Initial Visit What signs and symptoms presenting? Symptoms Usually the patient wants new dentures to look, eat and feel better, Signs of Future trouble or existing problems which may affect prognosis (success) of new dentures. 1. Epulis Fissuratum 3) Caused by overestension of existing donture cure reduce denture lange, but may require surgical removal a 2. Papillary Hyperplasia Hard palate + nodular, red, shiny * loose denture,smoker * Cure: Tissue conditioning existing denture may resuce inflammation, But only surgery will eradicate completely. cee 3. Angular Cwetens 4) Red cracked skin in folds of comer of mouth b) Usually denture bearing areas jaflammed, ¢). Usually unclean dentures, worn all night (can do but must have superb hygiene) 4) Inadeq} 1 dimension of occlusion (1655 of intermaxillary space). ©) Vitamin B deficiency f) Candida all 8) Cure: Hygiene, hygiene, hygiene. Leave out at night. Tissue conditioning. Nystatin, New denture with correct vertical dimension of occlusion t._Kelly's Combination Syndrome a) Patient has denture history of: + Maxillary complete denture + Retained mandibular anterior teeth * Does not weara mandibular removable partial dentures $963 cowie fo Sylar Sareea 2 BESS LATEb) You observe: + Moxilla => Denture anteriors “do not show”. = Mavillary anterior ridge bone resorbed, tissue flabby => Tuberosities abby and énlarged + Mandible => Mandibular anteriors extruded above suitable occlusal plane (along with alveolar ‘bone and gingiva). => Posterior ridge disuse atrophy (underemployed ridge) + Tongue => Loose dog without a fence = Holds maxillary denture in place ¢) Problems with new complete denture and mandibular removable partial denture, + Maxilla oe => Unstable denture due to flabby support = Will ned relief in tray and mucostatic impression technique = Poor retention/poor support = Often cannot bring anterior teoth down enough for esthetic occlusal plane = Tuberosities may be close to retromolar pad, therefore require reduction. NB: Must have minimum of 3 mm clearance for two denture bases, + Mandible => Mandibular anteriors enameloplasty required but often still notable to do sufficient to obiain esthetic anterior occlusal plane. = Tongue will fight removable partial denture. Need to retrain it, Why did patient stop wearing removable partial denture after 2 t0 3 years? ‘The 3 “Rs” (Residual, ridge, resorption). Clasps then torqued abutments ~ PDL sore. Lingual bar or plate rotated and caused sores at inferior edge 5. Tori 3) Maxillary -+ keep it b) Mandibular ~ off with it ©) Exostosis and spicules (common sense) should be removed 6. Tuberosities 2) Reduce one only of bilateral undercuts b) Ifalso anterior ridge undercut ~+ reduce tuberosity undercut but keep anterior undercut ©) Reduce tuberosity if < 3 mm space > < tuberosity and retromolar pad 7. Maxillary labial freaum —* a) If on crest of ridge ~ adversely affect retention and can cause fracture of denture. Final Impressions (Second Visit) Border molding: maximum extension within physiological limits Final impression (wash) - detail and distribution of forces Flabby tissue ~ relief of tray and Mucostatic technique, e.g., mandibular “curled ridge” and Kelly's premaxilla and maillary tuberosity. - estar eee | ¢ D ery RANTLEPepned él Cok Fong Oh, x (pouch)? + coronoid process ‘What is pterygomandibular raphe? + tc yetween buccinator and Superior constrictor muscles. What muscle affects dsto-buceal comer of mandibular denture? —* masseter Maxillo-Mandibular Relations (Third Visit) Final Limit Is: "Poster ind of denture: hamular notches, vibrating line: Gunction of moveable and immoveable tissue) ‘Noseblow/Ahh! Dentist, not teckniefan, determines final limit ity De fos A re On displaceable, immovable tissue. Why? = polymerization and cooling shrinkage What if too deep? ~ De inseated. (It slowly descends). ‘Tentative Plane of Occlusion ‘Make wax rim simulate position of maxillary teeth Anterior: Lip support - tooth length (1 mm) Sounds “F.V". inciso-facial angle hits vermillon border of mandibular lip. (weUry line) Interpupillary line (unless hemifacial distrophy) parallelto condyles and commissures of mouth, Posterior: ala-tragus;, Half-way up (or down) retromolar pads Eacebow Transfer Record Relates maxillary cast to the hinge axis ofthe articulator ata distance which is the same as the distance of the patient's maxilla to the terminal hinge axis of the mandible, Result - On the articulator the casts will open and close on the same arc as occurs in the mouth, Why? - So that we can vary the vertical dimension of occlusion by up to 5 mm while maintaining accurate centric relation, If you change the vertical dimension of occlusion more than 5 mm (+ or -) take another centric relation record and remount the lower cast. ion of Ocelusion Elevator muscles belong to a very powerful labour union! They like to contract at their optimum contraction length, i, suitable vertical dimension of occlusion... Therefore they will not function well and may complain ifasked to work at an unsuitable vertical dimension of occlusion. Vertical dimension of occlusion is inversely proportionate to freeway space. A) At Good Vertical Dimension of Occlusion: Appearance is good => not strained, nor collapsed. Lips are even (assuming correct lip support) size (maxillary and mandibular) “S" sounds: rims almost touch = closest speaking space ‘Swallowing is comfortable. “Froeway space” is evident: Relax => close => can see chin jump At rest: lips lightly touching, rims apart Remember: Freeway space: average is 2-3 mm, but can vary, Have to evaluate. Vertical dimension of rest - Vertical dimension of occlusion = freeway space @ etree vie dod Age, 1997B) Excessive Vertical Dimension of Occlusion. ‘Appearance: face looks strained (like golf ball in mouth) Rims may touch at rest Phonetics: rims touch on “S” sound ‘Swallowing is uncomfortable - elevator muscles trying to bring mandibular to their suitable vertical dimension of occlusion and centric relation when swallowing. (Dr. Askinas'alginate sausage technique). Ifyou give a patient dentures at an excessive vertical dimension, they will complain of an aching face, ‘and ridge resorption could be accelerated, C) Inadequate Vertical Dimension of Occlusion Appearance: (when rims are touching “collapsed face”. (Lower 1/3 short) lips disappear, Class Ill profile. At rest: rims may be far apart. (Excessive Freeway Space] Phonetics: rims not close at all at “S” position. Tf make denture with inadequate vertical dimension of occlusion they may be comfortable, but not chew efficiently and dentures may contribute to angular cheilitis and tempromandibular joint disfunction, Try-In (Fourth Visit) Appearance: mid-line, planes tooth position. ‘Support of lips => vertical dimension of occlusion, thickness of denture border and position of tecth. (sec incisive papilla. Phonetics: “S” sounds Vertical Dimension of Occlusion Centric Relation: Check bite, if off => remount, do not adjust teeth in mouth. Mounting must be identical to mouth! Protrusive Record: to adjust condylar guidance angle of articulator, Fiow does the condylar guidance angle help you? To develop a compensating curve which will enable balanced occlusion, ie., all around contact in excentric position,e.g., posterior contact when patient is in protrusive position, ‘The curve compensates for the degree difference between CGA and posterior tooth cusp angle. Hanau’s Quint: Rules to help obtain a balanced occlusion Condylar guidance angle => comes with patient! Incisal guidance angle Occlusal plane ‘Cusp angle or height Compensating curve. : Denture Placement (Fifth Visit) Why Remount? Polimerization and cooling shrinkage Flask problems - not closed, pressure released during processing. Plaster mix weak - tecth moved. Acrylic packed in rubber stage. Occlusal adjustment: to regain even occlusion To adjust occlusion “detrei aie die . 2 Sapa, WOTCR - Bull Rule - Buccal Upper/Lingual Lower Cusps Protrusive - DUML rule - Distal Upper Mesial Lover inclines Page 137 (Denture handbook) Short Term Follow-Up If maxilla unseats - overextended or posterial palatal seal excessive, When speaking: Mandibular and maxillary - overextension When eating: Suspect occlusal prematurely. Swallow => vertical dimension of occlusion and entre relation. If entire ridge red and sore: vertical dimension of occlusion may be excessive => evaluate, or centric ‘ocelusion\centric relation => remount. Eace and ridges ache = vertical dimension of occlusion excessive. Why? Residual ridge (alveolar) always resorbing. That's why we advise overdenture = root retains alveolar bone Denture looses retention: less intimacy of fit May cause gagging when okay for years because it falls onto tongue. Flanges now overextended: fissuratum can develop Patient may abandon removable partial denture. Denture may fracture. Remember: immediates, overdentures and removable partial dentures need more frequent reline to maintain alveolar support Reline if; vertical dimension of occlusion okay - Centric occlusion=centric relation No large vertical anterior overlap, good aestheties. How: closed mouth technique! correct vertical dimension of occlusion in centric relation position: If after: Patient complains of “sores all over ridge” => question centric occlusion/centric relation Overdentures Why? abutment maintains alveolar bone =» stability f Proprioception Paychological (still have my own teeth!) Can add attachment => retention f Bone: Need $ mm for abutment, 10 mm for attachment. Why Coping? Cast attachment To restore abutment to dome shape. If metal denture base (or RPD base) Remember: Give 0.4% stannous fluoride Recall every 6 months = will need moré frequent reline Immediates - Two Tipst 1. When doing posterior extractions, leave $/28 or 12/21 to maintain vertical dimension of occlusion 2. Main disadvantage - no try-n!! Esthetics unseen by patient prior to placement of denture, 2p ei doe age, 1997 eanComplete Denture Prosthodontics ‘The hamular notch is important in complete denture construction BECAUSE it aids the dentist in positioning the maxillary posterior teeth. a. Both the statement and the reason are correct and related, Both the statement and the reason are correct but NOT related. he statement is correct, but the reason is NOT. ‘The statement is NOT correct, but the reason is accurate cc. NEITHER the statement NOR the reason is correct. The hamular notch is an important anatomical landmark to register in a final denture impression. It ts en ‘important part of the peripheral seal. Its not an aid in the positioning of maxillary posterior teeth. A patient has a chronically tender, knife-cdge mandibular residual ridge. In fabricating a complete denture for this patient, a dentist should consider which of the following? {&) Maximal extension of the denture - to distribute forces of occlusion over a greater area, {5 sinimal eenson of th denture to lint tenderness oa sale ae, ¢. Decreased occlusal vertical dimension - to decrease biting forces 4, A broad occlusal table «to provide. firmer contact in eccentric jaw relations, The idea here isto distribute the forces over the largest possible surface area and lessen the load on the tender Iniferedge area. Answer () is the exact opposite of answer (a), 50 you must remember the concept that a large surface area to distribute the load is desirable. Answer (@) is also the opposite of what we see - a decrease in occlusal vertical dimension will actually increase biting forces, (Think aBout it - which is easier to breok-« jax breaker candy or a breath mint?). Answer (d) can be eliminated since we know that a broad occlusal table increases the amount of force. Ina complete maxillary denture, accurate adaptation of the bi the following the most? of the maxillary facial flange affects which of a. Speech Support nen fod fig e._ Subiiy d. Esthetics istofacial periphery of the mandibular impression should receive special attention. Which of the following anatomical structures might cause soreness if the denture is overextended? Ca Masseter ~B. Buccinator . Pterygomandibular raphe 4. e Internal pterygoid Lateral tendon of the temporal. Uyou keiow where the “distofacial periphery” is then answers ¢, d de can be eliminated. The question refers 10 the area from the buccal shelf to the top of the retromolar pad. The buceinator is in this vicinity, but you now the masseter is medial t0 the buecinator and has a direct effect on the length of the denture border in this area (hat is hy you want to activate the masseter when border molding this region.) a95 4 \Gptti@ lower third of a patient's face appears deficient and the lower lip has curled inward causing it to [A dentist dotermined that it would be necessary to adjust a patient's denture teeth to correct the centric occlusion at the wax ty-in appointment, Which ofthe following should this dentist do? (a. Make a new centric relation record and remount. D8F Make a new face bow and centric record ee Make slight occlusal adjustment inthe mouth, “de Make adjustments only for Class If jaw relation pat This ts exactly what we do in clinic at the wax try-in visit. Ifthe occlusion on the articulator and in the mouth do rnot match, the case needs fo be remounted using a new centric relation record. Answer (8) also asks you to make a new centric record, but a new facebow is not necessary to remount if we preserve the facebow transfer by only ‘separating one cast from its mounting ring. Making “slight occlusal adjustments in the mouth" answer (e) will just compound the error. If you change something in the mouth it will also change on the articulator. Answer (d) does not make any sense ~ why would a Class If patient be any different than Class I or Il inthis scenario? For a complete denture balanced occlusion, the lingual cusps of maxillary posterior teeth on the non-working side ‘contacts which arcas of the mandibular posterior tecth? a, The facial inclines of the lingual cusps. b, The lingual inclines of the lingual cusps. ‘The lingual inclines of the facial cusps. ‘The central fossze. Think about what they are asking and draw yourselfa ltl picture or use your builtin cheat sheet if necessary. (four ovn dertition) In a complete denture balance occlusion itis desirable to have non-working side contacts. On the non-working side, the lingual cusps of mandibular posterior will actually move away from the lingual cusps of maxillary posterior teeth, and thus would not have potential for contact, so answer (@) can be eliminated. Answer (b) can be eliminated for the same reason. The central fossae will probably have contact in centrle occlusion, But as the patient moves into a lateral excursion, the cusps move out of the epposing central {fossae, s0 answer (d) can be eliminated. (c) 18 the correct answer - the lingual inclines of facial cusps of ‘mandibular posterior teeth will slide against the Buccal melines of lingual cusps of maxillary posierior teeth ‘The lower one third of a patient's face appears too short and there is an apparent loss of the vermilion border of the lips. Which of the following procedures is indicated to correct this situation? a. Moving the anterior teeth facially Increasing the interocclusal distance. Decreasing the occlusal vertical dimension, Increasing the occlusal vertical dimension disappear, then the patient looks like they do not have any teeth and they are overclosed. Ifyou (a) only move the anterior teeth facially, you may give better lip support, but the patient will still appear over closed. If) the interocelusal distance is increased, you are creating more freeway space and thus decreasing vertical dimension of occlusion and making the lower one third of the face even shorter. This is synonymous with answer (c), decreasing occlusal vertical dimension. The correct answer is (d) because increasing the occlusal vertical dimension (or “opening the bite") ard decreasing freeway space will give the patient a more normal appearance in this example. @8. What happens to the profiles of a majority of individuals as they mature? ‘a. They become more convex. b. They become less convex. c. They retain the same degree of convexity. This ts a lot like the previous question. As people age and lose teeth andor have wear on the occlusal and incisal surfaces of their teeth, the nose and chin will be closer together, giving a sunken appearance to the lower U3 of the face with loss of lip support. In profile, instead of appearing convex from the philtrum of the nose to the chin, it will appear caved in or concave (or less conver). 9. Which of the following isa principle of alveoloplasty? a, Undercuts that interfere with the seating of the denture should be removed. The remaining ridge should be as broad as possible, even if some undercuts exist. ‘©. Sharp bony projections need not be smooth as they will round off in a few days during the healing process. Jn abveoloptasty, sharp bony projections including mandibular tori and undercut areas that will interfere with denture seating should be removed. Sometimes small undercuts ean be negotiated by altering the path of insertion. Broad ridges are desirable (b) but not if there are multiple undercuts that interfere the denture seating 10. The speech sounds that bring the mandible closest to the masilla are the: Zo coe SS Crd = othpet Syeutiy When take Set a. 5" sounds, —5-4 b. “f' and “v sounds. ) ee and “iH SOUE “d-vowel sounds, This is a fact you should know “SH” and "CH" sounds are called sibilant sounds and represent the closest speaking space ..“F" and "V™ or JiGative-SOwmar GFE Wade by formig @ valve Beeween the maxillary incisal edges and the wetldry borders ofthe lower lip. The jaws are separated to make this sound. (Trp it) “T”" cand “TH” sounds are made by the tip of the tongue against the anterior portion of the hard palate, and again the ‘upper and lower teeth are separated during this sound. Vowel sounds are also made with the mouth open. To take a proper “S" sound, the mandibular incisal edges nust almost touch the lingual surface of the mecillary incisors between the cingulum (Class I patient) and the incisal edge (Class Ill patien). 11, A dentist relined a patient's maxillary complete denture, This patient returned repeatedly for adjustments of the erythematous arcas on the ridge crest. Which of the following is the most likely cause? a. Anallergy to the acrylic resin that was used for relining, b. Presence of a pressure spot in the rlined impression €. The loss of even centric relation contacts, 4, A decrease in the occlusal vertical dimension An allergy to cerylic resin (a) would cause a generalized erythema, not just on the ridge crest. A single area of pressure (b) should be readily adjusted out in I or 2 visits. A decrease in occlusal vertical dimension would not be the cause for repeated adjustments unless (¢) there was a loss of even centric contact or an occlusal prematurity. 12. A patient presents for try-in evaluation of balanced occlusion of complete maxillary and mandibular dentures. A. dentist notes that protrusive excursion results in separation of posterior teeth, ‘This dentist can best correct this problem by: a. changing the condylar inclination. b._inereasing the incisal guidance CE Ancreasing the compensating curve, — ieee A fy fo fal, fell 0A ryti aha using a fat plane cusp for the posterior teeth, 1 for complete dentures, it is desirable to have contact of posterior teeth in ion. A protrusive record should be made and condylar te )adjusted so the cast settles into the record. Further modification of the condylar-inclination after this point (a) is rot permissible as the patient's anatomy dictates this setting. A cusped or anatomic posterior tooth mold is chosen for a bilaterally balanced occlusion (eliminate answer d). The posterior teeth are then reset so that in a proirisive movement the mesial inclines of mandibular posterior buccal cusps slide against the distal incline of maxillary posterior teeth allowing the lower incisal edges to move down and forward without sliding against the lingual surfaces of maxillary incisors. Thus, answer (8), increasing incisal guidance will not help solve the problem here. Instead the best solution is to try to make the compensating curve steeper so there is more opportunity forthe posterior teeth 10 ntact in. protrusive. (Review Hanau's Quint until you are convinced!) 13. An edentulous patient has mobile, hypemplasti tissue in her mavillary anterior region. In making impression for this patient, the dentist should: 1. use the closed-mouth technique. use a high-fusing impression compound. ©) register the tissue in its passive position. @ involve maximum pressure. Mobile, hyperplastic tissue necessitates a passive or mucostatic impression technique. Answers (a, b, d) will alt ‘cause the hyperplastic tissue fo move and be registered in the impression under pressure, What kind of problems do you think this will cause in the final denture? How are you going to modify your impression technique in this situation? 14. tn complete denture fabrication, which of the following regulate(s) the paths of-the-congyles in mandibular movements? _—& The height of the cusps of posterior teeth. 1b The amount of horizontal and vertical overlap ©The size and shape of the bony fossae and the menisci and muscular influence, 4. The vertical occlusion, centric relation, and dogrec of compensating curve The condylar path ts the route taken by the mandibular condyle as it moves forwards and downwards from the lenoid fossa to the articular eminence. It is an anatomical possession of the patient and we cannot change it Wercan mieasure the condslar guidance angle by taking a protrusive record and setting the condylar angle of the articulator. peetl co Ke grows five avet flan Jobe ee cog he poker 10 plates MoutAin fob pop h roll WB byt 15A, In a complete denture patient, when the teeth, occlusion rims, and central bearing point are in contact and the ‘mandible is in centric relation, the length of the face is known as the: 2. interocclusal rest space. vertical dimension. . physiologic rest position d__rest vertical dimension. CE eeelusal vertical dimension ISB. An incorrect occlusal vertical dimension causes a patient to overclose and to have a poor facial profile, To correet this problem, the dentist should do which of the following? a. Increase the rest vertical dimension and increase the interocclusal distance. b. Decrease the rest vertical dimension and diminish the interocclusal distance. Decrease the occlusal vertical erocclusal distance. Increase the occlusal vertical dimension and diminish the interocelusal distance. The occlusal vertical dimension is the vertical dimension of the face when the teeth (or occlusion rims) are in contact in centric relation. Key word is occlusal, i.., eeth or rin touching. Remember: Vertical dimension of occlusion plus equals Physiologic vertical dimension of Interocclusal rest space rest position. Rest vertical dimension ts vertical dimension of face when jaws are in rest position. Interocelusal rest space = freeway space Vertical dimension ts of rest or of occlusion vO (Seesaw Relationship) 10D = Interocclusal (Freeway Space) distance 16. Which of the following best explains why the dentist should provide a postpalatal seal in a complete maxillary denture? The seal will compensate for a. errors in fabrication ba tissue a polymerization and cooling shrinkage. deformation of the impression material The border seclofa denture requires intimate contact of the denture border with displaceable tissues capable of intimate conta e tissues, But din Drvetten A Fis providing that Seal. The impression should have captured intimale contact with thesaicin tension changes that occur when the denture base material is molded and polymerized may be enough to prevent intimate ati 2oling shrinkage. Creation of a posterior palatal seal will retain contact of entire base to tissues along posterior border in spite of inevitable changes in material. Rememb, should extend laterally through the hanular notches into buccal vestibules 117, For complete dentures, which of the following three factors affect the correct positioning of lips? 2. Face-bow transfer, position of tecth, and correct rest vertical dimension. b. Face-bow transfer, thickness of the anterior border, and correct occlusal vertical dimension, & Correct rest vertical dimension, thickness of the anterior border, and position of teeth @ Correct occlusal vertical dimension, thickness of the anterior border, and position of teeth, Correct vertical dimension of occlusion: places teeth at correct length fo support total lip Anterior border thickness: restores contour lost by facial bone resorption. “Position of teeth: restores suppe by extraction of teeth and should restore natural contour if placed correctly - rot too far labially or lingually. NB: Facebow transfer has nothing to do with lips. It is ted to ‘vansfer position of maxilla with respect 19 terminal hinge axis of mandible to the articulator. 18. Under which of the following conditions wil it be eritica tWhen the patient has a severe Class Il occlusal relation When the patient requires several fixed partial dentures. ‘When the dentist plans to change the vertical dimension through restorations. When the dentist plans to fabricate dentures with high-cusped teeth on a fully adjusted articulator. Itis possible fo change the vertical relationship of the patient's cast by up to $ mm accurately (without having to a actbow transfer record has Been used. This ill relate the maxillary ast, and mandibular cast via centric relation record, in he Samé position with respect (othe hinge axis for articulator as the patlent’s maxilla to the terminal 19, The one relation of the Gondyles to the fossae in which a pure hinging movement is possible is: is of hs her mandible. centric occlusion, Ao ty wave Fi ya ee ee ae The key words are terminal hinge pasition. 11s the most retruded position in which a pure hinge movement can be demonstrated ‘The center ofexsof rotation is called Te ferminal Riige axis. 20. Which ofthe following jawrelation records should be used for setting both the medial and superior condylar guides ‘onan arcon articulator? oe ¢ 4 Iotercuspation pwedel of betel Centric relation ateral interocelusal records ~ G4 a, fyize pont 2 Gans coh 5 Protrusiveinterocclusal records Ds Key word is medial. 21, Which of the following adverse conditions may arise ifthe occlusal vertical dimension is increased? b, c 4 The closing muscles may become strained. ‘The opting mmaseles may become strained. The c: ig muscles may become too relaxed. Soreness may occur at the comers of the mouth, The elevator nivscles have an optimal contraction length at which they function efficiently. Hopefully a vertical dimension of ocelusion is chosen that will favor this length, i... the elevator muscles will shorten to their optimal ‘contraction length at which time the denture teeth will come together (vertical dimension of occlusion). If the vertical dimension of occlusion chosen is increased beyond the optimal muscle contraction length then the muscles will be forever straining to contract down to their dream length. Thus: sore face (muscles); strained appearance: generalized sore ridges. 22. Excessive depth of the posterior palatal seal usually results in: a. b 4 unseating of the denture, a tingling sensation ‘greater retention. increased gagging. The tissues will rebound against the denture and lift it off its tissue seal borders. Remember, a denture is worn riainly at rest (not occluding). a5 i 23, The pterygomandibular raphe is a tendon between which muscles? ‘Stapedius and stylohyoid. ’b.) Buccinator and superior constrictor. © Medial pterygoid and lateral pterygoid. 4. Levator veli palatine and tensor veli palatine. e. Anterior belly of digastric and stemnocleidomastoid Memorize this! NB. The plerygomandibular raphe may be in when the patient opens wide. ~~~ = inged by the posterior borders of the dentures “24, In an edentulous patient, the coronoid process can: = yar! Zorn A datean. Sige baer Sat Pore. ‘a. limit the distal extension of the mandibular denture, ’, affect the position and arrangement of the posterior teeth. cTimit the thickness of the denture flange in the maxillary buccal space. i, deterniie te Tocation oF the posterior palatal seal of the maxillary denture The coronoid process limits the width laterally of the maxillary buccal space (pouch). When making a maxillary impression have the paiient move the mandible side to side so that i will have freedom to move without impinging on the maxillary denture. Undercontour of this area of the maxillary denture may conipromise the border seal. 25, A flabby, maxillary anterior ridge under a complete dentute is frequently associated with: a. “V" shaped ridges. b. Class Il patients 5. osteoporosis (2D retin str manda anterior Classical Kelly's Combination Syndrome! 1. Maxillary complete denture — flabby anterior ridge, bone xs. resorption, fibrous = centlarged tubcrosities. 2. Retained mandibular (natural) anterior teeth —_extvtded above suitable occlusal plane. 3. No posterior occlusion — Mandibular posterior residual ridge disuse atrophy. 26. Ina protrusive condylar movement, interferences can occur between which posterior cusp inclines? Inclines of Inclines of maxillary mandibular a Mesial Distal b. Distal Mesial a Mesial Mesial a Distal Distal Again, use your own teeth and try to figure it out if you can't remember it. Also known in occlusal egiilibration 05 DUML RULE = distal upper mesial lower. 27. Which of the following expl mandible? ‘a. The denture base ends where the ramus ascends. b. The molars would interfere with the retromolar pad. ¢. The tecth in this area would encroach on the tongue space, dye tecth inthis arca would interfere with the action of the masseter muscle. (© Je oectusal forces over the inclined ramus would dislodge i cee Sop the mandibular gen 30 ‘why mandibular molars she ld NOT be placed over th. ~ ending area of theThe occlusal plane should be parallel to the residual ridges so thot occlusal forces will Be at right angle to residual ridge and therefore tend 1 sea the denture, not displace tt NB. Provided the teeth are set in the “neutral zone” they should not interfere with masseter or tongue. The dente Base ends on the retronolar pad which s posterior to start of rise of ramus 28. Loss of intermaxillary space, infection, or avitaminosis B can each cause which of the following? a. trophic glossitis b. Xerostomia ¢. Angular cheiltis 4. Recurrent aphtha €. Periadenitis mucosa necrotica recurrens Loss of vertical dimension of occlusion allows collapse of lips inward and collection of saliva at corners of mouth. This site becomes infected by candida. A vitaminosis B really doesn't tie in with the question (according 10 Dr. Kabani). So just memorize the answer! 29. Papillary hyperplasia is MOST frequently found in which of the following sites? .) Hard palate Br Sof palate €. Anterior gingival tissue d_ Posterior gingival tissue Again, memorize the answer. Mast frequently isthe key. 30. Which of te following is a major disadvantage of immediate complete denture therapy? 3. Trauma to extraction sites increased potential for infection, impossibility for an anterior tryin, 1 Excostive resorption of esidaat ridges. The patient ean only hope you make a denture which looks natural and atiracive! You can’t try it in Because the natural anterior (and any other remaining) teeth are token out inmmediately before the immediate denture is placed! There should be no trauma to the extraction sites ifthe denture is correctly fabricated, and adjusted carefully at placement (delivery). There is no evidence of increased potential for infection or excessive ridge resorption. 31. A patient who has a moderate bony undercut on the facial from canine-to-canine needs an immediate maxillary denture. There is also a tubcrositythat is severely undercut. This patient is best treated by ’) reducing surgically the tuberosity only. '. reducing surgically the facial bony undercut only. ¢. reducing surgically both tubcrosity and facial bony undercut. 4. leaving the bony undercuts and relieving the denture base. By reducing the tuberosity undercut the denture can be inserted along a path parallel to the facial canine-to- canine undercut. Ifyou leave both undercuts you'll have relieved away most of the denture by the time you get it seated. NB. If no facial undercut existed but bilateral tuberosity undercuts did - reduce only one_of the undercuts and rotate the denture into place. Try to maintain the facial Bone, it is subject to a lot of resorption in timie and we need this bone for support as long as possible. ' Immediate Denture 32. The dentist will extract the patient's mavillary teeth during two different appointments. Which teeth should be extracted during the first appointment? a. Teeth #'s 3 and 15 b. Teeth #'s3, 4,13 and 15 Teeth #"s 3, 12, 13 and 15 4d. Tecth #"s 3, 4, 5, 12, 13 and 15 iOE Ga Lae. Flaw Phen doing two sage extractions remove posterir teeth, then at denture placement visit renove remaining . teeth, Leave 5/28 and/or 12/21 t0 maintain vertical dimension of acelusion, only extracting them along with the remaining anterior teeth immediately prior to immediate denture placement (delivery). = Immediate Denture 33. In making the final impression for the maxillary immediate denture, the dentist must perform several procedures. Which of these procedures will present the dentist with the greatest difficulty? ced a. Border-molding the anterior mucobuccal fold. b. Border-molding the lateral mucobuccal fold. c. Locating the posterior peripheral seal, a 4. Border-molding the tuberosity areas e The dentist must carefully manewver the tray past the lips, over the teeth and into the labial suleus without os disturbing the softened border molding material, Tricky! ‘Usually most of the posterior teeth will hare boon removed and so the lateral mucobuccal fold presents no problem. Immediate Denture = 34. The dentist will extract the remaining maxillary teeth and place th i denture. Tn preparation for these Procedures, this dentist has Constructed a clear acrylic stent. The stent will Function to: achieve homeostasis after surgery. b. protect the soft tissue temporarily. © locate areas on the residual ridge that need reduction, idge that n The stent 15 made on the final cast after the teeth have been 4 planned, in whieh case the final east has bean appropriately see if sufficient bone has been removed by placing the ste ent over the ridge. Any underreduced areas will be Slanched Nowurally the stent and the demure base are almost identical face fit Off. Itis extremely useful if ar alveotoplasty is ‘inimed before the stent is made. The surgeon can Immediate Denture 35. When delivering the patient's immediate denture, the dentist should instruct the patieit to do eac of the following EXCEPT one. Which one is this EXCEPTION) a. To retum the next day for an evaluation Z b. To expect the denture to become loose aver time, ¢. To expect very little bleeding, — d__ To take the first dose. ‘of analgesics before the local anesthetic wears off —— GD To take the denture out overnight. A surgical site will swell for three days. Inflammation accompanies healing. Ifthe patient takes the denture out the tissues will continue to Swell and he/she may be unable to reseat the denture. NB. The 24 hour recall is most i important - We want to adjust the denture to accommodate the swelling which has taken place since insertion of denture. By adjusting the denture carefully over the firs fow days a lot ‘of sore spots and pain can be prevented,* Fixed and Removable Prosthodontics In constructing a fixed partial denture for a patiet, the dentist wil use a hygienic ponte. Which ofthe following will primarily determine the faciolingual dimension of the occlusal portion of this pontic? a. The length of the pontic. 1b, The masticatory force of the patient. ©.’ The position of the opposing contact areas. 4. The width and crestal postion ofthe edentulous ridge. Answers (a & d) can be readily eliminated - the length of the pontie and the ridge area will not have direct Influence on the faciolingual dimension of the pantie, Mesticator force will have a greater effect on the lengih of the connectors, since this is the most susceptible area (0 failure. The best answer ts (€] ~The area of occlusal Cohitact on the opposing dentition will have a direct influence on the faciolingual dimension of the pontie, Think narrow ocelusal tables and pin point centric occlusion contacts In adapting 2 pontic to the residual ridge, the dentist must maintain a proper biologic and hygienic environment Therefore, the pontic must NOT: a. be convex mesiodistally h the residual ridge c. be concave faciolingually. 4. be concave in two directions, The tissue surface of the pontie nust be easily cleaned, s0 a convex surface is most desirable. The pontie should clso rest passively on the ridge to discourage food entrapment. In a ridge lap situation for esthetics, itis okay to allow the portic 10 be concave faciolingually, but it must not be allowed to be concave mesiodistally at the same lime, This would create a “hole” which would encourage entrapment of debris and plague. A patient undergoes an extraction of a permanent mandibular first molar and elects not to have the tooth replaced Over a period of time, the teeth adjacent to the extraction site are likely to move in which of the following directions? Moverent of the Movement of the Second Molar Second Premolar a. Mesial Distal None Distal c. Mesiat None Teeth move to meet their neighbors - they are very social. The forces of occlusion and the tongue end check imuscles will cause mesial migration of the second molar, distal migration of the second premolar and possibly extrusion ofthe tooth opposing the edentulous space. The speech sounds that bring the mandible closest to the maxilla are the: c. “t'and “th” sounds, d. vowel sounds, ‘When cementing a cast restoration, where should the dentist apply the cement? 2. Only to the tooth, b. Only to the restoration, “€) On both the restoration and the preparation, {Don't ask-this is the answer they wanted! Orange stain is used to: Cc lo71 12 B. Is Is, 16 Which of the following is measured by the modulus of elasticity? (A) Stiffness or rigidity Ultimate strength Yield strength 4. Duelilty or malleability The higher the modulus of elasticity the stiffer the material. The best measure of the potential clinical performance of a casting alloy is its: castability. bumishability. ADA certification. tamish susceptibility. mechanical properties Non-working interferences usually occur on the inner aspects of the: 2. facial cusps of maxillary mola, b. facial cusps of mandibular molars. lingual cusps of mandibular molars. 4. facial cusps of maxillary premolars. Ina protrusive condylar movement, interferences can occur between which posterior cusp inclines/ Inclines of Inclines of maxillary — mandibular 2 Mesial Distal b. Distal Mesial . Mesial Mesial @ Distal Distal ‘The strength of a soldered connector ofa fixed partial denture is best enhanced by: 3, using a higher carat solder. (®) increasing its height, e sing its width, 4. increasing the gap. th Rule of beams. Strength is enhanced by cube of height and only by the square of the A dentist is restoring a patient's mandibular arch with a removable partial denture (RPD). The RPD will replace the second premolars and all molars on both sides, Which of the following is the best method for recording centric relation? a. Use a plaster record of the interdgitaton of teeth, 1b, Manually articulate the casts and secure with sticky wax, i‘) Use the framework that has an occlusal rim attached. \a7 Use a wax registration that covers premolars of the mandibular arch and anterior teeth ©. Use an occlusal rim made on the master cast to which is added a soft wax forthe registration, The clasps and rests will stabilize the RPD frame better than an acrylic registration base will be stabilized on movable tissue,23. Major connectors most frequently encounter interferences from which of the following? a. Lingually inclined maxillary molars. b.. Lingually inclined mandibular premolars. ¢. Facially inclined maxillary molars and premolars. 4. Bony areas on the facial aspect of edentulous spaces. @. Maxillary molars cannot often incline so for palatally as to interfere with path of insertion. 8. Mandibular molars offen do incline considerably to the lingual creating @ path of placement sncerforence. ~ a Path of insertion problems are rarely facial. 4. Facial bony protuberances rarely impact on path of insertion. 24, In the construction ofa removable partial denture, when isa lingual plate preferred over a lingual bar connector? a. When more rigiity is required. b. When the remaining teeth are widely spaced - ¢. When the remaining anterior teeth are mobil 4. When there is no space in the flaor of the mouth, A lingual bar can be made more rigid by making it thicker, wider, or higher. Widely spaced teeth would not be an indication as the metal of the apron would show between the teeth An apron will not necessarily stabilize the teeth. I there is not 7 mm from gingival margin on the mandible to the floor of the mouth, here is insuff ‘Space for strength of the major connector. sip es ‘ent 25, For an estension-base removable partial denture, which of the following is the most important to maintain the ° remaining supporting tissues? Using stress releasing clasps. Limiting eccentric occlusal contacts. 4. Using plastic teeth Stress reteasing clasps would release stress on reeth and could place more stress on the tissues 5. Preserving denture base support by extension of the denture base 10 reduce the force per unit area will reserve tissues best 5 & Limiting contacts may increase the unit force/contact and do nothing to decrease overall force. 4. Plastic teeth may not reduce force. 26. The one relation of the condyles to the fossae in which a pure hinging movement is possible is: a. centric occlusion. b.retruded contact position postural position of the mandible (rest vertical dimension). transverse horizontal axis (terminal hinge position), Centric occlusion is anterior to terminal hinge position. Retruded contact position is tooth to tooth rot anatomical, Rest position is usually opening from a position anterior to the hinge axis. The terminal hinge axis isa guided anatomical position of the mandible such that the jaw ean open and close only and cannot make any translatory movement. (0421. Which of the following is the primary reason for using plastic teeth in a removable partial denture? Plastic teeth are: a. resistant to weat b. resistant to stains, csthetically acceptable. jretained well in acrylic resin, in will chemically bond to.acrylic resin. Porcelain is mechanically attached. a. is incorrect because acrylic resin wears more than porcelain or metal/acrylic resin. 4. is incorrect as it is more porous than porcelain or metal. is correct, but porcelain is offen more esthetic. 28, Group function occlusion is characterized by having as non-working contacts (b. working contacts. “E protrusive contacts. 4. along centric, Maxillary buccal cusps (lingual inclines) contact mandibular buccal eusps (buccal inclines). 29-Which of the following is the best reason for pouring a condensation impression material as soon as possible? “D_ ja. The degree of polymerization of condensation polymers is initially high and then decreases with time. 2 | b. Evaporation of a volatile by-product causes shrinkage of the set material _/ © IElef unpoured, condensation impression materials expand as they absorb water from air, 4. Condensation polymers will start to react with the polymer of the impression tray and cause distortion 30. The dentist seats a full gold crown on a patient's mandibular right second molar. As the patient closes and as the tecth come into initial contact, the patient’s jaw deflects to the right, Before treatment, the patient’s occlusal relationship had been stable. To regain stability, the dontst will adjust the crown. On which incline of which cusp should the adjustments be made? Incline Cusp a. Toner (lingual) Facial b Outer (facial) Facial c Inner (facial) Lingual ri Outer (lingual) LingualFixed Prosthodontics Review Questions 1. In an arcon type articulator, 2. The face-bow the condylar elements are placed a. on the upper member of the articulator. b. on the lower member of the articulator. (p) The condyles are placed on the lower element just as the Agtural condyles are located on the mandible. is used to transfer the relationship of the wegen, the hinge axis, and a third reference point to the articulator. a. True b. False (a) To achieve the most accurate mounting on an articulator, {he mounted casts should be closing around an axis of Fotation as close as possible to the patients’ hinge axis. calciun sulfate hemihydrate is the principle ingredient of plaster. | stone. alginate. Answers a & b ors (a) Alginate is a sodium or potassium salt of alginic acid. She other two materials are related gypsum products. When burning out en invested pattern for a porcelain fused to metal coping, the temperature should reach a. 1000 degrees F 1450 degrees F. 2 2500 degrees F. (b) 1000 degrees F. would not provide sufficient expansion oP the Investment. 2500 degrees F. would cause breakdown of the investment material. tn a post and core, the post does not strengthen a root, its only purpose is to retain the core in a tooth. a bv true False (a) ample research indicates posts do not strengthen roots; Ul6. 7 8 9 Resistance form in a premolar full crown preparation is achieved by the a. chanfer-bevel- pb. occlusal reduction. c. axial reduction. L (c) Resistance forn prevents distodgenent of Fhe restoration a UrFSr—~—r—S—s—™s—CSi=—CiéSsrsesisizs)“(Ctwt the by forces ;ngival length and taper of the axial welds. are Seeeeeene in both resistance and retention form for a crown. pogitive nodules on the occlusal surfaces of @ stone cast peuld be due to air entrapment when 1. mixing the alginate. 2. seating the impression. 3] mixing the stone.\ a. 1 bi 1 and 2 c. 1, 2 and 3 a. land 3 (») Air entrapment in the stone would result in 2 void {negative} not a positive nodule- wquo plane" axial reduction is indicated on which axial surfaces? a. Buccal “pl Lingual c. Proximal @. All of the above (a) Two plane reduction is indicated on the buccal surfaces {2 prevent excess tapering of the preparation due to anatomical and occlusal considerations. Which of the following opposes removal of a casting opposite to the path of insertion of a restoration? a. Resistance form b. Retention forn (b) Resistance form is related to apical oF oblique forces not lifting forces from sticky foods. et10. In the "cone" waxing technique, which sequence is suggested? 1. Develop the marginal ridges 21 Develop the supporting cusps 31 Develop the guiding cusps 7 4. Develop the primary grooves pe tly oo b. 2, 3,1, ce. 3, 2, dr a. 4, 2, 3y - (c) This sequence developed by E.V. Payne was the first waxe (Shea technique for functional waxing. 11. Which impression material contains mercaptan groups? a. Reversible hydrocolloids b Irreversible hydrocolloids ¢. Rubber base a. Silicone (c) Polysulfide polymers have terminal and pendant rercaptan csups which are oxidized by the accelerator to produce Shein extensions and cross-linking, respectively. 42. Multiple accurate casts may not be poured from an 7 erguersible hydrocolloid because of which phenomenon? a. The brush-heap effect . b. Inbibition 7 | ct Syneresis (c) Syneresis causes the impression to lose accuracy quickly . {n air while the gypsum is hardening. 43. What is a Vicat Penetrometer used for? a. Determining yield strength b. Determining bond strength : ¢) Determining setting time @. strain . (c) The penetroneter is used to measure both working and, (Cteing Eimes for impression materials and other restorative materials.a4. The primary purpose of 2 custom tray is a. to allow roon for a large bulk of impression material. BL to conserve impression material. by £0 faximize accuracy of the impression @. for infection control. (c) A custom tray provides a uniform thickness of impression eterial which maximizes the accuracy of the impression is. sharp occluso-axial line angles in a full crown preparation gnould be avoided in order to facilitate fabrication of the restoration. « Sfoid fractures of remaining tooth structure. * Syoia stress on the dentin. { Gmprove retention form. nove (a) sharp Line angles on a preparation invite voids in one investment of a wax pattern which result in positive nodules inside the casting. 16. The impression material most often used for making diagnostic casts is __ ‘P"pydrocolloid which is classified as an pression material. a. irreversible; elastic b. irreversible; inelastic ¢, reversible; elastic @_ reversible; inelastic (a) alginate is both an irreversible (chenically set) and is An elastic impression material. 17. Nickel is not considered a known allergen. a. True b. False (b) Nickel is a known allergen with the incidence of (e) eeeSty 5 to 10 times higher in females than males. 1g. Which of the silicone impression materials is nore accurate? a.) Addition b. Condensation (a) Addition silicones have the best recovery from deformation during removal from the mouth U419. What is the function of potassium sulfate in alginate impression material? a. A principle reactor b. Retard chemical reaction . @. Improve compatability with gypsum @, Antimicrobial action = (c) Potassium sulfate counteracts the inhibiting effect of (c) Posrecolioia on the setting of gypsum, giving @ high= quality surface to the stone. go. The strength of a soldered connector of @ fixed partial Genture is best enhanced by a. using a higher carat solder. b) increasing its height. ¢, increasing its width. @. increasing the gap. (p) A connector is stronger when the 7ajoF axis of the . GQ beieal cross section is parallel to the direction of force. a1. Which of the following is the best method for evatvetsng which of celusion on a newly placed onlay restoration? shim stock Articulating paper Patient feedback \ occlusal indicator wax. pours (a) A narrow, thin strip of mylar shim stock a})oue aE raeneic: ene¥indiyidualycontacts) 00 iresters. eusueeas to using articulating paper. 22. A dentist primarily splints adjacent teeth in a fixed partial denture in order to a, improve the distribution of the occlusal load. b. improve embrasure contours. ¢, stabilize the abutment teeth. a. improve mesiodistal spacing. (a) Slinting adjacent teeth allows directing the forces more favorably along the long axis of the teeth. Wyae eee the I eine will use a hygienic pontic. Which of the following Ooty" primarily determine the faciolingual dimension of the Scciusal portion of the pontic? _ The length of the pontic The masticatory force of the patient he position of the opposing contact areas gee Plath and crestal position of the edentulous ridge noun (c) The occlusion with the opposing teeth will determine Ch resount of faciolingual dimension required a4. Which of the following is the most effective vay to reduce pescby to the pulp during a restorative procecure? a. Prepare dentin with slow-speed burs: $1 Use anesthetics without vasoconstrictors Be Mininize dehydration of the dentinal surface §. Keep the dentinal surface clean by frequent irrigation (c) Zt is important to prevent dehydration of the dentinal (o) ate since the dentinal tubules connect directly with the surface ulp, Tubular fluid flow can be produced Py air denboration of the surface thereby displacing the eypeeplastic cell bodies (hydrodynamic theory). 25. A dentist restored an endodontically treated Toone with a ee —r—“ Et cast Poet *Mecient calls and complains of pain, especialy 08 ese sr Bist probable cause of pain is a. a loose crown. pb. psychosomatic. ¢, a vertical root fracture @. a premature centric contact. (c) Vertical root fracture may not be visibie 0” 2 (oy veraph, A loose crown would exhibit mobility end a premature contact would cause pain in a few days 26. In adapting a pontic to the residual ridge, the dentist must an eeeeh a proper biologic and hygienic environment Therefore, the pontic must NOT a. be convex nesiodistally. b. touch the residual ridge. €. be concave faciolingually. @. be concave in two directions. Ié