Marksparks

Denture Insertion

Denture Insertion Important Notes

1. Denture adhesives:
   • Vegetable gums – possess very little cohesive strength
   • Gum-based adhesives – highly water-soluble and washed out easily
   • Synthetic salts of Gontrez  display good ionic adherence
2.  Soft liners:
   • They are denture-lining materials
   • Help in conditioning the traumatized tissues
   • It acts as a cushion between the hard plastic base of the denture and the oral tissues
   • Commonly used soft liners are
     • Poly ethyl methacrylate
     • Silicon soft liners
     • Heat activated silicones
3. Denture cleansers:
   • The most commonly used denture cleansers are alkaline peroxides and hypochlorites
   • Alkaline peroxides
     • Provided in powder and tablet forms
     • It contains alkaline compounds.
     • Detergents, sodium perborate, and flavoring agents
     • When mixed with water, sodium perborate decomposes releasing peroxides which in turn decompose releasing oxygen
     •  Hypochlorite solutions are available only in solution form
4. Problems in denture wearers:

Denture Insertion Long Essays

Question 1. Discuss in detail about insertion, instructions, and aftercare of complete denture.
Or
Instructions to complete denture patient.
(or)
Post-insertion instructions are to be given to a complete denture patient
Answer:

Instruction For Insertion & Removal:

• The patient is taught to insert & remove the denture along the path of insertion
• In the presence of a unilateral undercut, the Denture should be inserted into the undercut first then rotate the prosthesis into the final position
• If a denture is more retentive the patient is asked to blow with lips closed to break the peripheral seal

Maintenance of Prothesis:

• Patients are taught to clean the dentures regularly
• Cleansers used are:
  • Chemicals: Chlorhexidine
  • Ultrasonic cleaner
• Soaking & brushing the denture
• Avoid hard brushing
• Avoid excessive flossing

Read And Learn More: Prosthodontics Question And Answers

Night Wear of Prosthesis:

• Avoid nightwear of dentures
• Allowed to wear only in brutes
• Store the denture in water or any dilute medicinal solution at night
• Report to the dentist if the denture causes any irrita- tion even after 24 hours
• The patient is asked to read newspapers or novels loudly during 1st 24 hours to get adapt to the denture
• Recall the patient after a week to check for tissue reaction Recall after every 3–6 months to determine the amount of residual ridge resorption

Denture Insertion Short Essays

Question 1. Write Recall Visit
Answer:

Recall Visit:

• Explain the patient the sequences of denture insertion like increased salivation, and difficulty in speech.
• If it continues for more than 1 week, ask him to visit the dentist.
• If an ulcer or any irritation is experienced by the patient, ask him to visit the dentist.

Denture Insertion Short Question And Answers

Question 1. Factors in denture design affecting speech.
Answer:

• Denture wearers have shallow pronunciation
• In dentulous patient, rugae enhance speech
• In a denture wearer speech is affected due to absence of rugae
• The use of metal dentures improves speech
• Injury to the external laryngeal nerve
• Presence of tongue tie
• Production of various sounds
  1. Bilabial – b, p, m
  2. Labiodental-f, v
  3. Linguodental-th
  4. Linguoalveolar- t, d, s, z, v, 1
  5. ‘s’ sound is controlled by the anterior part of the palatal plate of the denture base

Question 2. Torus palatinus.
Answer:

It is exostosis/ overgrowth of cortical corticocancellous bone

Technique for excision of palatal torus:

Denture Insertion Viva Voce

1. Poor denture retention and excessive vertical dimension are the two common causes of clicking of complete dentures.

Maxillofacial Prosthetics

Maxillofacial Prosthetics Definition

Obturator: “A prosthesis used to close a congenital or acquired tissue opening, primarily of the hard palate and/or contiguous alveolar structures”.

Surgical obturator: It is defined as “A temporary prosthesis used to restore the continuity of the hard palate immediately after sur- gery or traumatic loss of a portion or all of the hard palate and/or contiguous alveolar structures”.

Interim obturator: It is defined as “A prosthesis that is made several weeks or months following the surgical resection of a portion of one or both maxillae. It frequently includes replacement of teeth in the defect area.’

Definitive obturator: It is defined as “A prosthesis that artificially replaces part or all of the maxilla and the associated teeth lost due to surgery or trauma”.

Maxillofacial Prosthetics Important Notes

1. Types of obturator

• Types:
  • Based on the phase of treatment
    1. Surgical Obturators -Types:
       • Immediate surgical obturator – Inserted at the time of surgery
       • Delayed surgical obturator – Inserted 7–10 days after surgery
    2. Definitive obturators
    3. Interim Obturators
  • Based on the Material used
    • Metal obturators
    • Resin obturators
    • Silicone obturators
  • Based on the area of restoration
    • Palatal obturator
    • Metal obturator

2. Materials used in maxillofacial prosthesis:

• Heat cure acrylic resin
• Polyvinyl chloride and copolymers
• Polyurethane elastomers
• Silicones
• Polyphosphates
• Chlorinated polyethylene

Maxillofacial Prosthetics Short Essays

Question 1. Treatment Planning for a maxillary prosthesis.
Answer:

1. First Phase – Initial Stabilization
   • It lasts for 2 weeks
   • The physician determines the prognosis
2. Second Phase – Early management
   • It extends for 2–8 weeks
   • Treatments like inter maxillary Fixation, Splinting, and RCT are done
3. Third Phase – Intermediate management
   • It extends for 3–8 months
   • A treatment prosthesis is provided and defects are evaluated
4. Fourth Phase – Definitive management
   • It extends from 6 months – 3 years
   • A permanent prosthesis is fabricated

Read And Learn More: Prosthodontics Question And Answers

Question 2. Obturators.
Answer:

Definition: “A prosthesis used to close a congenital or acquired tissue opening, primarily of the hard palate and/or contiguous alveolar structures”.

Types of Obturators:

1. Based on the phase of treatment:

• Surgical Obturators: It is defined as “A temporary prosthesis used to restore the continuity of the hard palate immediately after surgery or traumatic loss of a portion or all of the hard palate and/or contiguous alveolar structures”.
  • Types:
    1. Immediate surgical obturator:
       • Inserted at the time of surgery
    2. Delayed surgical obturator: Inserted 7 -10 days after surgery
       • Interim Obturators: It is defined as “A prosthesis that is made several weeks or months following the surgical resection of a portion of one or both maxillae. It frequently includes the replacement of teeth in the defect area.
         • This prosthesis when used, replaces the surgical obturator that is placed immediately following the resection and may be subsequently replaced with a definitive obturator”.
       • Definitive obturators: It is defined as “A prosthesis that artificially replaces part or all of the maxilla and the associated teeth lost due to surgery or trauma”.

2. Based on the Material used:

• Metal obturators
• Resin obturators
• Silicone obturators

3. Based on the area of restoration:

• Palatal obturator
• Metal obturator

Fabrication of Obturators:

• Plan the design and extent of the obturator
• Primary impression is made
• Fabricate the custom tray
• Carry out border molding by asking the patient to swallow
• The final impression is made using alginate or elastomeric impression materials
• Record the jaw relation and arrange the teeth. Insert the prosthesis

Uses of Obturators:

• Provides stable matrix for surgical packing
• Reduces oral contamination
• Effective speech obtained post-operatively
• Permits deglutition
• Reduces the psychological impact of surgery
• Reduce the period of hospitalization

Question 3. Materials for a maxillofacial prosthesis.
Answer:

1. Acrylic resin: Preferred for restoring defects that require minimal movement

Advantages of Acrylic resin:

• Easily available
• Commonly used material
• Intrinsic and extrinsic colouration can be used
• Has better colour stability

Disadvantages of Acrylic resin:

• Rigid
• Difficulty in duplicating

2. Acrylic copolymers: They are plasticized methyl meth acrylate polymers that are not commonly used

Disadvantages of Acrylic copolymers:

• Tacky so leads to a collection of dust and stains
• Poor edge strength
• Poor durability
• Degrades under sunlight

3. Polyvinyl chloride and copolymers: It is a hard, clear, tasteless, and odorless resin

Disadvantages of Polyvinyl chloride and copolymers:

• Excessive shrinkage
• Long processing time
• Discoloration
• Hardening of the margins

4. Chlorinated polyethylene:

• It requires metal molds for processing

5. Polyurethane elastomers:

• Have excellent elasticity
• Used to restore defects
• Has moisture sensitivity during processing
• Poor colour stability

6. Silicones: The most commonly used material

• Types:
  • Implant grade
  • Medical grade
  • Clean grade
  • Industrial grade

7. Polyphosphates:

8. Adhesives:

• Used to retain a maxillofacial prosthesis

9. Metal:

• Used to obtain bone anchorage for a prosthesis

Maxillofacial Prosthetics Viva Voce

1. The interim obturator can serve up to 6 months
2. The goal of the interim obturator is to restore deglutition and speech
3. The surgical obturator is used for approximately 5 days

Removable Partial Dentures Definitions

1. Removable partial denture: Any prosthesis that replaces some teeth in a partially dentate arch is called a removable partial denture It can be removed from the mouth and replaced at will
2. Direct retainer: It is defined as “A clasp or attachment placed on an abutment tooth for the purpose of holding a removable denture in position
3. Indirect retainer: It is defined as “a part of a removable partial denture which assists the direct retainers in preventing displacement of distal extension denture bases by functioning through lever action on the opposite side of the fulcrum”.
4. Major connector: It is defined as “A part of a removable partial denture which connects the components on one side of the arch to the components on the opposite side of the arch”
5. Minor connector: It is defined as “The connecting link between the major connector or base of a removable partial denture and other units of the prosthesis, such as clasps, indirect retainers, and occlusal rests”.
6. Rest: “It is defined as “A rigid extension of a fixed or removable partial denture which contacts a remaining tooth or teeth to dissipate vertical or horizontal forces.”
7. Denture base: It is defined as “that part of a complete or removable partial denture which rests upon the basal seat and to which teeth are attached”.
8. Surveyor: An instrument used in the construction of removable partial dentures to locate and delineate contours and relative positions of abutment teeth and associated structures
9. Retentive arm: “A flexible segment of a removable partial denture which engages an undercut on an abutment and which is designed to retain the denture”
10. Reciprocal arm: “A clasp arm or other extension used on a removable partial denture to oppose the action of some other part or parts of the prosthesis”
11. Reciprocation: It is defined as the means by which one part of a prosthesis is made to counter the effect created by another part
12. Stress breaker: A device that relieves the abutment teeth of all or part of the occlusal forces
13. Interim removable denture: “A transitional denture may become an interim denture when all of the natural teeth have been removed from the dental arch”.
14. Immediate partial denture:  “A complete removable partial denture constructed for insertion immediately following the removal of natural teeth”
15. Guiding planes: “Two or more vertically parallel surfaces of abutment teeth so oriented as to direct the path of placement and removal of removable partial denture”
16. Survey line: “A line drawn on a tooth or teeth of a cast by means of a surveyor for the purpose of determining the positions of the various parts of a clasp or clasps”.
17. Height of contour: A line encircling a tooth designating its greatest circumference at a selected position.
18. Internal attachment: “A retainer, used in removable partial denture construction, consisting of a metal receptacle and a closely fitting part: the former is usually contained with the normal or expanded contours of the crown of the abutment tooth and the latter is attached to a pontic or the denture framework”.
19. Fulcrum line: “An imaginary line around which a partial denture tends to rotate”

Removable Partial Dentures Important Notes

1. Kennedy’s classification:

• Class 1:
  • Bilateral edentulous areas located posterior to the remaining natural teeth
  • There are two edentulous spaces located in the posterior region without any teeth posterior to it.
• Class 2:
  • The unilateral edentulous area located posterior to the remaining natural teeth
  • There is a single edentulous space located in the posterior region without any teeth posterior to it.
• Class 3:
  • Unilateral edentulous area with natural teeth anterior and posterior to it.
  • It indicates a single edentulous area that does not cross the mid line of the arch
• Class 4:
  • Single Bilateral Edentulous area located anteriuor to the remaining natural teeth
  • It crosses the midline of the arch
  • Teeth are present only posterior to the edentulous arch
• Class 5:
  • The edentulous area is bounded anterior and posteriorly by natural teeth
• Class 6:
  • Edentulous area in which the teeth adjacent to the space are capable of total support of the required prosthesis

Read And Learn More: Prosthodontics Question And Answers

2. Applegate’s rules:

• Rule one – Classification should follow rather than precede extractions that might alter the original classification
• Rule two – If the third molar is missing and not to be replaced, it is not considered in the classification
• Rule three – If the third molar is present and is used as an abutment, it is considered in the classification
• Rule Four – If the second molar is missing and not to be replaced, it is not considered in the classification
• Rule Five – The most posterior edentulous area or areas always determine the classification
• Rule Six –  Edentulous areas other than those, which determine the classification, are referred to as modification spaces and are designated by their number
• Rule Seven – The extent of the modification is not considered, only the number of additional edentulous spaces are considered
• Rule Eight – There can be no modification areas in class 4.

3. Surveying tools:

• Analysing rod
• Carbon marker
• Undercut gauge
• Wax knife

4. Indications for removable partial dentures:

• Distal extension
• After recent extractions
• Long span edentulous arches
• Need for bilateral cross-arch stabilization
• Excessive loss of alveolar bone

5. Components of removable partial denture:

• Major connector
• Minor connector
• Direct retainer
• Indirect retainer
• Denture base
• Artificial teeth

6. Parts of surveyor:

• Surveying platform
• Cast holder/surveying table
• Vertical arm
• Horizontal arm
• Surveying arm
• Surveying tools

7. Types of major connectors:

8. Functions of minor connector:

• Joins other units of the prosthesis to major connector
• Transfers functional stress to the abutment teeth
• Transfers the effect of the retainers, rests, and stabilizing components to the rest of the denture

9. Types of minor connectors:

• The minor connector that connect the direct retainer to the major connector
• The minor connector that connect auxiliary rests to major connector
• The minor connector that connect the denture base to the major connector
• The minor connector that extends as the approach arm of a bar clasp

10. Parts of direct retainer:

• Retentive arm
• Shoulder
• Rest
• Reciprocal arm
• Body
• Minor connector

11. Functions of direct retainer:

12. Functions of reciprocal arm:

• Acts as an indirect retainer
• It can resist the rocking of the denture base
• It provides stability and reciprocation against the retentive arm
• The denture is stabilized against horizontal movement

13. Functions of indirect retainer:

• It counteracts the lifting forces and stabilizes the denture
• It counteracts horizontal forces and provide stability and support to the denture
• It can splint and protect the anterior teeth
• It may act as an auxillary rest
• The dislodgement of indirect retainer suggest the need of relining

14. Types of indirect retainers:

• Auxillary occlusal rest
• Canine rest
• Modification areas
• Direct indirect retention
• Canine extension
• Continuous bar retainer
• Rugae support
• Indirect retention from major connectors

15. Factors affecting stability of the RPD:

• Design of the framework
• Harmonious occlusion
• Relationship of the teeth to the residual ridge

Viva Voce

1. Distal extension partial denture derives support from both the teeth and residual ridge
2. The anteroposterior palatal bar and strap are the most rigid palatal major connector
3. The U-shaped palatal connector is least rigid palatal major connector
4. A partial denture is supported by dual support- soft tissue and tooth support
5. In Kennedy’s classification, the deciding factor is missing of most posterior tooth
6. In Kennedy’s classification, the most common arch is class 1
7. Totally tooth supported denture is class 3
8. In the palatal major connector, relief should always be given for the palatal torus
9. Elastomers are best material for taking impressions in RPD
10. Guiding planes prepared on enamel surfaces should be flat
11. The seat for occlusal rest on the abutment should be on the marginal ridge at 90 degrees to the long axis of the abutment
12. The main function of the reciprocal arm is to counteract the forces transmitted by the retentive arm
13. The indirect retainer should be placed on the opposite side of the fulcrum line
14. The main function of an indirect retainer is to minimize the movement of the denture away from supporting tissue
15. The major connector should be rigid enough to connect the Bilateral components of the removable denture
16. The flexibility of major connector causes greatest damage to a partial denture
17. The major connector should not terminate on gingival tissue
18. In case of large palatal torus, an anteroposterior palatal bar major connector is used
19. The outline form of occlusal rest is triangular
20. The rest seat for lingual rest is V-shaped
21. Incisal rests are frequently seen on mandibular canine
22. Lingual rests are commonly used on maxillary canines 23.
23. The terminal end of the retentive arm should be placed at a cervical third of the crown
24. The realeff effect is described by Hanau
25. The path of insertion of RPD is preferred to be perpendicular to the occlusal plane
26. The encirclement of each clasp is more than 180 degrees 27.
27. The easiest clasp to design and construct is a cast circumferential clasp
28. Ring clasp is most often indicated in tipped molars

Post Insertion Problems Long Essays

Question 1. Discuss post-insertion problems & their management.
(or)
Discuss post-insertion problems in edentulous patients using complete dentures. Enumerate the reason for it & their management
Or
Post-insertion instructions and problems encountered in complete dentures.
Answer:

Instruction for Insertion & Removal:

The patient is taught to insert & remove the denture along the path of insertion

Maintenance of Prosthesis:

• Patients are taught to clean the dentures regularly
• Cleansers used are:
  • Chemicals: Chlorhexidine
  • Ultrasonic cleaner
• Soaking & brushing the denture
  • Avoid hard brushing
  • Avoid excessive flossing

Night Wear of Prosthesis:

• Avoid nightwear of dentures
• Allowed to wear only in bruxers
• Report to the dentist if the denture causes any irritation even after 24 hours.
• The patient is asked to read newspapers or novels loudly during the 1st 24 hours to get adapt to the denture.

Post insertion problems:

Post insertion are

• Direct Sequelae
• Indirect Sequelae

Direct Sequelae:

1. Denture stomatitis:

It is the pathological reaction of the palatal portion of the denture-bearing mucosa

• Types:
  • Type 1: Localized simple infection
  • Type 2: Erythematous type
  • Type 3: Granular type

Read And Learn More: Prosthodontics Question And Answers

• Etiology:
  • Candida albicans
• Predisposing Factors:
  • Local factors:
    • Dentures
    • Xerostomia
    • High carbohydrate diet
    • Use of broad-spectrum antibiotics
    • Smoking
  • Systemic factors:
    • Old age
    • Diabetes mellitus
    • Nutritional deficiency
    • Immune defect
    • Malignancy
• Management:
  • 0.2-2% chlorhexidine
  • Removal & cleaning of dentures after every meal
  • Avoid night wearing of dentures
  • Polishing of denture
  • Administration of antifungal drugs
  • Surgically: Elimination of crypts, by cryosurgery

2. Flabby ridge:

Replacement of bone by fibrous tissue

• Site: Anterior part of maxilla
• Effect: Poor support to the denture
• Causes:
  • Excessive load overdenture
  • Unstable occlusal conditions
• Management:
  • Surgical removal

3. Denture irritation hyperplasia:

• The hyperplastic reaction of mucosa over the borders of the denture
• Cause: Trauma due to unstable dentures
• Features:
  • Deep ulceration
  • Fissuring
  • Inflammation
• Management:
  • Surgical excision
  • Correction of dentures

4. Burning mouth syndrome:

Burning sensation in the structures in contact with the dentures without any visible change in the mucosa

• Features:
  • Pain in the morning
  • Dry mouth
  • Persistent altered taste
  • Generalized symptoms
• Etiology:
  • Irritation by ill-fitting dentures
  • Constant masticatory activity Excessive friction on the mucosa
  • Candidal infection
  • Nutritional deficiency
  • Xerostomia
  • Medication
• Management:
  • Counseling
  • Repair of ill-fitted dentures

5. Gagging:

The gag reflex is a normal, healthy defense mechanism to prevent foreign bodies from entering the trachea

• Causes:
  • Over extended denture borders
  • Unstable occlusal conditions
  • Systemic conditions
  • Alcoholism, smoking
• Features:
  • Causes displacement of denture
  • Triggered by tactile stimulation of the soft palate, posterior part of tongue & fauces
• Site:
  • Posterior part of the maxillary denture
  • Distolingual part of mandibular denture

• Treatment: Limiting the posterior extension of the dentures

6. Residual ridge resorption:

• It is alveolar remodeling that occurs due to a change in the functional stimulus of bone tissue
• It is a chronic progressive change in the bone structure, which results in severe impairment in the fit & function of prosthesis
• Cause: Excessive forces over nonstress bearing areas causing activation of osteoclasts
• Clinical Features:
  • Decreased depth & width of the sulcus
  • Decreased vertical dimension at occlusion
  • Reduced lower facial height
  • Anterior rotation of mandible
  • Increase in relative prognathism
  • Increased mandibular arch
  • Decreased maxillary arch
  • Effects support, stability & retention of dentures

• Treatment:
  • Ridge augmentation to increase the height of the ridge
  • Vestibuloplasty to increase the depth of the sulcus

Indirect Sequele:

1. Atrophy of masticatory muscles:

• Masticatory efficiency depends on the skeletal forces
• This force decreases with age
• Besides, denture wearers donot use their muscles to their maximum function
• Due to poor usage, atrophy of muscle occurs
• Common Muscles Effected: Medial pterygoid & masseter
• Management:
  • Use of overdenture
  • Use of implants

2. Nutritional deficiencies:

• Causes of Malnutrition:
  • Poor general health
  • Poor absorption
  • Catabolic disturbance
  • Anorexia
  • Reduced salivary secretion

Management:

• Intake of protein-rich diet
• Encouraging patients to have good nutritious food
• It helps in the initial retention of the denture increasing the psychological comfort of the patient

Post Insertion Problems Short Essays

Question 1. Denture adhesive.
Answer:

Composition:

1. Basic ingredients:
   • Carbonyl methyl cellulose
   • Vegetable gum
     • Example: Tragacanth
   • Vinyl methyl ether
   • Polyethylene oxide
   • Polyvinyl pyrrolidone
   • Gantrez salts
     • Cationic polyacrylic amide polymers
     • Coloring agents-red dye
     • Flavouring agents-menthol
     • Wetting agents
     • Preservatives-sodium borate
     • Plasticizers- mineral oil
     • Dispersion agents-magnesium oxide
2. Indications:
   • Improve retention and stability of the dentures
   • To stabilize trial dentures
   • For handicapped patients
   • To provide a psychological sense of security
   • To simplify the insertion for patients
   • As an adjunct to the maxillary prosthesis
3. Contraindications:
   • Patients with ill-fitting dentures
   • In medication-induced xerostomia
   • In worn-out dentures
   • As a substitute for recliner
   • In patients with an inability to clean dentures
   • In immediate dentures
   • In case of allergy to components of the adhesive

Laboratory Procedures Prior To Try In Definitions

1.  Articulator: A mechanical device that represents the temporomandibular joints & the jaw members to which maxillary & mandibular casts may be attached to stimulate jaw movements
2.  Neutral zone: It is the potential space between the lips & cheeks on one side & the tongue on other side

Laboratory Procedures Prior To Try In Important Notes

1. Classification of articulators:

• Based on theories:
  • Bonwill theory articulator
  • Conical theory articulator
  • Spherical theory articulator
• Based on the type of occlusal record used:
  • Interocclusal record adjustment
  • Graphic record adjustment
• Based on ability to stimulate jaw movements:
  
  
• Based on adjustability
  • Nonadjustable- can open and close in fixed horizontal axis
  • Semi-adjustable – have adjustable horizontal condyla paths, adjustable lateral condylar paths, and adjustable intercondylar distances
  • Fully adjustable – capable of being adjusted to follow the mandibular movements in all directions

2. Functions of articulators:

• Holds maxillary and mandibular casts in a determined fixed relationship
• Stimulates jaw movements like opening and closing
• Produces border and intraborder movements of the teeth similar to those in the mouth

3. Arcon and non-arcon articulators:

4. Dentogenic concept – SPA concept

1. Sex:
   • Females: rounded incisal edges
     1. Less angular teeth
     2. Incisal edges follow the plane the curve of the lower lip
     3. Rotated distal surfaces of centrals
     4. A visible mesial third of canines
     5. Exposure of more anterior while smiling
   • Males: More angular teeth
     1. Incisal edges are above the plane of occlusion
     2. The mesial end of laterals are hidden by centrals
     3. Middle 2/3rd of canine are visible
     4. Prominent cervical regions
2. Personality:
   • Squarish – Vigorous people
   • Flat: Executives
3. Age:
   • Increased horizontal overlapping of posteriors
   • Reduced inter arch distance
   • Reproduce-abrasion, gingival recession in teeth as present in old individual

5. Types of teeth

6. Indications of non-anatomic teeth:

• Flat ridges
• Knife edge ridges
• Large interridge space
• Milling type of chewing pattern
• In bruxers
• Patients with neuromuscular disorders In
• highly resorbed ridges

Read And Learn More: Prosthodontics Question And Answers

7. Separating media:

Separating media Types:

• Tinfoil
• Cellulose lacquers
• Solution of alginate compound
• Calcium oleate
• Soft soaps
• Sodium silicate
• Starches
• Evaporated milk

8. Sodium alginate solution:

• Commonly known as cold mold seal
• It is widely used because of its effective and easy manipulation
• Sodium alginate Composition:
  • Sodium alginate 2% in water
  • Sodium phosphate
  • Glycerine
  • Alcohol
  • Preservatives
• When applied overcast the sodium alginate in the solution reacts with calcium on the cast producing insoluble calcium alginate that forms a membrane and serves as separating medium

Laboratory Procedures Prior To Try In Short Essays

Question 1. The age factor in dentogenic concept
Answer:

Dentogenic Concept Integration detail:

1. Young people have lighter teeth due to translucent enamel
2. Old people have dark & opaque teeth due to secondary dentin formation
3. Shiny teeth in old people
4. Teeth with a brownish tinge in older people
5. Certain diseases are limited to certain ages Thus age can be used to rule out certain systemic conditions
6. Age also determines the prognosis

Question 2. Nonanatomic teeth.
Answer:

Nonanatomic teeth Definition:

Artificial teeth with occlusal surfaces which are not anatomically formed but are designed to improve the function of teeth.

Advantages of Non anatomic teeth.:

• Useful in bruxers
• Greater range of movement possible
• Useful in patients with neuromuscular disorders
• Useful in patients with highly resorbed ridge

Disadvantages of Non anatomic teeth.:

• Unaesthetic appearance
• Less masticatory efficiency
• Balanced occlusion is not possible

Question 3. Trial dentures.
Answer:

A trial denture is the arrangement of teeth in wax, for trial, prior to completion of the denture.

• On receipt of the articulated trial dentures, the first stage is to ensure that the maxillary and mandibular trial dentures are well adapted to the respective master casts and that both bases are stable.
• The next stage is to remove the mandibular trial denture from the articulator and to assess the relationship of the maxillary posterior teeth to the mandibular ridge.
• When both trial dentures have been removed from the articulator, the clinician should inspect the intermaxillary space to ensure no unplanned increase or decrease in dimension has occurred.
• The clinician should also examine the casts to ensure that no laboratory-induced defects have been induced on the denture-bearing areas.
• If both dentures are replaced on their respective casts, the clinician may then examine the occlusal relationships of both dentures, to establish the balanced occlusion
• Next denture are inserted in the mouth and checked for extension, retention and stability of dentures
• When both trial dentures are in the mouth, the follow- ing four aspects of the dentures may be assessed in turn:
  1. Occlusal relations: Vertical, anteroposterior and coronal intermaxillary relation are checked for
  2. Occlusal planes: For evaluate incisal plane, left and right posterior occlusal planes, and plane of posterior mandibular teeth.
  3. Appearance of teeth and gingival: Tooth position, selection, and color of teeth are evaluated
  4.  Speech: Should not be adversely affected by dentures.

Question 4. Try in procedure.
Answer:

Try In:

It is defined as a preliminary insertion of a removable denture wax up or a partial denture casting or a finished restoration to determine the fit, aesthetics, maxillomandibular relation

Features:

It includes following procedures

1. Primary evaluation:
   • Check for adaptation of denture base
   • Evaluation complete occlusion of denture teeth in centric relation
   • Verify vertical height at rest and occlusion
   • Evaluate polished surface
2.  Preliminary evaluation in articulator:
   • Evaluate impression surface for adaptation
   • Evaluate polished surface for absence of voids
   • Evaluate occlusal surface for any wax residues present
   • Carve out gingival margins of the teeth
3. Evaluation in the mouth:
   • Check for denture coverage and borders
4. Evaluation of individual trial dentures:
   • Evaluate denture extension, retention, stability, support and esthetics
5. Evaluate lip and cheek support:
6. Evaluate occlusal plane, vertical height:
   • Intraorally by the position of the parotid papilla and extraoral by interpupillary line and Camper’s line
   • Evaluate centric and eccentric relation

Question 5. Semi-adjustable articulator.
Or
Arcon and non arcon articulator
Or
Define Arcon articulator
Answer:

They have adjustable horizontal condylar paths, adjustable lateral condylar paths, adjustable incisal guide tables & adjustable intercondylar distances

Semi-adjustable articulator Types:

1. Arcon Articulator:
   • In this type condylar element is attached to the lower member of the articulator & the condylar guidance is attached to the upper member
   • This resembles the TMJ.
     • Advantages:  All relations are preserved even when the articular is open or closed
     • Examples: Whip mix articulator:
2. Non-Arcon Articulator:
   • This articulator have a condylar element attach to the upper member
   • The condylar guidance is attached to the lower member
   • It is the reverse of TMJ
     • Examples: Hanau H series:

Question 6. Principles in teeth arrangement.
Answer:

1. Maxillary central incisor:

• Long axis of the tooth is parallel to the vertical axis
• Sloping labially
• Incisal edge contacts evenly

• M-Mesial
• D-Distal
• L-Labial
• P-Palatal

2. Maxillary lateral incisor:

• Long axis parallel to vertical axis, sloping labially
• Incisal edge 2 mm above the occlusal plane

• L-Labial
• P-Palatal
• M-Mesial
• D-Distal

3. Maxillary canine:

• Long axis parallel to vertical axis
• Mild mesial tilt
• Cervical prominence
• The cusp tip touches the plane of occlusion

• L-Labial
• P-Palatal
• M-Mesial
• D-Distal

4. Maxillary first premolar:

• Long axis parallel to the vertical axis
• Buccal cusp touches occlusal plane
• Palatal cusp 0.5 mm above the occlusal plane

• P-Palatal
• B-Buccal
• M-Mesial
• D-Distal

5. Maxillary second premolar:

• Long axis parallel to vertical axis
• Both cusps touches occlusal plane

• P-Palatal
• B-Buccal
• M-Mesial
• D-Distal

6. Maxillary first molar:

• Long axis tilted buccally
• Mesio palatal cusp touches the occlusal plane

• P-Palatal
• B-Buccal
• M-Mesial
• D-Distal

7. Maxillary second molar:

• Similar to first molar but at a higher level

8. Mandibular central & lateral ncisor:

• Long axis parallel to the vertical axis & sloping labially
• Incisal edge 2 mm above occlusal plane

• M-Mesial
• D-Distal
• F-Facial
• L-Lingual

9. Mandibular canine:

• Long axis parallel to vertical axis & sloping lingually
• Cusp tip more than 2 mm of occlusal plane

• M- Mesial
• D-Distal
• F-Facial
• L-Lingual

10. Mandibular first premolar:

• Long axis parallel to vertical axis & sloping lin- gually
• Lingual cusp below occlusal plane
• Buccal cusp 2 mm above occlusal plane

• P-Palatal
• B-Buccal
• M-Mesial
• D-Distal

11. Mandibular second premolar:

• Long axis parallel to vertical axis & sloping lingually
• Both cusps 2 mm above occlusal plane

• M- Mesial
• D-Distal
• F-Facial
• L-Lingual

12. Mandibular first & second molar:

• Long axis parallel to the vertical axis & sloping lingually
• All cusps above occlusal plane
• Mesial & lingual cusps at a lower level

• L-Lingual
• F-Facial
• M-Mesial
• D – Distal

Laboratory Procedures Prior To Try In Viva Voce

1. While setting condylar guidance, the incisal guide pin should be raised out of contact with the incisal table.
2. Alveolar sounds such as ‘s’, ‘n’, ‘d’, ‘t’, and ‘z’ are produced by contact of the tip of the tongue with anterior part of the palate or the lingual side of the anterior teeth.
3. If the teeth are too far anteriorly, the’d’ will sound like ‘t’. If the teeth are too far lingually, then that will sound like ‘d’.
4. The labiodental sounds ‘f’ and ‘v’ are made between the incisal edges of upper incisors and the posterior 3rd of the lower lip.
5. Labial sounds are b, p, and m
6. The dentogenic concept is given by Frush and Fischer
7. Artificial teeth must be arranged on a neutral zone

Maxillomandibular Relations Definitions

1.  Jaw relation: Any relation of the mandible to the maxilla
2. Orientation jaw relation: The jaw relation when the mandible is kept in its most posterior position, it can rotate in the sagittal plane around an imaginary transverse axis passing through or near the condyles
3. Vertical jaw relation: The length of the face as determined by the amount ofseparation of the jaws
4. Horizontal jaw relation: It is the relationship of the mandible to the maxilla in horizontal plane
5. Centric jaw relation: The maxillomandibular relation in which the condyles articulate with the thinnest avascular portion of their re- spective disc with the complex in the anterior-superior position against the slopes of the articular eminence 6.
6. Face bow: A calliper like device which is used to record the relationship of the jaws to the temporomandibular joints & to orient the casts on the articulator to the relationship of the opening axis of the temporomandibular joint
7. Occlusal rim: Occluding surfaces built on temporary or permanent denture bases for the purpose of making maxillomandibular relation records & arranging teeth
8. Physiological rest position: The mandibular position assumed when the head is in an upright position & the involved muscles, particularly the elevator & depressor groups, are in equilibrium in tonic contraction, & the condyles are in a neutral, un- strained position”
9. Balanced occlusion: The simultaneous contacting of the maxillary & mandibular teeth on the right & left & in the anterior & posterior occlusal areas in centric & eccentric positions, developed to lessen or limit tipping or rotating of the denture bases in relation to the supporting structures

Maxillomandibular Relations Important Notes

1. Types of jaw relations:

• Orientation jaw relation
• Vertical jaw relation
• Horizontal jaw relation

2. Dimensions of maxillary occlusal rim

• 22 mm – at canine eminence
• Anterior edge of occlusal rim at midline – 8 mm away from incisive papilla
• Width
  • In anterior region – 4-6 mm
  • In posterior region – 8-12 mm
• Occlusal table
  • Above crest of alveolar ridge in anterior region – 10-12 mm
  • From crest of alveolar ridge in posterior region – 5-7 mm
  • From depth of sulcus in posterior region – 18 mm
  • The anterior part of the maxillary occlusal plane should be 2mm below the upper lip line or smile line.
  • The posterior part of the maxillary plane should be parallel to Campers line of Ala-tragus line.

3. Tracing:

• Jaw movements can be recorded by the simple tracer assembly method. Tracing may be extraoral or intraoral.
• Intraoral tracing is less complicated. Extraoral tracers are less widely used
  • Extra-oral tracers:
    • High extraoral tracer assembly
    • Sears extraoral tracer assembly
  • Intraoral tracers:
    • Microtracer

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4. Freeway space:

• The distance between to arbitrary points on maxilla and mandible when the patient is relaxing is called vertical dimension at rest.
• The same distance when the patient is occluding on rims is called vertical dimension in occlusion.
• The difference between VDR and VDO is called interocclusal distance or “Free-way space”.
• It is usually 2-4 mm when observed at the position of 1 premolars.
• Free way space less than normal means increased vertical dimension of occlusion which results in :-
  • Reversible soft tissue changes and irreversible ridge resorption.
  • Difficulty in swallowing.
  • Diffuse pain of ridge area.
  • Clicking of dentures during speaking.
  • Trauma to TMJ.

5. Gothic arch tracing:

• Gothic arch tracing (also known as arrow point or needle point tracing) is an extra oral method recording centric relation in horizontal jaw relations.
• It indicates the relative position of upper and lower jaws in horizontal plane.

6. Immediate side shift or Bennett movement:

• Here the mandible shifts before the forward movement of the non-working condyle occurs.
• This movement occurs in 86% of the condyles.
• This shift ranges 1 to 4 mm in dimension.

7. Progressive side shift or Bennett side shift:

• Lateral translation that continues linearly after 2-3mm of forward movement of the non working condyle.

8. Beyron point:

• It is a line extending from the counter canthus of the eye to the top of the tragus of the ear and approximately 13mm in front of the external auditory meatus’
• This placement generally locates the rods within 5mm of the true center of the opening axis of the jaws.
• The imaginary line joining the two Beyron points is an approximate hinge axis.

9. Face bow:

• Face bow is a calliper like instrument used to orient maxillary cast on the articulator so that it has the same relation- ship to the opening axis of the jaws.
• There are two types, the kinematic and the arbitrary.
• The kinematic is used to locate the true terminal hinge axis and transfer this record to the articulator when mounting the maxillary cast.
• The arbitrary face bow is the one generally used in the construction of complete dentures is based on average computation of an axis opening of the jaw.
• It is simple to use and relatively accurate

10. Effects of change in vertical dimension:

11. Methods used to record centric relation:

1. Physiological methods
   • Tactile method
   • Pressureless method
   • Pressure method
2. Functional method
   • Needle house
   • Petterson method
3. Graphic method
   • Intraoral
   • Extra oral
   • Radiographic method

12. Materials used for interocclusal check records:

• Waxes
• Zinc oxide eugenol
• Decreased vertical dimension
• Increased freeway space

Maxillomandibular Relations Short Answers

Question 1. Effects of increased vertical dimension.
Answer:

• Increased trauma to the denture-bearing area Increased lower facial height
• Cheek biting
• Difficulty in swallowing & speech
• Pain & clicking in TMJ
• Stretching of facial muscles
• Increased space of oral cavity

Question 2. Interocclusal recording media
Answer:

Commonly used materials for inter-occlusal recording are:

Question 3. Christenson phenomenon.
Answer:

• Mandible is guided by the anterior teeth during protrusive movement
• This is followed by complete disocclusion of the posterior teeth
• This characteristic posterior separation seen during anterior protrusion is called Christenson’s phenomenon

Question 4. Lingualized occlusion
Answer:

• Proposed by Alfred Gysi in 1927 It involves the use of a large upper palatal cusp against wide lower central fossa
• The buccal cusps of upper and lower teeth do not contact each other It is preferred due to its superior chewing efficiency
• Payne proposed the use of 30-degree anatomical teeth which are then reshaped to obtain lingual occlusion

Question 5. Interpupillary line.
Answer:

• It is used for evaluation of occlusal plane extra orally
• It is the distance between the two pupils
• The anterior part of the maxillary occlusal plane should be parallel to the interpapillary line It should be 2 mm below the upper lip line or smile line

Question 6. Arbitrary face bow.
Answer:

It is commonly used for complete denture construction The condylar rods are positioned approximately 13 mm anterior to the auditory meatus on a line running from the outer canthus of the eye to the top of the tragus called cantho-tragal line This locates the rods within 5 mm of the true hinge axis of the jaws

Types:

• Facia type
• Earpiece type
• Hanau face bow
• Slidematictype Twirl bow
• Whipmix facebow

Question 7. Atmospheric pressure.
Answer:

• The peripheral seal prevents air entry between the denture & soft tissue
• Hence a low pressure is maintained within the space between the denture and the soft tissues
• To obtain it denture borders should rest on soft & resilient tissues
• On application of forces, a vacuum is created that aid in retention This is a natural suction of denture
• Hence atmospheric pressure is referred as emergency-retentive force or temporary restraining force
• Retention produced by atmospheric pressure is directly proportional to the denture base area

Question 8. Gothic arch tracing.
Answer:

• It is used for recording centric relation
• It is usually recorded in the horizontal plane
• It is done using an arrow point tracer
• A pen-like pointer is attached to one occlusal rim Recording plate is placed on the other rim
• When the mandible moves the pointer draws characteristic patterns on the recording plate
• The pointer is known as the central bearing point and the recording plate is known as the central bearing plate
• They act at the center of the arch and evenly distribute forces across the supporting structures
• The shape of the tracing pattern resembles arrowhead The apex of the arrow gives the centric relation It should be sharp enough

Maxillomandibular Relations Viva Voce

1. A kinematic face bow is usually used for fixed partial dentures
2. The arbitrary face bow is the one most commonly used in complete denture patients.
3. Wax, plaster, ZOE paste, and self-cure resins are commonly used for interocclusal records
4. Lateral movement produces an anterior translation of condyle on the working side and rotation about the center on
   the nonworking side (balancing side)
   Bennett angle is formed by the sagittal plane and the path of the advancing condyle during lateral mandibular movements as viewed in the horizontal plane.
5. Petterson and Needlehouse are functional methods of recording centric relation
6. Intraoral tracing contains a central bearing plate and a central bearing point tracer
7. The graphic method is accurate method of recording centric relation
8. Orientation jaw relation is related to the cranium
9. Vertical jaw relation is related to jaw separation Face bow is used to record hinge axis

Impression And Mouth Preparation Definitions

1. Impression: A complete denture impression is a negative registration of the entire denture bearing, stabilizing & border seal areas present in the edentulous mouth.
2. Retention: That quality inherent in the prosthesis which resists the force of gravity, adhesiveness of foods, and the forces associated with the opening of the jaws
3. Stability: The quality of the denture to be firm, steady & constant, to resist displacement by functional stresses & not to be sub-subject to change of position when forces are applied
4. Support: Resistance to vertical forces of mastication, occlusal forces & other forces applied in a direction toward the denture-bearing area
5. Posterior palatal seal: The soft tissues at or along the junction of the hard & soft palates on which pressure within the physiological limits of the tissues can be applied by a denture to aid in the retention of the denture
6. Anterior vibrating line: It is an imaginary line lying at the junction between the immovable tissues over the hard palate & the slightly movable tissues of the soft palate.
7. Posterior vibrating line: It is an imaginary line located at the junction of the soft palate that shows limited movement & the soft palate that shows marked movement

Impression And Mouth Preparation Important Notes

1. Types of impression:

1. Muco compressive – records tissue in functional and displaced form
2. Mucostatic records tissue in a relaxed form
3. Selective pressure – records tissue without interfering with the limiting structures at function and rest

2. Objectives of impression:

• Retention: It is the resistance to displacement away from the tissue surface. It is a mucosa-borne phenomenon.
• Support: It is the resistance to the occlusal forces in the vertical direction. It is a bone borne phenomenon.
• Stability: It is resistant to lateral shifting.
• Preservation of remaining structures.

3. Factors affecting retention:

• Anatomical factors- Size of denture bearing area, quality of denture bearing area
• Physiological factor – Saliva Physical factor-adhesion, cohesion, capillary attraction, interfacial surface tension, atmospheric pressure
• Mechanical factors- Undercuts, retentive springs, magnetic forces, denture adhesives
• Muscular factors

4. Primary stress-bearing areas:

5. Secondary stress-bearing areas:

Read And Learn More: Prosthodontics Question And Answers

6. Relief areas:


7. Anterior vibrating line:

• It is an imaginary line at the junction of the attached tissues overlying the hard palate and movable tissues of the soft palate
• It is always on soft palatal tissue
• It is visualized by asking the patient to say “ah” with a short vigorous burst

8. Posterior vibrating line:

• It is an imaginary line at the junction of the aponeurosis of the tensor veli palatine and muscular portion of the soft palate
• It represents the demarcation between the parts of the soft palate showing limited movements and those with marked movements
• It is the most distal extension of the denture

9. Alveolar lingual sulcus:

• Extends from the lingual frenum to the retro mylohyoid curtain
• It is divided into three parts

10. Posterior palatal seal:

• Lies between anterior and posterior vibrating line
• Functions
  • Retention of the maxillary denture
  • Maintain contact with the anterior portion of the soft palate during functional movements
  • Slightly displaces the soft tissue at the distal end of denture to ensure a complete seal that helps in retention of denture.
  • Prevents ingress of food and saliva beneath denture base.
  • Prevents excess impression material from running down the patient’s throat.

11. Buccal frenum:

• The buccal frenum of maxilla contains Caninus or levator anguli oris.
• The buccal frenum of mandible contains Triangularis or depressor anguli oris.

12. Pterygomandibular raphe:

• It is the tendinous insertion of superior constrictors and buccinators
• It arises from the hamular process of the medial pterygoid
• Gets attached to the mylohyoid ridge

13. Fovea palatine:

• The fovea palatine are indentations near the midline of the palate formed by the coalescence of several mucous gland ducts.
• They are always on the soft palate 2mm behind the vibrating line.

14. Retromylohyoid fossa is bounded by:

• Anterior – Retro mylohyoid curtain
• Posterolateral – Superior constrictor of the pharynx
• Posteromedial – Palatoglossus and lateral surface of the tongue
• Inferior- Submandibular gland

15. Buccal frenum has the following muscle attachments:

• Levator anguli oris
• Orbicularis oris
• Buccinator

16. Buccal shelf area is bounded by:

• Medially crest of the ridge
• Distally-retromolar pad
• Laterally external oblique ridge

17. Retromolar pad:

• Contains glandular tissue and fibers of temporalis, buccinators, superior constrictor, and pterygomandibular raphe
• All these prevent the placement of extra pressure
• Functions
  • Provides peripheral seal to mandibular denture
  • Marks distal extension
  • Provides retention, stability, and support to the denture

18. Frena present:

19. Border molding:

• It is the procedure by which the entire periphery of the tray is refined
• Polyether impression material is the material of choice
• Ideal requisites
  • Should have sufficient viscosity
  • Should not be sticky
  • Should have setting time 3-5 min
  • Should not displace tissues
  • Should be easily trimmed
  • Should retain its flow properties

20. Advantages of ZOE paste include:

• Accurate borders are formed since the material is more plastic in nature.
• Does not absorb the mucous secretion produced in the palate and thus accurately records the palatal part of the impression.
• Does not require a separating medium.

21. Modiolus is a point where eight muscles meet at the Angle Mouth:

• Depressor anguli oris (or) tringularis
• Levator anguli oris or canines
• Risorius
• Orbicularis oris
• Buccinators
• Zygomaticus major
• Quadratus labii superioris
• Quadratus labii inferioris

22. Snow shoe effect:

• The denture base should cover as much denture-bearing area as possible
• It results in the distribution of forces over a wider area
• Leading to the reduction of force per unit area
• Called snowshoe effect

Impression And Mouth Preparation Short Essays

Question 1. Pre-prosthetic surgical management in complete denture
(or)
Pre-prosthetic surgery
Answer:

1. Bony Surgeries:

1. Excision of the torus:
   • Tori are small bony projections of unknown etiology
   • They gradually increase in size
   • It should be excised because mucosa over tori is more prone to irritation
2. Alveoloplasty:
   • It is done to reduce severe undercuts or bilat- eral moderate undercuts
3. Reduction of genial tubercle or Reduction of mylohyoid ridge:
   • Sometimes these become very prominent due to ridge resorption
   • They should be removed if there occurs re- peated ulceration, loss of peripheral seal
4. Maxillary tuberosity reduction:
   • It is easy to correct wide tuberosity compared to the large tuberosity
   • It should be evaluated radiographically before surgical correction

2. Soft Tissue Surgeries:

1. Removal of redundant crystal soft tissue:
   • Crystal soft tissue may interfere with the stability of the denture so it should be removed
2. Frenectomy
   • It is indicated in case of
     • High frenal attachment which cannot be relived by large labial notch
     • Hypertrophic lingual frenum
3. Excision of epulis
   • Epulis is the hyperplastic reaction of the mucosa occurring along the borders of the denture
   • Treated with excision of the tissues and shortening and smoothening of dentures

Question 2. Mucostatic impression.
Answer:

Mucostatic Impression:

• It is an impression technique used in complete denture patients based on theory of impression-making.
• By Richardson
• The impression is made with the oral mucous membrane & the jaws in a normal relaxed condition
• The material Of Choice is impression plaster
• Border moulding is not done here
•  Tray Used: Oversized tray
•  Retention: Due to interfacial surface tension

Significance of Mucostatic impression:

• Closely adapted denture
• Good stability of the denture

Disadvantages of Mucostatic impression:

• Poor peripheral seal
• Poor retention
  • Synonym: Passive impression as the impression is made in rest position of oral tissues

Question 3. Posterior palatal seal area
Or
Definition & functions of the posterior palatal seal.
Answer:

Posterior palatal seal Definition:

The soft tissues at or along the junction of the hard & soft palates on which pressure within the physiological limits of the tissues can be applied by a denture to aid in retention of the denture

• Functions of Posterior Palatal Seal:
  • Aids in retention
  • Maintain constant contact with soft palate during functions
  • Reduces gag reflex
  • Prevents formation of gap between denture & pal- ate during function
  • Prevents food accumulation
  • Compensate for polymerization shrinkage
• Parts of Posterior Palatal Seal:
  • Pterygomaxillary seal
  • Postpalatal seal

Methods To Record It:

• Conventional approach
• Fluid wax technique
• Arbitrary scraping of the master cast
• Extended palatal technique

Question 4. Methods of recording posterior palatal seal
Answer:

1. Conventional method

Fabricate trial base using shellac base plate or self-cure resin

• The posterior palatal area is wiped with gauze
• T burnisher is used to locate the hamular notch by palpating posteriorly to the maxillary tuberosity on both sides
• The full extent of the hamular notch is marked with in- delible pencil
• The posterior vibrating line is marked
• Line marked in the hamular notch is connected with a posterior vibrating line
• The trial base is inserted into the patient’s mouth
• Markings are transferred to the trial base is seated on the master cast
• This transfers the markings to cast
• The trial base is trimmed to the posterior border Anterior vibrating line is marked in the patient’s mouth
• These markings are transferred to the cast The area between the anterior and posterior vibrating line is scrapped

2. Fluid wax technique:

• Wash impression is made
• Anterior and posterior vibratory lines are marked in the patient’s mouth
• The impression is re-inserted in the patient’s mouth
• Markings are transferred into impression The impression is painted with wax in the area of markings
• The impression tray is inserted in the patient’s mouth and the patient is asked to make rotational movements
• The impression is removed after 4-6 minutes and examined
• In contrast to green stick compound, glossy areas show tissue contact
• The procedure is repeated till even tissue contact is achieved
• Wax in the region of the anterior vibrating line should have a knife-edge margin

3. Arbitrary scrapping of master cast:

• In this technique, anterior and posterior vibratory lines are visualized in patient’s mouth and ap- proximately marked overcast
• Technician scrapes 0.5-1 mm of stone in posterior palatal seal area and fabricates the denture

Impression And Mouth Preparation Viva Voce

1. The anterior portion of the lingual flange is called Dublin- goal crescent area
2. The hamular notch determines the distolateral termination of the denture base
3. Posterior vibrating line marks most distal extension of the denture
4. The mid-palatine raphe is the most sensitive part of the palate
5. Retromolar pad aids in the stability of the denture
6. The mandibular denture border should not interfere with the opening of Wharton’s duct
7. The anterior lingual border is the secondary peripheral seal area for the mandibular denture
8. Primary impression can be made using impression compound, impression plaster, or alginate
9. Secondary impression can be made using ZOE im- impression paste, medium-bodied elastomeric impression material
10. Underextension of the peripheral border of mandible- lar denture affects the stability
11. Flabby tissue will interfere with the stability of the denture
12. Passive impression or mucositis or pressure-less impression technique records the tissues with minimal distortion and causes the least possible displacement of tissues.
13. Silicone or metallic oxide paste or rubber base materials are used in a custom tray during the final impression.
14. A wax spacer is used to provide space in the tray for the final impression material
15. The selective pressure technique is the most widely respected and accepted theory by transferring load to acceptable areas.

Diagnosis And Treatment Planning

Diagnosis And Treatment Planning Important Notes

1. Thin mucosa is found over:

2. House’s classification of mental attitude:

3. Classification of the soft palate:

4. Classification of lateral throat form:

5. Classification of the tongue size:

Diagnosis And Treatment Planning Long Essays

Question 1. Discuss briefly the diagnosis & treatment planning for complete denture patients.
Answer:

Diagnosis: Includes:

1. Patient’s evaluation:

• Gait:
  • Different gate present in patients with neurological problems
  • This affects the adaptation of dentures
• Age:
  • Different aged people have different healing abilities
• Sex:
  • Women are more esthetic concerned than men
• Complexion:
  • Selecting the shade of teeth required

Read And Learn More: Prosthodontics Question And Answers

• Mental Attitude of Patient:
  • According to De Van” Meet the mind of the patient before meeting the mouth of the patient
• 4 types of patients are recognized:

1. 1. Class 1: philosophical
      • Easy-going, cooperative patients
   2. Class 2: Exacting
      • Dissatisfied with the previous denture
      • Difficult to satisfy them
   3. Class 3: Hysterical
      • Have a negative attitude toward the dentist
      • Poor prognosis
      • Difficult to manage
   4. Class 4: Indifferent
      • Uncooperative
      • Do not maintain the denture

2. Clinical history taking:

• Name:
  • To address a patient
  • To maintain the record
• Age:
  • For age-related diseases
• Sex:
  • For sex-related diseases
• Occupation:
  • To know the affordability of the treatment
• Location:
  • For further reference
  • For treatment planning
• Dental History:
  • To know the dental attitude of patient
• Medical History:
  • To know about any diseases that may affect the denture as well as the healing of tissues

3. Clinical examination:

• Extra Oral:
  • To evaluate any pathology
  • To determine the shape of teeth as compared to the profile of the patient

• • Determine vertical dimension: helps in deciding the size of teeth
  • Examine the lip & cheek fullness
• Intra Oral:
  • Examine the mucosa
  • Condition of the residual alveolar ridge
  • Arch length: to accommodate the teeth

• • Any pathology present
  • Gag reflex & palatal sensitivity
  • Undercuts present: Effect retention of the denture

• • Frenal attachment: Effect path of insertion

• • Tongue: Its size affects the stability of the denture

• • The floor of the mouth: For retention & stability of the denture

4. Radiographic examination:

• Bone Quality:
  • Examine any pathology
  • Bone contour

5. Evaluation of existing prosthesis:

• Need for repair
• Need for replacement

Treatment Planning Includes:

1. Adjunctive care:

• Elimination of Infection:
  • Treatment of ulcers
  • Removal of nonvital teeth
  • Elimination of periodontal problems
• Elimination of Pathosis:
  • Removal of any pathologies present
• Pre-Prosthetic Surgery:
  • Removal of flabby tissues
  • Removal of bony spicules
  • Frenectomy
  • Vestibuloplasty
  • Removal of tori
• Tissue Conditioning:
  • In case of tissue irritation due to dentures
  • Reline the existing denture with tissue conditioners

2. Prosthetic care:

• Patient Is Recently Edentulous:
  • Immediate denture
  • Interim denture
  • Implants
• Patient Already Edentulous:
  • Implants
  • Teeth selection
  • Soft tissue support

Diagnosis And Treatment Planning Short Answers

Question 1. Leon William’s classification.
Answer:

According to him, the facial form can be described among four types:

1. Ovoid
2. Tapering
3. Square
4. Combination

• The selection of teeth depends on the facial form
• For example Ovoid teeth for ovoid facial form

Question 2. The mental attitude of the patient.
Answer:

According to De Van, “meet the mind of the patient be- fore meeting the mouth of the patient”

4 types of patients are recognized:

1. Class 1: Philosophical
   • Easy-going, cooperative patients
2. Class 2: Exacting
   • Dissatisfied with the previous denture
   • Difficult to satisfy them
3. Class 3: Hysterical
   1. Have a negative attitude toward the dentist
   2. Poor prognosis
   3. Difficult to manage
4. Class 4: Indifferent
   1. Uncooperative
   2. Do not maintain the denture

Question 3. House’s palate classification
Answers:

It shows the relationship between the soft palate and hard palate  It is as follows

1. Class 1:
   1. Large and normal in form
   2. Has immovable tissue band 5-12 mm distal to a line drawn across the distal edge of tuberosities
2. Class 2:
   • Medium-sized and normal in form
   • Has immovable tissue band 3-5 mm distal to a line drawn across the distal edge of tuberosities
3. Class 3:
   • Accompanies small maxilla
   • Has soft tissue band 3-5 mm anterior to the line drawn across palate at the distal edge of tuberosities

Question 4. Classification of the soft palate.
Answer:

1. Class 1:
   • Horizontal line
   • Shows little muscular movement
   • Covers posterior palatal seal
   • Has flat palatal vault
2. Class 2:
   • The soft palate makes a 45° angle to the hard palate
   • Coverage to the posterior palatal seal is less
   • Has flat palatal vault
3. Class 3:
   • The soft palate makes a 70° angle to the hard palate
   • Coverage to the posterior palatal seal is minimum
   • Has V-shaped palatal vault

Question 5. Critical patients of House classification
Answer:

• They are very methodical, precise, and accurate making several demands
• They are comfortable when each procedure is ex- plained and discussed with them in detail
• They require extreme care, effort, and patience on the part of the dentist
• The intelligent and understanding category in this class can be best type of patient
• But for those lacking the same, extra time should be spent in education and treatment started only after an understanding is achieved

Question 6. House’s classification of the mental attitude of patients.
Answer: