12. adapted from quizlet: ryanef123 FP 21 - Establishing VDO in Fixed and Removable Prosthodontics (Dr. Nui)

Can you make an intellectual guess what the diagnosis is?

Epulis fissuratum, aplastic hyperplastic gingiva often from sharp, overextended denture

When you see these images, what comes to your mind?

• Epulis fissuratum

• Edentulous areas

• Make sure denture will not cover pterygomandibular raphe

• Might need new mandibular cast (poor capture of retromolar pad and lingual sulcus)

How do you establish VDO?

• Determine Vertical Dimension at Rest (VDR)

• Determine Freeway Space: VDR−VDO

• Evaluate Facial Esthetics and phonetics

• Verify comfort/function

What are the 3 factors do you need to consider to determine that you have established the proper VDO?

• Comfort

• Function (phonetics and occlusion)

• Appearance

What is the length of the face as determined by the amount of separation of the jaws?

Vertical dimension

What is the distance between two selected anatomic or marked points when in Maximum Intercuspation?

Occlusal vertical dimension

These are methods of what?

• Physiological Rest Position

• Closest Speaking Space (Phonetic Test)-pre-extraction measurement

• Pre-extraction record

• Distance from the bony shelf under the nose to the bottom of the mandible = distance from pupil of the eyes to the rima oris or parting line of the lip

Establishing VDO

These are methods of what?

• 40 mm occlusal vertical dimension

• Maximum biting force

• VDR-VDO= 3 mm

• Pt's own judgement

• Use F and V sound

• Lateral ceph radiograph

Establishing VDO

Which method to establish VDO?

A 40 mm occlusal vertical dimension

• max LI: 22 mm

• mand LI: 18 mm

after analyzing the facial appearance and phonetics, you evaluate the Interocclusal Rest Space (Freeway Space). What is the average Freeway Space?

2-4mm

With this measurement, how do you find VDO?

VDR - 3 mm

When finding VDR, where do the lines go?

tip of nose and chin

Use record bases + occlusal rims as a tool to transfer Pt's VDO to a ___________

Semi-adjustable articulator

During teeth try-in, what four factors do you need to ensure are correct? (!)

• VDO

• CR

• Function ("s" sound and occlusion)

• Appearance

What sound do you have the patient make to determine VDR?

"m" sound

When a patient says "Mississippi or 66", when they stop on the "s" sound, what teeth should be touching? (!)

No teeth

"F/V" sounds aid in setting which denture teeth?

Maxillary central incisors

Pronouncing "___" sound will slightly advance the mandible to recordable, repetitive horizontal and vertical position when the patient is at the /____/ position during speech. This position is almost closed to the correct VDO.

S

Distal extension RPD requires which two lab records?

• Record bases

• Occlusal rims

What do you have to check on the casts before the patient leaves?

Check clearance and make sure no interferences

What do you need to do here?

Restore VDO

If a patient has a functional problem (speech, clicking noise), what is most likely the problem?

Excessive VDO

If a patient has angular cheilitis, functional problem, whistling or air escaping, what is most likely the problem?

Loss of VDO

If posterior teeth are set in edge-to-edge, what is the most likely problem going to be? (!)

Cheek biting (always set posterior teeth with horizontal overlap)

T/F: You should always follow a pts existing max/mand relationship, if not, you can cause the denture to tip

true

How would you describe the dentition?

Worn down dentition

corrected sequence of steps for cementation: (!!!)

1. Remove temp crown 

2. Clean xr-ayual cement 

3. Check proximal from last lecture BUT Dr. Nui says to ask pt to bite down first to MIP and visually check if teeth are in contact; verify occlusion w/o prosthesis in place; crown must have same bite

4. check proximal 

5. x-ray