Prosthodontics

Impression And Mouth Preparation Long Essays

Question 1. Define impression. Discuss in detail the most widely accepted technique of making an impression in complete dentures.
Answer:

Impression:

A complete denture impression is a negative registration of the entire denture-bearing, stabilizing & border seal areas present in the edentulous mouth.

Impression Techniques:

1. Mucostatic
2. Mucocompressive
3. Selective pressure technique
   • It is the most widely accepted impression technique
   • In this technique, forces are confined to stress-bearing areas, whereas non-stress-bearing areas are relieved

Read And Learn More: Prosthodontics Questions And Answers

Impression Technique:

• The primary impression is made with overextended borders. The primary cast is prepared from it
• Undercuts are blocked with wax on the cast. Relief wax is applied over relief areas on the cast
• A spacer is adapted throughout the extent of the special tray
• Separating media like cold mold seal or tin foil is applied overcast
• A special tray with a handle is fabricated
• Impression should be 2 mm short of the sulcus
• Materials used for it are: Shellac, cold-cure acrylic, Type II impression compound
• The wax spacer is then scraped off
• Border molding is done using greenstick compound
• Relief wax is removed
• Escape holes are made over the tray
• Secondary impression material is loaded over the tray
• Impression is then seated in the patient’s mouth, and the secondary impression is made.

Impression and Mouth Preparation in Complete Dentures

Impression Materials Used:

Question 2. Define impression.
Or
Discuss various impression procedures in the complete denture.
Or
Add a note on the selection of impression materials.
Answer:

Impression:

A complete denture impression is a negative registration of the entire denture-bearing, stabilizing & border seal areas present in the edentulous mouth.

Impression Selection Of Materials:

• Impression should be fluid enough to adapt to oral tissues
• Impression should be viscous enough to be contained in the tray that is seated in the mouth
• While in the mouth, they should set into a rubbery or rigid solid in a reasonable amount of time
• The set impression should not tear or distort when removed
• The impression made should be dimensionally stable
• Stability should be maintained after the removal of a cast so that a second or third cast can be made
• The material should be biocompatible
• Impression should be cost-effective
• Should be nontoxic
• Impression should be acceptable to patients with a pleasant odor and color
• Should have adequate shelf life, Easy to use with minimum equipment, should have adequate strength

Complete Denture Pre-Prosthetic Preparation

Question 3. Define retention, stability, and support in the complete denture. Discuss various factors affecting retention.
Or 
Define complete denture retention. Enumerate various factors of retention.
Or
Write in detail about retention in complete dentures.

Answer:

• Retention: That quality inherent in the prosthesis that resists the force of gravity, adhesiveness of foods, and the forces associated with the opening of the jaws
• Stability: The quality of the denture to be firm, steady, and constant, to resist displacement by functional stresses & not to be subject to change of position when forces are applied
• Support: Resistance to vertical forces of mastication, occlusal forces, and other forces applied in a direction toward the denture-bearing area

Factors Affecting Retention:

1. Anatomical Factors:

• Size Of Denture Bearing Area:
  • The retention increases with an increase in the size of the denture-bearing area
  • Maxillary dentures are more retentive than mandibular as it has 24 cm² compared to that 14 cm²

• Quality Of Denture Bearing Area:
  • Displaceability of the tissues influences the retention of dentures
  • Displacement of tissues during impression-making
  • Result in tissue rebounding
  • This leads to a loss of retention of dentures

2. Physiological factors:

• Saliva:
  • Thick & ropy saliva-loss of retention
  • Thin & watery saliva- compromised retention
  • Ptyalism- gagging
  • Xerostomia-Soreness & irritation

3. Physical factors:

• Adhesion:
  • The physical attraction of unlike molecules to one another
  • The amount of adhesion present is proportional to the denture base area
  • In xerostomia there is no adhesion

• Cohesion:
  • The physical attraction of like molecules for each other
  • Act within the film of saliva
  • Watery serous saliva- more retentive

• Interfacial Surface Tension:
  • The tension or resistance to separation possessed by the film of liquid between two well-adapted surfaces
  • Present within the film of thin saliva
  • Useful in the retention of the maxillary denture
  • Depends on the presence of air at the margins of liquid & solid contact

• • To attain maximum interfacial tension
  • Saliva should be thin
  • Perfect adaptation
  • Covering a large denture area
  • The presence of good cohesive and adhesive forces

• Capillarity Attraction:
  • That quality or state, because of surface tension, causes elevation or depression of the surface of a liquid that is in contact with a solid
  • The presence of close adaptation between the denture and the mucosa increases surface contact
  • Results in an increase in retention
  • Capillarity Attraction Factors:
    1. Close adaptation
    2. Greater surface area
    3. A thin film of saliva

Impression Techniques in Prosthodontics

• Atmospheric Pressure And Peripheral Seal:
  • Atmospheric Pressure And Peripheral Seal prevent air entry between the denture and soft tissue
  • To obtain it denture borders should rest on soft and resilient tissues
  • On application of forces, a vacuum is created that aids in retention
  • This is a natural suction of the denture
  • Atmospheric Pressure and Peripheral Seal are directly proportional to the denture base area

4. Mechanical Factors:

• Undercuts
• Retentive springs
• Magnetic forces
•  Denture adhesives
• Suction chambers and suction discs

5. Muscular Factors:

• The balance should be between the forces acting from the buccal musculature and the tongue

Question 4. Define complete denture impression. Discuss impression theories and techniques in treating complete denture patients.
Answer:

Complete Denture Impression:

A complete denture impression is a negative registration of the entire denture-bearing, stabilizing, and border seal areas present in the edentulous mouth.

Techniques Of Impression:

Mouth Preparation Before Complete Dentures

1. Custom Tray Impression:

• Design a custom tray with a spacer
• It should be 2 mm short of the sulcus
• Border molding is done
• It results in recording the sulcus in dynamic function
• Spacer is scraped
• The impression is recorded by ZOE
• It results in recording the stress-bearing areas under pressure, and the non-stress-bearing areas are relieved

2. Tray Compound:

• The impression made using the tray impression compound
• The impression is refined and trimmed
• The metal wire is attached to the tray compound to act as a handle
• Treat it as a custom tray
• Border moulding done
• Wash the impression made on it

Question 5. Define impression. Discuss biological considerations for a maxillary impression.
Answer:

Complete Denture Impression:

A complete denture impression is a negative registration of the entire denture-bearing, stabilizing, and border seal areas present in the edentulous mouth.

Biological Considerations Of Maxillary Impression :

• The anatomy of the edentulous ridge in the maxilla is important in designing a complete denture
• Some parts of the ridge are capable of withstanding forces compared to others
• Thus, it is considered before impression-making

Impression Limiting Structures:

• Labial Frenum:
  • Labial Frenum is the limiting structure of the Maxilla and Mandible
  • Labial Frenum is a fibrous band
  • Covered by a mucous membrane
    • Extension: Labial aspect of the residual ridge to the lip
    • Maxillary: Passive due to the absence of muscle fibers

Recorded In Impression:

Recorded in impression as a V-shaped notch

• Requirement: Notch should be narrow and deep

• Labial Vestibule:
  • That portion of the oral cavity which is bounded on one side by the teeth, gingival, and alveolar ridge and on the other side by the lips and cheeks
  • Presence of orbicularis oris
  • Labial Vestibule has an indirect displacing effect on the denture
•  Buccal Frenum:
  • Buccal Frenum separates the labial and buccal vestibule
  • Muscle attachments present: Levator anguli oris, orbicularis oris, and buccinator
  • Buccal Frenum needs greater clearance on the buccal flange of the denture

• Buccal Vestibule:
  • Buccal Vestibule extends from the buccal frenum to the hamular notch
  • Its size varies with: the contraction of muscle, the position of mandible and amount of bone loss in the maxilla
• Hamular Notch:
  • Depression present between maxillary tuberosity and hamulus of medial pterygoid plate
  • Can be easily displaced to achieve posterior pala tal seal

Impression Supporting Structures:

1. Primary Stress Bearing Areas:

•  Hard Palate:
  • Trabeculae pattern of it perpendicular to the direction of forces acting on it
  • Thus it acts as a primary stress-bearing area

• Postero-Lateral Slopes Of Residual Ridge:
  • Ridge rapidly resorbs following extraction of teeth
  • Resilient submucosa over provides support to the denture

2. Secondary Stress Bearing Areas:

1. Rugae:
   • Rugae is a secondary support area in Maxilla
   • Rugae is covered by a thin mucosa

1. • Rugae Location:
     1. In the anterior region of the palatal mucosa
     2. At the angle of the occlusal plane of the residual ridge
   • Rugae Significance: Important in speech
   • Precautions During Fabrication:
     1. Should not distort this area while impression-making
     2. Metal dentures should reproduce this area to make it comfortable
2. Maxillary Tuberosity:
   1. Bulbous extension of residual alveolar ridge in 2nd 3rd molar region
   2. It is least likely to resorb

Secondary Stress Relief Areas:

• Incisive papilla
• Relief Areas Location:
  • Midline behind central incisors
• Reason For Relieving:
  • The reason For Relieving is the exit point of nasopalatine nerves and vessels
  • If it is not relieved it compresses vessels and nerves
• Reason For Relieving Results:
  • Necrosis of the area
  • Paraesthesia of the anterior palate

1. Cuspid Eminence:

• Bony elevation on residual alveolar ridge
• Location: between canine and 1st premolar

2. Mid-Palatine Raphe:

• Median suture area
• As it is covered by thin mucosa, it should be relieved

3. Fovea Palatine:

• Coalescence of ducts of mucous glands
• Determines the position of the posterior border of the denture
• Relieved because of the presence of ducts

Question 6. Describe mandibular anatomical structures.
Answer:

Limiting Structures:

• Labial Frenum:
  • Active due to the presence of muscle incisive and orbicularis oris
  • It is a fibrous band
  • Covered by mucous membrane
  • Extention: labial aspect of the residual ridge to lip
  • Recorded In Impression: Recorded in impression as a V-shaped notch
  • Requirement: Notch should be narrow and deep
    
• Labial Vestibule:
  • That portion of the oral cavity which is bounded on one side by the teeth, gingiva, and alveolar ridge and on the other side by the lips and cheeks
  • Influences retention of dentures
• Buccal Frenum:
  • Contains fibers of the buccinator
  • Prevent displacement of denture

Buccal Vestibule:

• • Extends from buccal frenum to retromolar region
  • Bound by alveolar ridge and buccinator
  • Influenced by masseter
  • Notch is produced in denture flange called masseteric notch
• Lingual Frenum:
  • Effects stability of denture high frenal attachment is called tongue tie

Alveololingual Sulcus:

• Has 3 Regions:

1. 1. Anterior Region
      • From lingual frenum to pre-mylohyoid fossa
   2. Middle Region
      • From the pre-mylohyoid fossa to the distal part of the mylohyoid ridge
   3. Posterior Region
      • In the region of retro mylohyoid fossa
      • Determines lateral throat form

• Retromolar Pad:
  • Forms posterior seal of denture
  • Location: Distal to the third molar
  • Consists of: Loose connective tissues, mucosal glands
  • Retromolar Pad Boundaries:
    1. Posteriorly: temporalis
    2. Lateral: buccinator
    3. Medial: Pterygomandibular raphe and superior constrictor

• Pterygomandibular Raphe:
  • Extend: Hamular process to the mylohyoid ridge
  • Muscles Attached:
    • Postero- medially- superior constrictor
    • Antero-laterally-buccinator

Alveololingual Sulcus Supporting Structures:

1. Buccal Shelf Area:

• Between the buccal frenum and anterior border of the masseter
• Buccal Shelf Area Boundaries:
  • Medial: crest of the ridge
  • Distal: retromolar pad
  • Lateral: external oblique ridge
• Buccal Shelf Area Significance: Width increases with resorption of the ridge
• Serves as primary stress-bearing area

2. Residual Alveolar Ridge:

• Flat with concave denture-bearing surface
• On resorption inclines outward

Relief Areas Mylohyoid Ridge:

• Lies close to the inferior border of the mandible
• Covered with mucosa so should be relieved

3. Mental Foramen:

• Location: Between 1st & 2nd premolar region
• Relieved as it may lead to paraesthesia

4. Genial Tubercle:

• Location: anterior on the lingual side of the body of the mandible
• Increases due to resorption

5. Torus Mandibularis:

• Location: on lingual side near premolar region (b)
• Covered by a thin mucosa
• Relieved or surgically removed

Question 7. Discuss principles and objectives of making impressions for completely edentulous patients.
Or
What are the objectives of impression-making
Answer:

Principles Of Impression Making:

1. Presence of healthy oral tissues
2. Inclusion of all supporting and limiting tissues
3. Borders within anatomical and physiological limitations
4. Border molding – physiological type
5. Space between material and tray
6. Not damaging the tissues
7. Application of selective pressure technique
8. Use of guiding mechanism
9. Use of dimensionally stable materials
10. Similarity to the form of dentures

Objectives Of Impression Making:

1. 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”.

• Retention Factors:

1. 1. Anatomical Factors:
      • Size of denture-bearing area
      • Quality of denture-bearing area
   2.  Physiological Factors:
      • Saliva
   3.  Physical Factors:
      • Adhesion
      • Cohesion
      • Interfacial surface tension
      • Capillary attraction
      • Atmospheric pressure
   4. Mechanical Factors:
      • Undercuts
      • Retentive springs
      • Magnetic forces
      • Denture adhesives
      • Suction chambers and suction discs
   5. Muscular Factors:

• • • The balance should be between the forces acting from the buccal musculature and tongue

2. Stability:

• The quality of the denture to be firm, steady, and constant, to resist displacement by functional stresses and not to be subject to change of position when forces are applied
• Stability withstands horizontal forces
  • Stability Factors:
    1. The vertical height of the residual ridge
    2. Quality of soft tissue
    3. Quality of impression
    4. Occlusal rims
    5. Teeth arrangement
    6. Shape of denture

3. Support:

• Resistance to vertical forces of mastication, occlusal forces and other forces applied in a direction toward the denture-bearing area
• The denture base should cover as much denture-bearing area as possible
• Results in the distribution of forces over a wider area
• This leads to a reduction of force per unit area

Called Snow Shoe Effect:

4. Aesthetics:

• Thicker flange leads to fullness of the mouth

5. Preservation of Remaining Structures:

• Muller stated that the preservation of what remains is more important rather than to replace what is lost.
• Stress is provided over the stress-bearing area.
• Relief is provided over non-stress-bearing areas.
• Prevent damage to oral structures.
• Avoid overextension of dentures.

Question 8. Define stability and discuss factors affecting it.
Answer:

Stability:

• “The quality of denture to be firm, steady and constant, to resist displacement by functional stresses and not to be subject to change of position when forces are applied”.
• Stability withstands horizontal forces

Stability Factors:

1. Vertical Height Of Residual Ridge:

• A ridge with an adequate height of ridge provides sufficient support
• Resorbed ridge causes loss of stability or reduced stability of the denture

Full Denture Clinical Steps – Impression and Prep

2. Quality Of Soft Tissue:

• Adequate submucosa is required for good stability
• Excessive submucosa results in poor stability

3. QualitOf Impression:

• The Impression Should Be:
  • Accurate
  • Smooth surface
  • Devoid of voids
  • Not wrap on removal, Dimensionally stable

4. Occlusal Plane:

• Should be parallel to the ridge
• Should divide interarch space equally

5. Teeth Arrangement:

• Teeth are arranged in a neutral zone
• That is balance is achieved between tongue and buccal musculature

6. Shape Of Denture:

• The polished surface should resemble oral structures
• Should not interfere with the functioning of oral structures

Diagnosis And Treatment Planning

Diagnosis And Treatment Planning Important Notes

1. Thin Mucosa Is Found Over:

Read And Learn More: Prosthodontics Question And Answers

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 and treatment planning for complete denture patients.
Answer:

Diagnosis: Includes:

1. Patient’s Evaluation:

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

Diagnosis and Treatment Planning in Complete Dentures

• 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

Complete Denture Treatment Planning Steps

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 the 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 and cheek fullness
• Intra Oral:
  • Examine the mucosa
  • Condition of the residual alveolar ridge
  • Arch length: to accommodate the teeth

Prosthodontics Diagnosis for Edentulous Patients

• • Any pathology present
  • Gag reflex and 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 and stability of the denture

4. Radiographic Examination:

• Bone Quality:
  • Examine any pathology
  • Bone contour

Full Denture Clinical Examination Guide

5. Evaluation Of Existing Prosthesis:

• Need for repair
• Need for replacement

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

How to Plan Complete Dentures

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

According to De Van, “meet the mind of the patient before 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

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 of the posterior palatal seal is less
   • Has a flat palatal vault
3. Class 3:
   • The soft palate makes a 70° angle to the hard palate
   • Coverage of the posterior palatal seal is minimal
   • Has a V-shaped palatal vault

Question 5. Critical patients of the House classification
Answer:

• They are very methodical, precise, and accurate, making several demands
• They are comfortable when each procedure is explained 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 the best type of patient
• But for those lacking the same, extra time should be spent on education, and treatment started only after an understanding is achieved

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

Complete Dentures Short Answers

Question 1. Parts of a complete denture
Answer:

Question 2. Steps in the fabrication of a complete denture
Answer:

• Diagnosis and treatment planning
• Making diagnostic casts
• Mouth preparation
• Primary impression
• Primary cast
• Fabrication of custom trays
• Secondary impression
• Master cast
• Fabrication of occlusal rims
• Recording jaw relations
• Articulation
• Arrangement of artificial teeth
• Try in
• Processing of denture
• Insertion
• Post-insertion review and maintenance

Read And Learn More: Prosthodontics Question And Answers

Question 3. Effects of aging.
Answer:

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

Complete Dentures: Short Questions and Answers

Question 4. Metal dentures.
Answer:

Question 5. Gagging
Answer:

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

Causes of Gagging:

• Over-extended denture borders
• Unstable occlusal conditions
• Systemic conditions
• Alcoholism, smoking

Dental Prosthodontics MCQs

Features of Gagging:

• Causes the displacement of the denture
• Triggered by tactile stimulation of the soft palate, the posterior part of the tongue, and the fauces

Site of Gagging:

• Posterior part of the maxillary denture
• Distolingual part of mandibular denture

Gagging Treatment:

• Correction of overextended dentures
• Correction of occlusal vertical dimensions and occlusal prematurities

Question 6. Angular cheilitis.
Answer:

Angular Cheilitis Etiology:

• Angular Cheilitis occurs at the angle of the mouth among persons having deep commissural folds secondary to the overclosure of the mouth
• Angular Cheilitis can occur among persons with lip-licking habits, denture-wearing, or deficiency of riboflavin, vitamin B_12, and folic acid

Question 7. Kelly’s combination syndrome.
Answer:

Kelly’s Combination Syndrome was identified by Kelly in 1972 in patients wearing a maxillary complete denture opposing a mandibular distal extension prosthesis

Complete Denture FAQs

Kelly’s Combination Syndrome Pathogenesis:

• It occurs in a sequential manner
• The patient tends to concentrate the occlusal load on the remaining natural teeth
• Results in more force acting on the anterior portion of the maxillary denture
• Increased resorption of the anterior part of the maxilla
• The labial flange will displace and irritate the labial vestibule
• Posteriorly, there will be fibrous overgrowth in the maxillary tuberosity
• The shift of the occlusal plane posteriorly downwards processes resorption in the mandibular distal extension denture-bearing area
• Mandible shifts anteriorly during occlusion
• There is
  • Decrease in vertical dimension at occlusion
  • Decrease in retention and stability of a denture
  • Disocclusion of lower anterior
  • Reduced periodontal support of anterior teeth

Question 8. Infection control
Answer:

Infection Control Methods:

• Immunization:
  • Vaccination for Hepatitis B for all dental personnel
• Personal Barrier:
  • Hand washing before gloving and after degloving
  • Gloves protect against contamination
  • Changed between patients and for the same patient, is torn or worn out
    • Face Mask:
      1. Protects from inhalation of aerosols
      2. Prevents spatter from the patient’s mouth
      3. Prevents droplets from the contaminated solution
      4. Protective clothing
      5. Gown with long sleeves, high neck & long knee length
    • Eyewear:
      1. Prevention of bacterial/viral contact
• Surgical Asepsis:
  • Preparation of the surgical site
  • Draping the patient
  • Isolation
• Surface Asepsis:
  • Sterilization of instruments
  • Use of disposable instruments
• Disposal Of Waste: Methods
  • Incineration
  • Burial in a landfill
  • |Sterilization

Question 9. Hypermobile ridge tissue.
Answer:

Hypermobile Ridge Tissue Cause:

• Due to excessive residual ridge resorption, Management:
• Small tissues that do not interfere with tissue functioning:
  • Left Untreated: Impression is made using the mucositis technique
  • Large Tissues: removed surgically

Denture Objective Questions

Question 10. Polished surface.
Answer:

• The Polished Surface is defined as that portion of the surface of a denture that extends in an occlusal direction from the border of the denture and includes the palatal surfaces
• The Polished Surface is the part of the denture base that is usually polished, and it includes the buccal and lingual surfaces of the teeth
• Polished Surface refers to the external surfaces of the lingual, buccal, and labial flanges and the external palatal surface of the denture
• The Polished Surface should be well polished and smooth to avoid the collection of food debris
• The Polished Surface should be harmonious with the oral structures
• They should not interfere with the action of oral mus- culture

Question 11. Denture irritation hyperplasia.
Answer:

The hyperplastic reaction of mucosa over the borders of the denture

Question 12. Xerostomia.
Answer:

Xerostomia refers to a subjective sensation of a dry mouth, but is not always associated with salivary hypofunction

Xerostomia Etiology:

1. Developmental:
   1. Salivary gland aplasia
2. Water/metabolic Loss:
   • Impaired fluid intake
   • Hemorrhage
   • Vomiting/diarrhea
3. Iatrogenic:
   • Medications:
     • Antihistamines: Diphenhydramine
     • Decongestants: Pseudoephedrine
     • Antidepressants: Amitriptyline
     • Antipsychotic: Haloperidol
     • Antihypertensive: Methyldopa, CCB
     • Anticholinergic: Atropine
4. Radiation therapy of the head and neck:
   1. Both stimulated and unstimulated salivary flow decreases with increasing radiotherapy.
   2. Systemic Diseases:
      • Sjogren’s syndrome
      • Diabetes mellitus
      • Diabetes insipidus
      • HIV infections
      • Psychological disorders.
      • Graft-versus-host disease
5. Local Factors:
   • Decreased mastication.
   • Smoking
   • Mouth breathing

Question 13. Functions of saliva.
Answer: 

Question 14. Combination syndrome.
Answer:

Combination Syndrome was identified by Kelly in 1972 in patients wearing a maxillary complete denture opposing a mandibular distal extension prosthesis

BDS Prosthodontics Viva Questions

Combination Syndrome Pathogenesis:

• Combination Syndrome occurs in a sequential manner
• The patient tends to concentrate the occlusal load on remaining natural teeth resulting in more force acting on the anterior portion of the maxillary denture
• Increased resorption of the anterior part of the maxilla
• The labial flange will displace and irritate the labial vestibule. Posteriorly, there will be fibrous overgrowth in the maxillary tuberosity
• The shift of the occlusal plane posteriorly downwards processes resorption in the mandibular distal extension denture-bearing area
• Mandible shifts anteriorly during occlusion
• Decrease in vertical dimension at occlusion
• Decrease in retention and stability of the denture
• Disocclusion of lower anterior
• Reduced periodontal support of anterior teeth.

Introduction To Complete Dentures

Definitions Of Complete Dentures

1. Complete Denture: A removable dental prosthesis that replaces the entire dentition and associated structures of the Maxilla or mandible.
2. Residual Ridge Resorption:
   • Residual Ridge Resorption is alveolar remodeling that occurs due to changes in the functional stimulus of bone.
   • Residual Ridge Resorption diminishes the quality and quantity of the residual ridge after teeth are removed.

Read And Learn More: Prosthodontics Question And Answers

Complete Dentures: Important Notes

• Surfaces Of Complete Denture:
  • Occlusal surface
  • Impression surface
  • Polished surface
• Parts Of a Complete Denture:
  • Denture base
  • Denture flange
  • Denture borders
  • Denture teeth
• Objectives Of Complete Denture:
  • Should be compatible with the surrounding oral environment
  • Should restore oral function
  • Should be in harmony with the function of speech, respiration, and deglutition
  • Should be aesthetically acceptable
  • Should preserve the remaining oral tissues.
• Direction Of Residual Ridge Resorption:
  • Maxillary ridge – Upward and lingual direction
  • Mandibular anterior ridge  – Downward and lingual direction
  • Mandibular posterior ridge – Downward and buccal direction.
• Angular Stomatitis Occurs Commonly Due To:
  • Decreased VDO or
  • Deficiency of ‘Riboflavin or Thiamine’ or
  • Due to Candida infection.
•  Denture Stomatitis:
  • Denture Stomatitis refers to pathological reactions of the denture-bearing palatal mucosa
  • Stomatitis Types:
    • Type 1 – Localized inflammation
    • Type 2 – Generalized inflammation
    • Type 3 – Granular type
• Predisposing Factors For Candida-Associated Denture Stomatitis:
  • Aging
  • Malnutrition
  • Immunosuppression
  • Radiation therapy
  • Diabetes
  • Antibiotics

Complete Denture Meaning

8. Epulis Fissuratum:

• Epulis Fissuratum is a soft tissue reaction that appears in the sulcular area due to overextension of the denture flanges
• Epulis Fissuratum is treated by shortening and smoothing the denture border

9. Papillary Hyperplasia:

• Papillary Hyperplasia results from Candida infection and improper relief of the palatal area in the denture
• Small lesions are treated by curettage
• Large lesions are treated by split-thickness suprapenosteal excision

Introduction to Complete Dentures

Complete Dentures: Short Essays

Question 1. Denture induced hyperplasia
Answer:

The hyperplastic reaction of the mucosa over the borders of the denture

Cause Of Hyperplasia:

• Trauma due to unstable dentures:

Features Of Hyperplasia:

• Deep ulceration
• Fissuring
• Inflammation

Management Of Hyperplasia:

• Surgical excision
• Correction of dentures

Question 2. Epulis fissuratum
Answer:

Epulis Fissuratum is a soft tissue reaction that appears in the sulcular region due to overextension of the denture flange.

Question  3. Indications and contraindications of complete denture

Answer:

Complete Denture Indications:

• Presence of adequate edentulous ridges with sufficient vertical space
• Serious loss of masticatory functions
• Impairment of aesthetics, speech, and psychological well-being
• In patients where remaining teeth cannot be retained

Complete Denture Contraindications:

• An edentulous patient who has not worn dentures in many years
• Unmanageable mechanical problems
• Patient with no salivary function due to radiation
• Altered systemic health
• Allergic to acrylic resinPatient with severe or total paralysis of the motor nerves of the tongue, cheeks, lips, or floor of the mouth
• Excessive loss of maxilla or mandible
• Large maxillary or mandibular tori.

What is a Complete Denture?

Question 4. Residual ridge resorption.
Answer:

• Residual Ridge Resorption is alveolar remodeling that occurs due to a change in the functional stimulus of bone tissue
• Residual Ridge Resorption is a chronic progressive change in the bone structure, which results in severe impairment in the fit & function of the prosthesis

Cause of the Residual ridge:

• Excessive forces over non-stress-bearing areas cause the activation of osteoclasts

Clinical Features of Residual Ridge:

• Decreased depth & width of sulcular
• 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 Of Residual Ridge:

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

Question 5. Burning mouth syndrome
Answer:

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

Question 6. Denture stomatitis
Or
Denture sore mouth
Answer:

Denture Stomatitis is the pathological reaction of the palatal portion of the denture-bearing mucosa

Types Of Denture Stomatitis:

1. Type I: Localized simple infection
2. Type II: Erythematous type
3. Type III: Granular type

Etiology Of Denture Stomatitis:

• Candida albicans

Predisposing Factors Of Denture Stomatitis:

1. Local Factors:
   • Dentures
   • Xerostomia
   • High-carbohydrate diet
   • Use of broad-spectrum antibiotics
   • Smoking
2. Systemic Factors:
   • Old age
   • Diabetes mellitus
   • Nutritional deficiency
   • Immune defect
   • Malignancy

Complete Dentures in Prosthodontics

Treatment Of Denture stomatitis:

• Good oral hygiene
• Keep the denture as clean as possible
• Avoid wearing dentures at night
• Clean the dentures by brushing, soaking, and then brushing again
• If the denture contains metal work, do not use anything that contains bleach.

Basics of Complete Denture Fabrication

Management Of Denture Stomatitis:

• 0.2-2% chlorhexidine
• Removal & cleaning of dentures after every meal
• Avoid wearing dentures
• Polishing of denture
• Administration of antifungal drugs
• Surgically: Elimination of crypts, by cryosurgery

Complete Denture Viva Voce

1. Surfaces of complete dentures are described by Fish.
2. The Fit of the denture depends on the accuracy of the impression surface.
3. Occlusal surface aids in mastication
4. The polished surface is the external surface of the complete denture
5. Result of residual ridge resorption
   • Prognathic appearance
   • Wide mandible, narrow maxilla
   • Concave profile
6. The ratio of anterior maxillary residual ridge resorption to anterior mandibular residual ridge resorption is 1:4.
7. Factors affecting residual ridge resorption (RRR)
   • RRR – directly proportional to bone resorption factor/bone formation factor
   • RRR is directly proportional to the pressure/ damping factor
   • RRR is directly proportional to the anatomic factor
8. The cause of Epulls fissuratum is overextension of the denture flange
9. Treatment of Epulis fissuratum involves shortening and smoothing the denture
10. The cause of papillary hyperplasia is a candidal infection
11.  Treatment of papillary hyperplasia
    • Small lesions curettage
    • Large lesions split thickness subperiosteal exclusion
12. A diffuse erythematous zone under denture denture-covered area is a sign of denture stomatitis
13. The cause of the flabby ridge is excessive load on the residual ridge
14.  Cause of traumatic ulcer
    •  Overextended flanges
    • Occlusal imbalance
15. Burning mouth syndrome is common in females older than 50 years.