, elevated borders.

What are two common causes of traumatic ulcers?

Over-extended denture flanges or errors in occlusion.

What is another name for denture irritation hyperplasia?

EPULIS FISSURATUM.

How does mucosal hyperplasia typically develop?

Slowly from chronic low-grade trauma, induced by unstable dentures or overextended flanges.

What criteria determine the classification of denture stomatitis?

Extent and severity.

Describe Newton Type I denture stomatitis.

A localized simple inflammation or pinpoint hyperemia.

Describe Newton Type II denture stomatitis.

A more generalized erythematous area involving either a portion or the entire surface of the denture-covered mucosa.

Describe Newton Type III denture stomatitis.

A composite of types I and II plus granular inflammatory hyperplasia involving the midline of the hard palate and alveolar ridges.

What plays a role in the development and maintenance of denture stomatitis?

Candida biofilms.

Is denture stomatitis more prevalent in the maxilla or the mandible?

Maxillary.

List three systemic factors predisposing a patient to Candida-Associated Denture Stomatitis.

Old age, diabetes mellitus, and nutritional deficiencies (iron, folate, or vitamin B12).

List three local factors predisposing a patient to Candida-Associated Denture Stomatitis.

Dentures (trauma/cleanliness), xerostomia, and high-carbohydrate diet.

What condition manifested at the corners of the mouth is associated with Candida infection?

ANGULAR CHEILITIS.

How are 'flabby' ridges described in the notes?

Edentulous ridges that are mobile or resilient with little evidence of underlying supportive bone.

What causes pendulous maxillary tuberosities?

The description suggests they are similar to flabby ridges, appearing mobile/resilient.

Is there evidence that denture-related mucosal irritation leads to oral cancer?

No evidence.

What are the primary predispositions to oral cancer according to the text?

Excessive use of tobacco/alcohol, UV radiation, age, low socioeconomic status, and poor dental health.

What causes residual ridge reduction (RRR)?

Alveolar remodeling due to altered functional bone stimulus.

In what areas is the remodeling process particularly important?

Areas with thin cortical bone (buccal/labial maxilla and lingual mandible).

What anatomical facial type is associated with elevated masticatory forces and RRR?

Short and square face.

List three prosthodontic factors that can etiologically contribute to RRR.

Intensive denture wearing, unstable occlusal condition, and immediate denture treatment.

Which metabolic factor is specifically mentioned as a factor for RRR?

Osteoporosis.

What are the two indirect sequelae of wearing complete dentures mentioned?

1. Atrophy of masticatory muscles, 2. Nutritional status and masticatory function.

Which muscles have demonstrated greater atrophy in complete denture wearers according to CT studies?

Masseter and medial pterygoid muscles.

Why does chewing efficiency decrease in subjects wearing complete dentures?

The number of natural teeth is reduced.

How many more chewing strokes does a conventional denture wearer need compared to a dentate subject for equivalent particle size reduction?

Approximately seven times more.

List the four factors related to dietary status and nutrition of denture wearers.

1. Oral health and masticatory function, 2. Systemic health, 3. Socioeconomic status, 4. Dietary habits.

What is a case history defined as?

A planned professional conversation to obtain insight into the nature of the patient’s problem/illness and their attitude.

What specific data is collected as part of a case history?

Symptoms, concerns, and expectations.

What are the first three parts of an interview for history taking?

1. Recognition and acknowledgement of the problem, 2. Identification and exploration, 3. Interpretation and explanation.

What is the fourth and final part of an interview for history taking?

The offering of a solution to the problem.

Why is the patient's first visit considered a 'crucial' one?

It is the occasion when the seeds of success or failure are sown.

What four things should be assessed regarding patient attitude during the first visit?

1. Expectations, 2. Understanding of procedures, 3. Attitude toward dentures, 4. Ability to control prostheses.

What is the ultimate objective of the first appointment?

The development of a treatment plan that addresses and accommodates the patient's needs.

How can knowledge of a patient's social environment assist the dentist?

It helps the dentist understand their expectations and the background of their current dental status.

In House's classification, which patient type has the best mental attitude for denture acceptance?

Philosophical Patient.

How is a Philosophical Patient described?

Rational, sensible, calm, and composed in different situations.