Constant use of the prosthesis should be discouraged for these patients. Pre-treatment Records The pre-treatment record is a very valuable infor- Neurological Disorders mation. The reason denture should be noted. The patients who keep changing examined.
It should be marked as acceptable dentures in a short period of time are difficult to or unacceptable. The reason for wanting a checked. At-least the maxillary denture replacement should be evaluated. This denture should coincide with the facial midline.
It should be marked as acceptable functional habits of the patient. It should be marked surfaces of the mandibular teeth against the as acceptable or unacceptable. It should be marked as acceptable or ra. It should be recorded as none, unilateral and unacceptable. It arranged in a reverse smile line Fig.
Reproduction of rugae should be noted. Good noted for any valving nasal twang. Fair de. This may be an indica- tion of bruxism. Denture wear can be classified as: 1. Minimal 2. Moderate 18 Fig. It influences radiographs, photographs, diagnostic casts, etc. It also influences the aesthetics. They can also be used to guide jaw degree of tooth display. Rough texture skin will require the. Wrinkles on the keeps moving his jaws and altering ridge relation- cheeks show decrease in vertical dimension.
In such cases it may be necessary to prepare All the above-mentioned factors aid to. This set-up serves to of teeth Fig. It includes extraoral and intraoral examination. Facial outline of the face as square, tapering, square colour, tone, hair color and texture, symmetry and tapering and ovoid. Examining the facial form llib. It includes helps in teeth selection Figs 2.
Angle classified facial profile as: nt. Facial Features The following features on the Lower facial height Determining the lower facial face should be noted during diagnosis of the height is important to determine the vertical jaw patient: relation see jaw relation. Decreased VD produces wrinkles around the mouth. Excessive VD will cause the facial tissues to appear stretched Figs 2. Muscle Tone llib. Muscle tone can affect the stability of the denture. No degeneration. It is common in immediate nt.
Class II: Normal muscle function but slightly de. Class III: Decreased muscle tone and function. It is usually accompanied with ill-fitting dentures, decreased vertical dimension, decreased biting force, wrinkles in the cheeks and drooping of Fig.
Muscle Development Neuromuscular Examination 2 People with excessive muscle development have It includes the examination of speech and neuro- more biting force. House classified muscle muscular coordination. Class II: Medium.
The colour of the eye, hair and the skin guide the Type 2: Affected. Patients who have impaired. Pale skin colour is articulation or coordination of speech with their indicative of anaemia and should be treated. Patients whose speech was altered due to a. They also fall under affected speech. Thus, the operator is free to place the that the patient is suffering from neuromuscular teeth to his wishes. These conditions also produce their mani- r. Short lips will tend as bodily movements. Abnormal facial move- to reveal more of the tooth structure and also ments like lip smacking, tongue tremors, uncon- llib.
Based on the length, lips are trollable chewing movements can influence classified as long, normal or medium and complete denture performance and may also lead short. If present these indicate vitamin B defi- Neuromuscular coordination of a patient can be nt. Class I: Excellent. Class II: Fair. TMJ plays a major role in the fabrication of a CD. Intraoral Examination The joint should be examined for range of Existing Teeth movements, pain, muscles of mastication, joint sounds upon opening and closing.
The diagnosis and treatment planning for a overdenture is discussed in detail in Chapter Which is twice in thickness mucosa should be examined. Any amount of redness. This requires tissue treatment Fig.
This may be due to ill-fitting denture, smoking, infection or a systemic disease. Inflamed tissues provide a. Other colour changes such as white patches should be noted, as this might indicate an area of frictional keratosis.
The viscosity of the y. Saliva can be mucoperiosteum may vary in different parts of classified as: the arch. Variations in the thickness of mucosa Class I: Normal quality and quantity of saliva.
House Class II: Excessive saliva. Contains much ra. Remaining saliva is tissue approximately 1 mm thick. Investing mucinous. Thin serous saliva does Class II: Fig. It can be of two types: not produce such effects.
Xerostomic patients show poor retention and a. Soft tissues have a thin investing mem- brane and are highly susceptible to irri- excessive tissue irritation wheras excessive sali- nt. Soft tissues have mucous membranes that are twice the normal thickness. Residual Alveolar Ridge de. While examining the residual alveolar ridge the arch size, shape, inter-arch space, ridge contour, ridge relation and ridge parallelism should be noted. Arch size Arch should be observed for two main 22 Fig. Arch size can be classified as follows: Fig.
Arch form This plays a role in support of a denture There is another classification for ridge cont— and in tooth selection. The various arch forms are our. According to that classification, the maxillary nt. Discrepancies between and mandibular ridges are classified separately. Class I: Square to gently rounded.
Class I: Square Fig. Class II: Tapering Fig. The ridge should be palpated for Fig. Ridge parallelism can be classified as: llib. While examining ridge relation, the pattern of Class I: Both ridges are parallel to the occlusal resorption of the maxillary and mandibular plane Fig. Ridge relation refers to the anterior posterior nt. Angle classified ridge relationship.
Class I: Normal Fig. Class II: Retrognathic Fig. Ridge parallelism Ridge parallelism refers to the relative parallelism between the planes of the ridges. The ridges can be parallel or non-parallel. Class II: Excessive inter-arch space Fig. Increase in Ridge defects include exostosis and pivots that inter-arch space will be due to excessive residual may pose a problem while fabricating a complete r.
These patients will have denture. Redundant Tissue Decrease in inter-arch space will make teeth- arrangement a difficulty. However, stability of the It is common to find flabby tissue covering the llib. These movable tissues decrease in leverage forces acting on the denture. This leads to loss of retention. The most common hyperplastic lesions are epulis nt.
Treatment for these lesions includes rest, tissue conditioning and denture de. Surgery is considered if the above mentioned treatments fail. Hard Palate The shape of the vault of the palate should be Fig. Tissue coverage for posterior palatal r. While examining soft palates, it is important to observe the relationship of the soft palate to the hard palate. The relationship between the soft palate and the hard palate is called palatal throat a.
Classification of soft palates Class I: It is horizontal and demonstrates little Fig. In this case more tissue coverage is possible for posterior palatal seal Fig. It should be observed here that a class—III soft 2. Tissue coverage for posterior palatal are associated with a flat palatal vault. House classified palatal throat forms as: Class I: Large and normal in form, relatively.
Class II: Medium sized and normal in form, with a relatively immovable resilient band of y. The curtain of soft tissue turns down abruptly 3 Gag Reflex and Palatal Sensitivity to 5 mm anterior to a line drawn across the palate de.
Some patients may have an exaggerated gag reflex, the cause of which can be due to a systemic Lateral Throat Form disorder, psychological, extraoral, intraoral or iatrogenic factors. The management of such Neil classified lateral throat form retromylohyoid patients is through clinical, psychological and fossa area as Class—I Fig.
Bony undercuts do not help in retention, rather. Bony under-. In the maxillary arch, they are found in the anterior region and laterally in the region of the. In the mandibular arch, the area under the mylohyoid ridge acts as an undercut Fig. Class II: Clinical examination reveals tori of lo moderate size. Such tori offer mild difficulty in denture construction and use. Surgery is not required Fig. In case of maxillary arch, surgical removal of the undercut is not necessary, providing relief is enough.
In case of the mylohyoid ridge, surgical llib. Bilateral undercuts should be eleminated. These tori nt. It is not dentures. Such tori require surgical contouring necessary to remove maxillary tori surgically or removal Fig. In order to prevent injury to the thin mucosa Muscle and Frenal Attachments covering the tori, adequate relief should be pro- vided in that region during complete denture Muscular and frenal attachment should be fabrication.
Rocking of the denture around the examined for their position in relation to the crest tori will occur in cases with excessive residual of the ridge.
In cases with residual ridge resorp- 28 ridge resorption. These abnormal attachments can produce. These muscular and frenal attachments should be surgically relocated. Classification of border attachments Class I: Attachments are placed away from the lo Fig. There is at least 0. Surgical the ridge Fig.
Class II: Distance between the crest of the ridge and the attachment is around 0. Tongue-biting is of the ridge Fig. A small Class II: The frenum is located nearer to the crest tongue does not provide adequate lingual of the ridge Fig.
They are also necessary in maintaining the denture in the mouth during functional activities like speech, deglutition and mastication, etc. Sufficient teeth are present to maintain Fig. All teeth have been absent for a extended period of time, Class-I position is ideal, because in such a case allowing for abnormal development of the size the floor of the mouth is at an adequate height, r.
Insufficient denture can sometimes hence the lingual flange of the denture contacts ra. This is not the case in class-II and especially llib. In class-II and class-III cases, the floor of the mouth is too low, hence, the dentist tends to overextend the denture flange.
This leads to loss of retention instead of obtaining peripheral a. Floor of the Mouth de. The Class II: moderate resorption loss of upto 2 floor of the mouth can be measured with a two-thirds of the vertical height.
The patient should touch his Class III: severe resorption loss of more than upper lip with the tongue to activate the muscles two-thirds of the vertical height. Radiographic Assessment of Bone Quantity and. He classified bone quality radiographically. Wical and Swoope devised a method Sources of infection like infected necrotic ulcers, for measuring ridge resorption.
According to periodontally weak teeth, and nonvital teeth them, the distance between the lower border should be removed. Infective conditions like llib. The commencement of treatment. The patient should be de. Some pathologies may involve the entire follows: bone.
In such cases, after surgery, an obturator Class I: mild resorption loss of upto one-third may have to be placed along with the complete of the vertical height. Preprosthetic Surgery balanced diet. Patients with vitamin B2 deficiency will show angular cheilitis. Prophylactic vitamin Preprosthetic surgical procedures enhance the A therapy is given for xerostomic patients.
Nutri- success of the denture. Some of the common tional counseling is also done for patients show- preprosthetic procedures are: ing age-related changes such as osteoporosis.
The type of prosthesis, denture base material,. Denture relining material should be applied on For Patients Destined to be Edentulous ra. Nutritional counseling is a very important step a. In this chapter ensured. Care should be taken not to cast, and surveying the diagnostic cast.
It should be understood that r. It should not be too large or denture. A diagnostic impression is defined as small. Making the Impression Diagnostic impressions are prepared using an elastic impression material like agar or alginate. Rigid impression materials are contraindicated for making diagnostic impressions. This is because the rigid materials get locked in the undercuts and tend to break easily.
Alginate is chosen because it is elastic records the undercuts 34 and economical. Alginate powder is dispensed logagues like methanthaline bromide, etc.
This helps to prevent dis- tortion of the impression. In such cases, the impression should be with- drawn along the long axis of the remaining.
If there are gross deficiencies, the lo impression should be repeated. The lips should be moved brush dipped in water. Impression should not llib. This helps be washed under direct water because it may to record the freni and sulci Fig. Immersing the impression a. The impression is sufficient for complete disinfection. Slurry water improves the wettability of de. Failure to trim the alginate will lead to distortion when the tray is placed on the table and the impression rests Fig.
Dental plaster is preferred because it is economical and reproduction of lo finer details is not an important requisite. The dispensed in a rubber bowl and mixed in a second pour should fill the entire ridge Fig. In the first pour it should be of a more liquid consistency.
The plaster mix should be placed on the distal end of the impression and allowed to flow all over. This prevents the a. The Fig. Plaster is mixed and poured onto ridge. A small quantity is applied de. The impression with the consistency. Surface irregularities should not second pour is inverted over the base former.
After pour- areas to remove any demarcation between the ing the second pour it should be placed in second and third pours Fig. Posterior surface of the cast must be perpendicular to the floor. Edentulous casts will not have distinct surfaces. Care should be taken to avoid overtrimming y.
Later, this base r. Removing dry sludge is difficult and nt. Surveyors are discussed in detail ridge, is the highest point or the height of in the removable partial denture section Ref contour of the ridge. The area below the height 38 Chapter Diagnostic Impressions in Complete Dentures 3. Measuring the Depth of the Undercut Fig.
This is something like a mock surgery preparation. The scrapped cast gives an Fig. Mouth especially if there is any sign of pathology. The lesion should be cured and the lo tissue should be given adequate rest for sufficient Hypermobile tissues result due to excessive residual ridge resorption. These mobile tissues should For patients with normal tissues, hour rest be recorded carefully using a mucostatic with frequent tissue massage is sufficient.
The impression. Tissue-conditioning materials can be used to reline the existing dentures to reduce tissue inflammation and thus facilitate in subsequent llib.
Removal of Retained Dentition The decision to remove or preserve the tooth is a. An OPG Fig. Additional relief in the labial notch of the denture may be sufficient. Frenectomy is indicated for cases with a hypertrophic lingual frenum. In case of a hypertrophic tongue-tie, surgical llib. Tongue-tie test Fig. The patient is asked to touch his upper Treatment of Epulis Fissuratum lip with his tongue.
If the lingual frenum pro- a. It is commonly seen in imme- diate denture cases where rapid ridge resorp- tion occurs Fig. Shortening and smoothening the denture border is sufficient. Hence, radiological evaluation is be left untouched. Treatment of Sharp Spiny Ridges Figs 4. Usually rection alveoloplasty, ridge augmentation.
Sometimes they become very prominent due All three ridges have a sensitive mucosal lin- to ridge resorption Fig. Care should be taken to protect the mucosa. Interference of speech b. Loss of posterior palatal seal c. Poor denture stability. The exposed area is allowed to heal by r. It is a surgical procedure to increase the vestibular that a full thickness graft is placed over the expo- depth.
It can be done using one of the following sed region allowing it to heal by primary techniques: intention. Depending on the technique:. Hand manipulation for functional movements. Depending on the type of tray: with these tissues. Depending on the material used: mouth.
Impres- sions are made to produce a negative replica of compound. CD is fabricated. A primary impression is made after the pre- Mucostatic or Passive Impression a. It is used to It was first proposed by Richardson and later nt. If the patient did not require popularised by Henry Page. In this mucostatic preprosthetic surgery, then the diagnostic cast technique, the impression is made with the oral made from the diagnostic impression can be used mucous membrane and the jaws in a normal, de.
Border moulding is not done here. Classification The impression is made with an oversized tray. Impressions can be classified as: Impression material of choice is impression 1. Depending on the theories of impression plaster. Retention is mainly due to interfacial making: surface tension. Pressure or pressureless peripheral seal. Thus, these dentures will have impressions can be made using this technique. Closed-mouth Impression Mucocompressive Impression Carole Jones This method records the tissues in the functional The mucocompressive technique records the oral.
In this technique, record blocks trays tissues in a functional and displaced form. The with occlusal rims are used instead of impression materials used for this technique include impres- trays. The patient is forces are relieved. Dentures made by this asked to close his mouth exerting pressure on the technique tend to get displaced due to the tissue occlusal rims and perform functional movements rebound at rest.
During function, the constant such as swallowing, grinning and pursing of the. Hence the blood supply is decrea- possible to confine the forces acting on the den- sed leading to ridge resorption. This is achieved through the design of the special tray in which Hand Manipulated Functional Movements the nonstress-bearing areas are relieved and the r.
Dynamic Impression stress-bearing areas are allowed to come in ra. It is a mucofunctional technique, which involves contact with the tray Fig. Border moulding or llib. Relief is given using wax in the special tray, functional movements of the lips and cheeks to which should be removed before impression obtain a functional impression of the vestibular making.
It is discussed in detail in the Chapter 7. The patient is also asked to perform move- ments of the tongue to record the alveololingual Open-mouth Impression sulcus.
Active opening and closing movements The open mouth method includes the impression of the jaws are performed to record the disto- 46 techniques, which record the tissues in an buccal portion of both the impressions. Primary Impressions in Complete Denture. Diagnostic Impression Once the tray is ready, the peripheral struc- 5 tures are recorded by a procedure called Border It is made to prepare diagnostic cast, which is moulding or Peripheral tracing. Tracing compound used for the following purposes: or elastomers can be used.
The amount balance. The paste and medium-bodied elastomeric impres- preliminary impression is made with a stock tray. The the tray is tilted downwards and the posterior agar is taken from the tempering section, which y. The impression is made using this tray. Similarly, the mandibular tray should It has excellent surface detail reproduction be raised anteriorly to check for posterior upto 25 microns.
But it has poor dimensional extension upto the retromolar pad. It is an r. Generally elastic impression materials are The preliminary impression can be made indicated for recording undercuts.
Irreversible Hydrocolloid Impression Secondary Impressions or Wash Impression Alginate is the hydrocolloid used for this type of impression. It is available as a powder, which can This is a clinical procedure in complete denture be mixed with water in a rubber bowl. Spatulation a. This is is carried out until a homogeneous mix is done after mouth preparation is complete.
It is a nt. The mix is loaded onto an impression very important step as it should record the den- tray and the impression is made. They are This method makes use of a custom tray or economical. They do not cause cross-infections special tray prepared from the primary cast. The as they are used only once.
The tray can be made of stability due to syneresis and imbibition. All auto-polymerizing resin or reinforced shellac base hydrocolloid impressions should be poured plate. Modelling Plastic Impression This variety of silicone does not undergo dimensional change. The casts can be poured Impression compound is a reversible thermoplastic even after a week. Apart from tubes and cart- material, which is used for making preliminary ridges, the material is available in jars Putty. Thiokol Rubber Impression The impression is made using a stock tray.
It has good dimensional materials. They are available as base and accele- rator pastes. Manipulation is similar to other. Polysulfide materials are hydrophobic. As it is highly Precaution should be taken to avoid any moisture viscous, it can displace the tissue surface. It also contamination on the tissue surface. Silicone and thiokol impression materials are. All other mentioned materials are used to make primary Type I dental plaster Soluble plaster is used here. The impression plaster is mixed with water in a For more information refer books on dental.
This material has potato starch which helps in easy separation of the cast from the impression. The starch in the maxilla and mandible is very important for the y. The consistency of the mucosa impression thus making it easy to remove the cast. A thorough knowledge of these landmarks is essen- ra. Both of mucosa. This mix is used to make the impression.
When it is thin, it easily gets trauma- When cartridges are used, they have to be dis- tized. When it is loosely attached, inflamed 48 pensed in dispenser guns and used accordingly. Primary Impressions in Complete Denture 5. Notice that the submucosal layer lateral hard palate. Notice the abundance of gland tissue is sufficiently thick to provide resiliency for support to complete dentures and that bone covering the crest of the y. The submucosal layer is thin or may nt.
This reduces the resistance of epithe- lium to trauma. Removing the dentures for hours everyday Fig. Toothbrush anterolateral part of the hard palate. Notice that the physiotherapy over the soft tissues can stimulate 49 submucosa contains abundant adipose tissues keratinisation of the epithelium. It is divi-. The vestibule is covered Supporting Structures by the lining mucosa.
Orbicularis oris is the main muscle of the lip. Its fibers run horizontally and. The buccal frenum separates the labial and buccal vestibule. It has attachments of the following r. Limiting Structures muscles, ra. They determine and confine the extent of the Levator anguli - Attaches beneath the fre- denture. Labial Frenum ward direction. Download Link. Moreover Medicalstudyzone.
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