The document discusses the history and clinical exam process for complete dentures, including taking medical and dental histories, conducting oral cancer screenings and prosthetic assessments, and examining factors like bone resorption, saliva and salivary glands that influence denture retention, stability and support. Key areas of the mouth that provide support are identified, like the retromolar pad and buccal shelf, and how their integrity is compromised by ridge resorption over time. Preventive measures to slow resorption like retaining roots and using implants are also outlined.
This document discusses stress breakers in prosthodontics. It defines stress and stress breakers, and describes their aims in directing occlusal forces and preventing harm to remaining teeth. Various types of stress breakers are presented for different prosthesis applications, including removable partial dentures, fixed partial dentures, and tooth-implant supported prostheses. Philosophies of stress distribution like stress equalization, physiologic basing, and broad stress distribution are covered. Specific stress breaker designs like hinges, non-rigid connectors, split pontics, and key-keyway joints are explained.
This document discusses rest seats and rests used in removable partial dentures. It defines rest and rest seat, and classifies rests based on tooth surface and location. The key functions of rests are to provide resistance against occlusal loads and direct forces parallel to abutment teeth. Requirements for appropriate rest seats include withstanding occlusal forces without damage. Different types of rest seats are described, including occlusal, lingual, incisal, and various modifications.
RBBs are resin-bonded bridges that are a minimally invasive option for replacing missing teeth. They are suitable for short spans of missing teeth when the patient is unwilling or unsuitable for surgery. Key factors in determining if a tooth can support an RBB include adequate size, minimal restoration, healthy periodontium, and proper angulation. The bridge design depends on factors like coverage, number of abutments, and framework rigidity. With careful case selection and attention to detail, RBBs can successfully replace missing teeth for select patients.
This document provides instructions for making final impressions for complete dentures. It discusses the objectives of impressions which are preservation of tissue, support, stability, esthetics and retention. The techniques described are aimed at recording tissues in their resting position to avoid displacement. Border molding is used to establish contours and test peripheral seal. A selective pressure technique uses light material to achieve a mucostatic impression. Proper tray design and customization are emphasized.
This document provides an overview of over dentures, including:
- Definitions of over dentures and the advantages of using them to preserve remaining teeth and bone.
- Classifications of over dentures based on the type of support (tooth, implant, or mixed) and the timing of placement.
- Common attachment types used for retention, including studs, bars, and magnets attached to teeth or implants.
- The minimum number of implants needed for fully implant supported maxillary and mandibular over dentures.
The document discusses balanced occlusion in prosthodontics. It defines balanced occlusion as simultaneous contact of opposing teeth in centric relation position, with smooth bilateral gliding to eccentric positions. It describes Hanau's quint, which are the five factors that determine balanced occlusion: condylar guidance, incisal guidance, occlusal plane, compensating curves, and cusp inclination. It also discusses selection of posterior teeth based on ridge morphology, and arrangements for different molar and arch relationships. Examples are provided for managing resorbed ridges and flabby tissues. The goal is to understand principles of occlusion to provide patients with balanced occlusion.
Preeti Chaudhary acknowledges the staff of the Department of Prosthodontics for their support during clinical training. The document discusses the posterior palatal seal area of maxillary dentures. It defines the posterior palatal seal and describes its functions in retaining the denture and reducing gagging. Methods for marking the seal area include the conventional approach using a trial denture base, the fluid wax technique, and arbitrary scraping of the master cast. Errors in recording the seal area can lead to under or overextension of the denture border.
Abutment & Its Selection In Fixed Partial DentureSelf employed
This document discusses factors to consider when selecting abutment teeth for fixed partial dentures (FPDs). It defines an abutment tooth and outlines how to assess potential abutments, including taking radiographs and evaluating crown morphology, root configuration, crown-to-root ratio, and other anatomical features. Good abutment teeth are vital with adequate bone and root support and crown structure to withstand forces from the FPD. Location, occlusion, tooth structure and root health must be optimized for successful force distribution from the prosthesis.
This document discusses stress breakers in prosthodontics. It defines stress and stress breakers, and describes their aims in directing occlusal forces and preventing harm to remaining teeth. Various types of stress breakers are presented for different prosthesis applications, including removable partial dentures, fixed partial dentures, and tooth-implant supported prostheses. Philosophies of stress distribution like stress equalization, physiologic basing, and broad stress distribution are covered. Specific stress breaker designs like hinges, non-rigid connectors, split pontics, and key-keyway joints are explained.
This document discusses rest seats and rests used in removable partial dentures. It defines rest and rest seat, and classifies rests based on tooth surface and location. The key functions of rests are to provide resistance against occlusal loads and direct forces parallel to abutment teeth. Requirements for appropriate rest seats include withstanding occlusal forces without damage. Different types of rest seats are described, including occlusal, lingual, incisal, and various modifications.
RBBs are resin-bonded bridges that are a minimally invasive option for replacing missing teeth. They are suitable for short spans of missing teeth when the patient is unwilling or unsuitable for surgery. Key factors in determining if a tooth can support an RBB include adequate size, minimal restoration, healthy periodontium, and proper angulation. The bridge design depends on factors like coverage, number of abutments, and framework rigidity. With careful case selection and attention to detail, RBBs can successfully replace missing teeth for select patients.
This document provides instructions for making final impressions for complete dentures. It discusses the objectives of impressions which are preservation of tissue, support, stability, esthetics and retention. The techniques described are aimed at recording tissues in their resting position to avoid displacement. Border molding is used to establish contours and test peripheral seal. A selective pressure technique uses light material to achieve a mucostatic impression. Proper tray design and customization are emphasized.
This document provides an overview of over dentures, including:
- Definitions of over dentures and the advantages of using them to preserve remaining teeth and bone.
- Classifications of over dentures based on the type of support (tooth, implant, or mixed) and the timing of placement.
- Common attachment types used for retention, including studs, bars, and magnets attached to teeth or implants.
- The minimum number of implants needed for fully implant supported maxillary and mandibular over dentures.
The document discusses balanced occlusion in prosthodontics. It defines balanced occlusion as simultaneous contact of opposing teeth in centric relation position, with smooth bilateral gliding to eccentric positions. It describes Hanau's quint, which are the five factors that determine balanced occlusion: condylar guidance, incisal guidance, occlusal plane, compensating curves, and cusp inclination. It also discusses selection of posterior teeth based on ridge morphology, and arrangements for different molar and arch relationships. Examples are provided for managing resorbed ridges and flabby tissues. The goal is to understand principles of occlusion to provide patients with balanced occlusion.
Preeti Chaudhary acknowledges the staff of the Department of Prosthodontics for their support during clinical training. The document discusses the posterior palatal seal area of maxillary dentures. It defines the posterior palatal seal and describes its functions in retaining the denture and reducing gagging. Methods for marking the seal area include the conventional approach using a trial denture base, the fluid wax technique, and arbitrary scraping of the master cast. Errors in recording the seal area can lead to under or overextension of the denture border.
Abutment & Its Selection In Fixed Partial DentureSelf employed
This document discusses factors to consider when selecting abutment teeth for fixed partial dentures (FPDs). It defines an abutment tooth and outlines how to assess potential abutments, including taking radiographs and evaluating crown morphology, root configuration, crown-to-root ratio, and other anatomical features. Good abutment teeth are vital with adequate bone and root support and crown structure to withstand forces from the FPD. Location, occlusion, tooth structure and root health must be optimized for successful force distribution from the prosthesis.
An impression in complete dentures is a negative registration of the denture bearing areas made of a material that sets in the mouth. There are different types of impressions based on theories, techniques, trays, and materials used. The objectives of making an impression are to preserve remaining structures, provide retention, stability, support and esthetics. A stock or custom tray is used depending on needs, and materials must be dimensionally stable and reproduce anatomical details accurately.
This document discusses pontic design in fixed partial dentures. It begins with definitions of a pontic and outlines key considerations for pontic design including pretreatment assessment of the pontic space and residual ridge contour, classification of pontics, and biologic, mechanical and esthetic factors. Optimal pontic design aims to provide an esthetic appearance while enabling adequate oral hygiene and preventing tissue irritation. Pontic selection depends on factors like location and materials used. The document discusses various pontic designs like sanitary, modified sanitary, saddle/ridge lap and ovate pontics and their appropriate uses. Biologic considerations for pontic design include maintaining pressure-free contact to prevent inflammation.
Indications contraindications and classification of bridges/endodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses different types of finish lines used in fixed prosthodontic restorations. It defines finish lines and describes their principles and configurations for both extracoronal and intracoronal restorations. For extracoronal restorations, finish line types for full veneer crowns, partial veneer crowns, and laminate veneers are explained. For intracoronal restorations, finish line designs and bevels for direct restorations using amalgam, composites, and direct gold are outlined. Guidelines for finish line placement and exposure techniques are also provided.
This document discusses removable partial dentures (RPDs). It describes the objectives of prosthodontic treatment, consequences of tooth loss, components and classification of RPDs, principles of design including support, retention and stability, and types of major connectors and retainers. The Kennedy classification system and Applegate's rules for applying it are also summarized.
This document provides guidelines for selecting teeth for complete dentures. It discusses selecting anterior teeth based on size, form, and shade to match the patient's facial features and complexion. Posterior tooth selection considers shade, size, number, and form, prioritizing function over aesthetics. Tooth forms can be anatomic, semi-anatomic, or non-anatomic based on the patient's jaw ridge relationship and health conditions. Proper tooth selection is important for denture stability and masticatory function.
Minor connectors are components that join parts of a removable partial denture like clasps or indirect retainers to the major connector. They transmit functional stresses to abutment teeth and stabilize the denture. Minor connectors should be rigid with sufficient bulk and located in tooth embrasures rather than on convex surfaces. They come in different designs like open construction, mesh construction, or using beads, wires, or nails to improve retention of the denture base to the framework. Proper placement and design of minor connectors are important for the support and retention of removable partial dentures.
This document provides an overview of cast partial denture design. It discusses the steps in planning a cast partial denture, components such as direct and indirect retainers, rests, connectors, and Kennedy's classification system. Design considerations are presented for different Kennedy classes for both maxillary and mandibular cast partial dentures, including the use of straps, bars, clasps and rests. The key differences between tooth-supported and tooth-tissue supported cast partial dentures are also summarized.
This document provides definitions and classifications of direct retainers used in removable partial dentures. It discusses the basic parts of a clasp assembly including the rest, body, shoulder, retentive arm, and terminal. It covers principles of clasp design including retention, support, stability, encirclement and passivity. Factors affecting retention such as clasp type, flexibility, length, diameter, taper, curvature and material are explained. The location of the retentive terminal in the undercut is also an important factor for retention.
The document discusses various aspects of pontic design for fixed dental prostheses. It defines a pontic as an artificial tooth that replaces a missing natural tooth. Ideal requirements for pontics include smooth surfaces, easy cleanability, minimal pressure on the ridge, and no irritation to tissues. Factors such as biologic considerations, oral hygiene, occlusion, esthetics, and materials must be considered in pontic design. Common types of pontics include sanitary, modified sanitary, ridge lap, ovate, and others. Proper pretreatment assessment and fabrication techniques help ensure successful pontic design.
This document discusses the components and design of an I-bar removable partial denture (RPD). It begins by defining RPI, which stands for rest, plate, and I-bar clasp. It then describes the key components of an I-bar RPD including mesial rests, proximal plates, and a modified I-bar retainer called the RPI system developed by Krol. The RPI system aims to reduce tooth coverage and stress compared to a standard I-bar by modifying the rest, plate, and I-bar clasp design.
1. Classification of jaw relations establishes orientation, vertical, and horizontal relations between the jaws. Orientation defines cranial references, vertical defines jaw separation, and horizontal defines front-back and side-to-side jaw positions.
2. Centric relation is a repeatable reference position important for recording jaw relations and developing occlusion. It is the starting point for mandibular movements and where opposing teeth contact without proprioceptive guidance.
3. Methods for recording centric relation include interocclusal records, graphic tracings, and functional methods to position the mandible at the correct vertical dimension. The record must be made with equal pressure and avoid distortion until casts are mounted.
1. Major connectors join the component parts of a removable partial denture together and contribute to its support, bracing, retention, and stabilization functions.
2. The most common types of major connectors include palatal straps and plates. Palatal straps are preferred as they are thinner, cover less tissue, and interfere less with speech and comfort.
3. The design of a major connector depends on factors like the locations of edentulous areas, the need for rigidity and indirect retention, and patient comfort. A middle palatal strap is often the most versatile option.
This document discusses residual ridge resorption (RRR), which is the ongoing loss of jawbone that occurs after tooth extraction. It begins with definitions and an overview of the extraction healing process. It then covers the basic bone structure, cells involved in bone remodeling, and the mechanisms of bone resorption. The pathology, pathophysiology, and pathogenesis of RRR are explained. Changes to the maxilla and mandible due to RRR are described. The document lists anatomical, metabolic, functional, and prosthetic factors that contribute to RRR and discusses its epidemiology and etiology.
The labial bow is a component of removable orthodontic appliances that helps retract and retain anterior teeth. It has several functions including moving teeth lingually/palatally, restraining the lip, aligning anterior teeth, and acting as a fulcrum. The main components are the horizontal bow portion, vertical loops, occlusal crossover section, and retentive ends. There are different types of labial bows including short, long, split, reverse, fitted, Mill's retractor, and Robert's retractor, each used to address different orthodontic issues like overjet reduction, space closure, and anterior retraction.
This document discusses the process of a complete denture try-in. It begins by defining complete denture prosthetics and try-in. It then outlines the steps to check the mandibular denture alone, including the peripheral outline, stability, tongue space, and occlusal plane height. It describes similarly checking the maxillary denture alone and then both dentures together, evaluating the occlusion, vertical height, even occlusal pressure, and appearance. The goal of the try-in is to evaluate and adjust the dentures before processing to ensure proper fit and function.
This document discusses the design of removable partial dentures (RPDs). It defines the differences between Class I/II and Class III RPDs, and describes the design sequence including placing rests, major connectors, minor connectors, and direct and indirect retainers. Color codes for design elements are also explained. The objective of RPD design is to control denture movement while preserving oral tissues. Proper design follows diagnostic information and mechanical principles.
This document discusses factors that influence the stability, retention and support of complete dentures. It covers the impact of ridge resorption, saliva flow, oral lesions, tongue position and floor of mouth contour on denture outcomes. Maintaining keratinized tissue and using implants/retained roots can help prevent bone loss and improve denture support and retention.
The document discusses many factors that influence the stability, retention and support of complete dentures. It covers the impact of ridge resorption, saliva levels, oral lesions, tongue position and floor of mouth contour on denture outcomes. Proper assessment of these clinical factors is important for determining prognosis and developing an effective treatment plan.
An impression in complete dentures is a negative registration of the denture bearing areas made of a material that sets in the mouth. There are different types of impressions based on theories, techniques, trays, and materials used. The objectives of making an impression are to preserve remaining structures, provide retention, stability, support and esthetics. A stock or custom tray is used depending on needs, and materials must be dimensionally stable and reproduce anatomical details accurately.
This document discusses pontic design in fixed partial dentures. It begins with definitions of a pontic and outlines key considerations for pontic design including pretreatment assessment of the pontic space and residual ridge contour, classification of pontics, and biologic, mechanical and esthetic factors. Optimal pontic design aims to provide an esthetic appearance while enabling adequate oral hygiene and preventing tissue irritation. Pontic selection depends on factors like location and materials used. The document discusses various pontic designs like sanitary, modified sanitary, saddle/ridge lap and ovate pontics and their appropriate uses. Biologic considerations for pontic design include maintaining pressure-free contact to prevent inflammation.
Indications contraindications and classification of bridges/endodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses different types of finish lines used in fixed prosthodontic restorations. It defines finish lines and describes their principles and configurations for both extracoronal and intracoronal restorations. For extracoronal restorations, finish line types for full veneer crowns, partial veneer crowns, and laminate veneers are explained. For intracoronal restorations, finish line designs and bevels for direct restorations using amalgam, composites, and direct gold are outlined. Guidelines for finish line placement and exposure techniques are also provided.
This document discusses removable partial dentures (RPDs). It describes the objectives of prosthodontic treatment, consequences of tooth loss, components and classification of RPDs, principles of design including support, retention and stability, and types of major connectors and retainers. The Kennedy classification system and Applegate's rules for applying it are also summarized.
This document provides guidelines for selecting teeth for complete dentures. It discusses selecting anterior teeth based on size, form, and shade to match the patient's facial features and complexion. Posterior tooth selection considers shade, size, number, and form, prioritizing function over aesthetics. Tooth forms can be anatomic, semi-anatomic, or non-anatomic based on the patient's jaw ridge relationship and health conditions. Proper tooth selection is important for denture stability and masticatory function.
Minor connectors are components that join parts of a removable partial denture like clasps or indirect retainers to the major connector. They transmit functional stresses to abutment teeth and stabilize the denture. Minor connectors should be rigid with sufficient bulk and located in tooth embrasures rather than on convex surfaces. They come in different designs like open construction, mesh construction, or using beads, wires, or nails to improve retention of the denture base to the framework. Proper placement and design of minor connectors are important for the support and retention of removable partial dentures.
This document provides an overview of cast partial denture design. It discusses the steps in planning a cast partial denture, components such as direct and indirect retainers, rests, connectors, and Kennedy's classification system. Design considerations are presented for different Kennedy classes for both maxillary and mandibular cast partial dentures, including the use of straps, bars, clasps and rests. The key differences between tooth-supported and tooth-tissue supported cast partial dentures are also summarized.
This document provides definitions and classifications of direct retainers used in removable partial dentures. It discusses the basic parts of a clasp assembly including the rest, body, shoulder, retentive arm, and terminal. It covers principles of clasp design including retention, support, stability, encirclement and passivity. Factors affecting retention such as clasp type, flexibility, length, diameter, taper, curvature and material are explained. The location of the retentive terminal in the undercut is also an important factor for retention.
The document discusses various aspects of pontic design for fixed dental prostheses. It defines a pontic as an artificial tooth that replaces a missing natural tooth. Ideal requirements for pontics include smooth surfaces, easy cleanability, minimal pressure on the ridge, and no irritation to tissues. Factors such as biologic considerations, oral hygiene, occlusion, esthetics, and materials must be considered in pontic design. Common types of pontics include sanitary, modified sanitary, ridge lap, ovate, and others. Proper pretreatment assessment and fabrication techniques help ensure successful pontic design.
This document discusses the components and design of an I-bar removable partial denture (RPD). It begins by defining RPI, which stands for rest, plate, and I-bar clasp. It then describes the key components of an I-bar RPD including mesial rests, proximal plates, and a modified I-bar retainer called the RPI system developed by Krol. The RPI system aims to reduce tooth coverage and stress compared to a standard I-bar by modifying the rest, plate, and I-bar clasp design.
1. Classification of jaw relations establishes orientation, vertical, and horizontal relations between the jaws. Orientation defines cranial references, vertical defines jaw separation, and horizontal defines front-back and side-to-side jaw positions.
2. Centric relation is a repeatable reference position important for recording jaw relations and developing occlusion. It is the starting point for mandibular movements and where opposing teeth contact without proprioceptive guidance.
3. Methods for recording centric relation include interocclusal records, graphic tracings, and functional methods to position the mandible at the correct vertical dimension. The record must be made with equal pressure and avoid distortion until casts are mounted.
1. Major connectors join the component parts of a removable partial denture together and contribute to its support, bracing, retention, and stabilization functions.
2. The most common types of major connectors include palatal straps and plates. Palatal straps are preferred as they are thinner, cover less tissue, and interfere less with speech and comfort.
3. The design of a major connector depends on factors like the locations of edentulous areas, the need for rigidity and indirect retention, and patient comfort. A middle palatal strap is often the most versatile option.
This document discusses residual ridge resorption (RRR), which is the ongoing loss of jawbone that occurs after tooth extraction. It begins with definitions and an overview of the extraction healing process. It then covers the basic bone structure, cells involved in bone remodeling, and the mechanisms of bone resorption. The pathology, pathophysiology, and pathogenesis of RRR are explained. Changes to the maxilla and mandible due to RRR are described. The document lists anatomical, metabolic, functional, and prosthetic factors that contribute to RRR and discusses its epidemiology and etiology.
The labial bow is a component of removable orthodontic appliances that helps retract and retain anterior teeth. It has several functions including moving teeth lingually/palatally, restraining the lip, aligning anterior teeth, and acting as a fulcrum. The main components are the horizontal bow portion, vertical loops, occlusal crossover section, and retentive ends. There are different types of labial bows including short, long, split, reverse, fitted, Mill's retractor, and Robert's retractor, each used to address different orthodontic issues like overjet reduction, space closure, and anterior retraction.
This document discusses the process of a complete denture try-in. It begins by defining complete denture prosthetics and try-in. It then outlines the steps to check the mandibular denture alone, including the peripheral outline, stability, tongue space, and occlusal plane height. It describes similarly checking the maxillary denture alone and then both dentures together, evaluating the occlusion, vertical height, even occlusal pressure, and appearance. The goal of the try-in is to evaluate and adjust the dentures before processing to ensure proper fit and function.
This document discusses the design of removable partial dentures (RPDs). It defines the differences between Class I/II and Class III RPDs, and describes the design sequence including placing rests, major connectors, minor connectors, and direct and indirect retainers. Color codes for design elements are also explained. The objective of RPD design is to control denture movement while preserving oral tissues. Proper design follows diagnostic information and mechanical principles.
This document discusses factors that influence the stability, retention and support of complete dentures. It covers the impact of ridge resorption, saliva flow, oral lesions, tongue position and floor of mouth contour on denture outcomes. Maintaining keratinized tissue and using implants/retained roots can help prevent bone loss and improve denture support and retention.
The document discusses many factors that influence the stability, retention and support of complete dentures. It covers the impact of ridge resorption, saliva levels, oral lesions, tongue position and floor of mouth contour on denture outcomes. Proper assessment of these clinical factors is important for determining prognosis and developing an effective treatment plan.
The document discusses various preprosthetic surgical procedures used to improve the denture foundation for patients requiring removable dentures. Some common procedures mentioned include tuberosity reduction, removal of palatal papillary hyperplasia and fibrous lesions caused by denture irritation, frenectomies, and alveoloplasty to reshape sharp bony ridges. Reconstructive procedures like vestibuloplasty and bone grafting are also briefly covered. The goal of these procedures is to enhance denture support, retention, and stability.
Management of abused tissue involves addressing factors that cause tissue damage from dental prostheses. Tissue abuse can result from ill-fitting dentures, continuous wearing, and traumatic injuries. Associated conditions include epulis fissuratum from overextended denture flanges, traumatic ulcers from minor trauma, and inflamed flabby ridges from chronic irritation. Management focuses on removing the irritant, improving denture fit, and surgically excising hyperplastic tissue when needed. Denture stomatitis, inflammation under dentures, is treated with antifungal medications and improved denture hygiene.
This document discusses the implications of oral prosthetics on oral mucosa. It begins by explaining the biomechanics of oral mucosa, including how it distributes loads and responds elastically and viscously to pressure. It then examines types of oral mucosa and discusses common mucosal pathologies from removable prosthetics like denture stomatitis and from fixed prosthetics like secondary caries. Specific mucosal conditions caused by ill-fitting dentures like flabby ridge and hyperplasia are also explained. The document emphasizes the importance of proper prosthetic design and maintenance of oral hygiene to prevent mucosal complications.
Endodontic Treatment For Children by professor hasham khanJamil Kifayatullah
This document discusses endodontic treatment options for children, including the aims of endodontic therapy in primary and young permanent teeth, types of treatments such as indirect and direct pulp capping, pulpotomy techniques using various medicaments, and the advantages and difficulties of treatments in pediatric patients.
macroscopic/ clinical features of gingiva
With video clips
Short video descriptions
Lecture for 3rd BDS students
Periodontology
Periodontics aspect
Clinical features of the gingiva
The document provides an overview of the anatomy and histology of the gingiva. It discusses the different layers of the gingiva including the marginal gingiva, attached gingiva, and interdental gingiva. Microscopically, it describes the epithelial layers covering the gingiva and the underlying connective tissue layer. Key points include that the gingival epithelium can be parakeratinized, orthokeratinized, or non-keratinized depending on its location. The junctional epithelium attaches to the tooth surface and renews rapidly. The connective tissue layer mainly comprises collagen fibers, vessels, and fibroblasts. Gingival fluid maintains tissue health and possesses antimicrobial properties
This document discusses peri-implant diseases, their management, and differences from periodontal diseases. It defines peri-implant mucositis as an inflammatory reaction restricted to soft tissues around implants that is reversible with treatment. Peri-implantitis is defined as inflammatory reaction of soft tissues plus clinically detectable bone loss around implants. Key differences between tooth and implant interfaces are described. Etiology of peri-implant diseases includes poor oral hygiene and microbial factors. Diagnosis involves probing depth, bleeding, bone loss on radiographs. Management involves non-surgical debridement followed by systemic antibiotics and surgical therapies like bone grafting for advanced cases.
This document provides information on describing gingival characteristics. It discusses the normal color, size, consistency, contour, surface texture, and position of gingiva. It describes changes seen in these characteristics due to various inflammatory and non-inflammatory conditions. Treatment approaches for conditions that alter gingival characteristics are also summarized, such as procedures for depigmentation and techniques for treating gingival recession.
This document provides an overview of the gingiva, including its macroscopic and microscopic features. It discusses the different types of gingival epithelium (oral, sulcular, junctional), their histological characteristics. It also describes the renewal process of gingival epithelium and cuticular structures. Additionally, it covers the microscopic features of gingival connective tissue and blood supply. Key points include the layers and keratinization process of gingival epithelium, the non-keratinized nature of sulcular and junctional epithelium, and the formation and structure of the dentogingival junction.
This document discusses root caries, including its definition, causes, classification, diagnosis and treatment. It describes the microbiology, clinical features and prognosis of root caries lesions. It also compares various restorative materials that can be used, including composites, glass ionomers and resin-modified glass ionomers. Emphasis is placed on the importance of preventive measures, proper isolation and adhesion to root surfaces for successful treatment of root caries.
The document provides an overview of the anatomy of the gingiva. It discusses the nerve supply, blood supply, lymphatic drainage and microscopic anatomy of the gingiva. It also covers the development, color, size, contour, shape, consistency, surface texture, and position of the gingiva. The document summarizes repair and healing of the gingiva, age-related changes, gingival diseases, clinical considerations like biological width and gingival biotype, and defines the different types of oral mucosa including alveolar mucosa.
The document discusses the effects of radiation on salivary glands, bone, and teeth, including the mechanisms by which radiation damages these tissues. It covers topics like reduced saliva production and flow due to radiation sterilizing stem cells in salivary glands, changes in oral flora that increase risks of caries and fungal infections, challenges with managing xerostomia, and impacts of radiation on bone remodeling and tooth development. Management strategies for radiation-induced xerostomia like salivary substitutes and stimulants are also examined.
Gingival recession is the displacement of gingival tissue away from the tooth surface, exposing the root surface. It can be caused by periodontal disease, traumatic brushing, occlusal issues, or iatrogenic factors. Treatment depends on the severity and classification of the recession. For mild cases with no sensitivity or aesthetic concerns, improved brushing may suffice. More severe recession involving sensitivity or aesthetics may be treated with surgical root coverage procedures like laterally positioned pedicle grafts or coronally advanced flaps, which can achieve 65-98% root coverage depending on the technique and recession classification. The laterally positioned pedicle graft involves sliding keratinized gingiva from an adjacent tooth to cover the exposed root
The direct sequelae of wearing complete dentures include mucosal reactions like denture stomatitis, candidiasis, angular cheilitis, traumatic ulcers, and flabby ridges. Denture stomatitis is a common inflammation under dentures caused by microbial plaque accumulation and candida species. Candidiasis includes different forms of oral candida infections associated with denture wearing. Angular cheilitis and traumatic ulcers develop from mechanical irritation or nutritional deficiencies. Flabby ridges are caused by excessive bone resorption replacing bone with fibrotic tissue under dentures, compromising denture support. Management focuses on improving denture fit, oral hygiene, and treating underlying causes.
Acquired diseases of teeth, Dental materials and Dental radiography in small ...GangaYadav4
This document discusses various dental diseases and conditions seen in small animals including dental caries, calculus, enamel hypoplasia, endodontic disease, tooth fractures, periodontal disease, tooth resorption, luxations, swellings, tumors, and dental materials and radiography. It provides details on the pathogenesis, clinical findings, diagnosis, and treatment of each condition in 2-3 concise sentences. Dental radiography is described as a vital diagnostic tool that requires general anesthesia and uses intraoral film and dental machines to obtain diagnostic images of the teeth and surrounding structures.
Effects of restorative procedure on periodontiumParth Thakkar
The document discusses several factors related to restoring teeth and maintaining periodontal health. Restorative procedures should aim to place margins in a supragingival location to avoid biological width violations that can cause inflammation and bone loss. Crown contours and materials should facilitate plaque removal. Esthetic considerations include maintaining ideal embrasure forms between teeth. Occlusion should distribute forces across all teeth to prevent trauma from excessive forces.
The document discusses several factors related to restoring teeth and maintaining periodontal health. Restorative procedures should aim to place margins in a supragingival location to avoid biological width violations. Overhanging restorations and poor marginal fit can promote plaque retention and inflammation. Proper crown contours are also important to allow for adequate cleaning. Esthetic considerations include maintaining ideal embrasure forms between teeth.
Similar to Complete dentures 3.history and exam (20)
There are three basic phases of the digital workflow when designing and/or fabricating removable partial denture frameworks; data acquisition, designing (computer aided design (CAD)), and computer-aided manufacturing (CAM). The bulk of this presentation is dedicated to the design steps used in this workflow utilizing sample maxillary and mandibular casts
There are three basic phases of the digital workflow when designing and/or fabricating removable partial denture frameworks; data acquisition, designing (computer aided design (CAD)), and computer-aided manufacturing (CAM). The bulk of this presentation is dedicated to the design steps used in this workflow utilizing sample maxillary and mandibular casts
This document discusses prosthodontic procedures and complications in posterior quadrants. It covers topics such as exam and workup, selection of implants, platform switching, abutment selection, provisional restorations, and new technologies like shape memory sleeve abutments. Key points addressed include that no implant design has been proven superior for marginal bone loss, and custom abutments offer better control of margins and occlusal thickness than prefabricated abutments. New technologies aim to simplify procedures and improve retrievability of restorations.
This document discusses single tooth defects in the posterior quadrants and their restoration. It compares fixed dental prostheses to implants, noting that implants are generally preferred when adjacent teeth are healthy or nearly so. For endodontically treated teeth, a fixed restoration is preferred if sufficient tooth structure remains and occlusion and parafunction are minimal. Considerations for implant placement include anatomic factors, timing of placement, and prosthodontic issues like abutment selection and cement versus screw retention. The goal is to restore function while avoiding complications like fracture, overload, and peri-implantitis.
This document discusses implant biomechanics and treatment planning considerations for restoring posterior quadrants. It notes that implant restorations must be designed to avoid overload, as excessive loads can lead to bone loss and implant failure over time. Key factors discussed include implant number, length, alignment relative to curves of Spee and Wilson, and linear versus curvilinear configurations. Curvilinear arrangements are emphasized as withstanding more load than linear arrangements due to greater cross-arch stabilization. Case examples demonstrate successful long-term outcomes and failures where biomechanics were not adequately considered.
This document discusses the use of implants to supplement removable partial dentures (RPDs) in various clinical situations. Implants can be used to improve support, stability, and retention of RPDs when existing dentition is compromised. Common scenarios include using implants in extension base RPDs, with questionable implant anchorage or unfavorable configurations, to replace lost implants in key locations, replace a lost natural tooth abutment, or supplement insufficient existing dentition. Resilient attachments are often used to retain implant-assisted RPDs while avoiding implant overload. Complications can include peri-implantitis, loose abutments, and wear of attachments. Overlay RPDs are also discussed as an option to
This document discusses computer guided treatment planning and implant placement. It describes how computer guided planning allows visualization of potential implant sites in 3D and more precise placement compared to free-hand drilling. Fully guided surgery uses surgical templates to control position, angle, depth and diameter of osteotomies, while semi-guided surgery controls initial position and angle only, allowing more flexibility. Fully guided is used for edentulous patients, while semi-guided is preferred for partially edentulous patients where soft tissue manipulation or bone grafting may be needed.
This document discusses dental implants, specifically angled (tilted) implants used to restore edentulous maxillas. It describes several approaches for using tilted implants, including placing 4-6 implants with angled abutments to offset the implant angles, or using co-axis implants where angulation correction is subgingival. Tilted implants provide advantages like longer distal implants, improved primary stability, and eliminating the need for sinus augmentation. Studies show success rates above 90% for tilted implants.
Crowns significantly improve the success of endodontically treated posterior teeth but do not improve the success of anterior teeth. Posterior teeth require crowns more often than anterior teeth due to greater cuspal deflection after root canal treatment. The main purpose of a post is to retain a core, not strengthen teeth. Posts should extend to retain 5mm of gutta percha and not exceed 7mm in molars. The diameter of posts should not exceed one-third of the root diameter and range between 0.6-1.2mm. A ferrule of at least 2mm helps prevent tooth fracture.
Charles J. Goodacre presents on provisional restorations in fixed prosthodontics. He discusses the functions and requirements of provisional restorations including protection, mastication, esthetics, positional stability, and providing diagnostic information. He describes various provisional restoration resins and their properties. Goodacre also outlines different types of provisional restorations including prefabricated, custom-fabricated, direct and indirect techniques. He demonstrates techniques for direct provisional restorations using templates and indirect restorations fabricated by a laboratory.
This document discusses secondary impression materials used in fixed prosthodontics. It defines an impression as a negative reproduction of prepared teeth that provides information to fabricate a crown or fixed prosthesis. Impressions can be physical materials or digital scans. Physical impressions include reversible hydrocolloid, condensation silicone, polysulfide, polyether, and addition silicone. Custom trays are often used and are fabricated from autopolymerizing or light-cured resin. Ideal impressions accurately record all prepared surfaces and maintain dimensional stability until the laboratory casts are made.
This document discusses techniques for fluid control and tissue management during fixed prosthodontic impressions. It describes the need to displace gingiva to record tooth structure below the finish line. Various methods of fluid control are outlined, including retraction cords, suction, and isolite systems. Retraction cords should be moistened with hemostatic agents before gentle placement to displace tissue. The document recommends a two-cord technique using different diameter cords and additional hemostatic agents if needed to control bleeding and produce accurate impressions. Proper fluid management is essential for high quality fixed prosthodontic impressions.
This document provides an overview of ceramics used in fixed prosthodontics. It discusses various types of ceramics including glass ceramics, glass infiltrated mixtures, and polycrystalline ceramics. Examples mentioned include lithium disilicate, zirconia, and alumina. The document reviews clinical indications and uses of different ceramics, as well as case considerations, preparation designs, and causes of failure. An outline is provided of the topics to be covered in the presentation on ceramics in dental practice.
1) There are two main hardening mechanisms for dental cements - acid-base reactions and polymerization reactions. Common cements that use acid-base reactions include zinc phosphate, polycarboxylate, and glass ionomer cements. Resin cements use a polymerization reaction.
2) Zinc phosphate cement has a long history of success but lacks adhesion and fluoride release. Polycarboxylate cement bonds to tooth structure and has short mixing/working times. Glass ionomer cement releases fluoride and bonds to tooth structure.
3) Resin-modified glass ionomer cement combines the benefits of glass ionomer cement with the strength and handling of resin, providing good early strength and reduced moisture sensitivity.
1. Single tooth defects in the posterior quadrants can often be restored with either fixed dental prostheses or dental implants, depending on the clinical situation and anatomical factors.
2. Implant placement can be immediate, delayed, or staged depending on factors like infection, bone quality, and proximity to anatomical structures.
3. Site enhancement procedures may be needed to augment bone in order to place implants in ideal positions and ensure adequate bone volume.
This document discusses cement retention versus screw retention for dental implants. Both methods can be used if done properly. Cement retention is simpler but risks residual cement being left under gums, which can lead to peri-implantitis. Screw retention allows easy removal but requires access holes. Residual subgingival cement is the major problem, as it is difficult to fully remove and can cause inflammation and bone loss over time.
This document summarizes research on the success rates and complications of resin bonded prostheses (RBPs). It finds that on average, 26% of RBPs experience complications within 4 years, increasing to 28% after 5 years, with debonding being the most common at 21%. Debonding rates are higher for posterior teeth, longer spans, and cantilever designs. Tooth preparation techniques like covering lingual and proximal surfaces, adding proximal grooves or pinholes, and occlusal rests can reduce debonding. Maintaining a minimum of 0.5mm occlusal clearance and 1mm metal thickness also impacts success. Proper diagnosis, treatment planning and cementation techniques are keys to optimizing longevity
This document is a lecture on fixed partial denture (FPD) designs by Charles J. Goodacre from Loma Linda University School of Dentistry. The lecture discusses key considerations for FPD treatment planning including tooth stability, occlusal forces, abutment selection, and material choices. It provides examples of different FPD designs for single and multiple tooth replacements in the maxilla and mandible. Challenges with each case such as cantilevers, oral hygiene access, and risk of failure are evaluated. The goal is to create the best online programs of instruction in prosthodontics.
Crowns significantly improve the success of endodontically treated posterior teeth. Posts are primarily used to retain cores and do not strengthen teeth. The appropriate post length is to extend to the radiographic apex with 5mm of gutta percha retained. Post diameter should not exceed 1/3 of the root diameter and range from 0.6-1.2mm. A ferrule of at least 2mm is recommended to prevent root fracture.
This document discusses various dental cements and cementation procedures. It describes the compositions, characteristics, and mixing procedures of different cement types including provisional cements, zinc phosphate cement, polycarboxylate cement, glass ionomer cement, resin-modified glass ionomer cement, resin cement, and calcium aluminate cement. It also outlines various clinical procedures for cementation such as provisional crown removal, tooth preparation, crown placement, adjustment, and cement cleanup.
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2. History and Clinical Exam
• Medical and dental history
• Orofacial exam
• Prosthodontic assessment
• Prognosis
• Preliminary impressions
• Tissue conditioning
3. Medical History
Potential medical emergencies
Effects on denture supporting
tissues
Effects on oral neuromuscular
control
4. Effects of Smoking
Predisposition to oral
cancer
Predisposition to
periodontal disease
Success – failure rates
of osseointegrated
implants
5. Oral Facial Exam:
Oral cancer screening exam
Exam for other pathology
Local
Systemic
Prosthodontic assessment
6. Intraoral and Extraoral Exam
Palpate the temporomandibular joint
Checking for:
• Clicking
• Popping or crepitus
7. Intraoral and Extra Oral Exam
Conduct a thorough oral cancer screening
exam
• Lips and cheeks
•Lateral border of the tongue
•Floor of the mouth
•Tonsillar region and the soft palate
•Base of the tongue
•Oropharynx
•Neck
9. Examination of the Lips and Cheeks
Visual inspection
Palpation
Bidigital
You are palpating for:
• Lumps and bumps, indurations etc.
10. Intraoral Exam
Examine the denture bearing
surfaces, the soft palate,
tonsillar region, the vestibules
and the buccal mucosa.
Hamular notch
11. Intraoral Exam
Examine the lateral
borders of the tongue
Examine the ventral
surface of the tongue
and the floor of the
mouth.
12. Oral Lesions and Disease Factors
Impact on Complete Dentures
Diabetes (long term insulin
dependent)
Epithelium is thinner and
less keratinized.
Result:
Compromised, support
and impaired tolerance of
complete dentures.
13. Disease Factors
Wickham’s striae
Oral Lichen Planus –
Erosive lesions and subsequent
scarring in the buccal shelf area
limit denture extension in this
region and make it difficult for
some patients to tolerate their
dentures.
Result – Compromised support
and tolerance of the mandibular
denture.
14. Disease Factors
Pemphigoid – Chronic
ulceration with subsequent
scarring of the oral mucosa.
Result – Limited denture
extensions compromising
support, stability, retention
and tolerance of complete
dentures.
15. Chronic Candidiasis
Mild Low saliva flow
Candidiasis rates leads to
increased numbers
of fungal organisms
Severe leading to a high
Candidiasis incidence of chronic
Candidiasis.
Angular cheilitis
secondary to chronic
Candidiasis.
16. Clinical Manifestations
Burning and irritation of the denture
bearing mucosa, making tolerance of
complete dentures difficult. In addition
the fungus is keratolytic, further
compromising support and tolerance.
17. Treatment
Topical antifungal therapy followed
by relining of the dentures (Nystatin
is the drug of choice. It can be
dispensed as a cream, a powder or
an oral lozenge).
18. Common Oral Lesions
Inflammatory fibrous hyperplasia
Begins as a traumatic ulcer secondary to an overextended denture flange.
19. Common Oral Lesions
Inflammatory fibrous hyperplasia
Continued denture wear and irritation
leads to inflammatory fibrous hyperplasia
(epulis fissuratum).
Therapy – Surgical excision
20. Common oral lesions
Inflammatory papillary hyperplasia
Secondary to ill fitting maxillary dentures. Usually complicated by
chronic candidiasis.
Therapy:
Antifungal medications applied topically. In extreme
cases,surgical excision.
21. Therapeutic Approaches – Palatal Papillary
Hyperplasia**with Associated Candida Albicans
Antifungal therapy*
a) Reline or remake denture
b) Nystatin powder (100,000 units per gram) Apply to undersurface of denture
three times per day for 3-4 weeks
c) Nystatin cream – Best used for lesions associated with the corners of the
mouth
d) Reline denture with temporary reline material
Surgical excision with electrosurgery (when antifungal therapy has reached an
end point)
*Nystatin rinse is generally ineffective. Nystatin oral or vaginal
suppositories used as an oral lozenge are reserved for fungal
infestations that extend beyond the denture bearing surfaces.
**Is this a premalignant lesion? No!!!!
22. Other Oral Lesions of Importance
Premalignant Lesions
Leukoplakia Erythroplakia
Both these lesions can transform into Squamous Cell Carcinomas
23. Other Oral Lesions of Importance
Squamous cell carcinomas
Unless detected early most patients with squamous carcinoma have a
survival of less than 50%. Early detection dramatically improves survival.
24. Other Oral Lesions of Importance
Squamous Cell Carcinoma
A
•A thorough oral cancer screening exam must be
performed on all patients
considered for complete dentures.
•Early oral cancers (A) are difficult to
detect and may be confused with other
phenomenon, but the cure rates are high.
B •Advanced oral cancers (B,) are easy to detect,
but cure rates are very low.
•Our challenge is to detect oral cancers
when they are small, localized, and
treatable.
25. Oral Exam
Clinical Factors Influencing
Stability, Retention, and Support of
Complete Dentures
26. Definitions – Removable Prosthodontics
Retention – Resistance to vertical
displacement of the denture away from the
denture bearing surface during.
Stability – Resistance to lateral displacement
of the denture during function.
Support – Resistance to vertical forces of
occlusion. Factors of the bearing surface that
resist or absorb occlusal loads during
function.
27. What factors associated with the
denture bearing tissues influence
the quality of retention,
stability, and support provided
the complete denture?
28. Quality of Bearing Surface Mucosa Affects Support.
a) Degree of keratinization
b) Amount of attached mucosa vs unattached mucosa
Stratum corneum
Stratum granulosum
Stratum
spinosum
Basal layer
Keratinized Lamina propria
Less keratinized
The more keratinized attached mucosa available,
particularly in the mandible, the better the support.
29. Keratinized Attached mucosa is the
Remnant of Attached Gingiva.
Mucogingival junction
Attached Gingiva Keratinized attached mucosa
The more available on the denture bearing surfaces, the better the support.
30. Maxilla vs Mandible
Note the
amalgam tattoo
Maxilla – Abundance of Mandible – Narrow zone of
keratinized attached mucosa. keratinized attached mucosa.
Covers entire palate and alveolar Confined to the alveolar ridges.
ridges.
31. Loss of Keratinized Attached Mucosa
Result:
(a) Reduced support.
(b) Reduced tolerance to occlusal load.
Zone of
keratinized
mucosa
32. Ridge Resorption
What is the impact of bone
resorption on retention, stability,
and support?
All three are negatively impacted.
33. Pattern of Ridge Resorption*
The rate of resorption is much higher
in the mandible than in the maxilla.
*Talgren, 1964
34. Ridge Resorption
Resorption patterns in the
edentulous patients*
*From Zarb et al, 1983
36. Mandible – Prime Support Areas
Retromolar pad
Buccal shelf
Alveolar process
*Of the above, the alveolar process is most affected by the process of bone resorption
37. Retromolar Pad
One constant, relatively unchanging structure on the mandibular
denture bearing surface is the retromolar pad (dotted line).
The pad contains glandular tissue, loose areolar connective tissue,the lower margin of
the pterygomandibular raphe, fibers of the buccinator, and superior constrictor and fibers
of the temporal tendon. The bone beneath does not resorb secondary to the pressure
associated with denture use. It is one of the primary support areas.
38. Buccal Shelf
Masseter
groove
Boundaries of the buccal
area
shelf: The external oblique
line and the crest of the
alveolar ridge (area within
the dotted lines).
Buccinator
limits the
extension in
this area
The buccal shelf is a prime support area because it is parallel to the occlusal
plane and the bone is very dense. It is relatively resistant to resorption.
39. Buccal Shelf
Buccal shelf area (area within the dotted lines). The greater the access to
the buccal shelf the more support there is available for the denture. Access
is determined by the attachment of the buccinator.
40. Patterns of Resorption - Mandible
Mandible – initially buccal lingual dimension of the alveolar
ridge is narrowed, compromising support (A, B, C).
A B
C
41. Patterns of Resorption - Mandible
E
D
But thereafter, the height is affected compromising
support,stability, and retention (D,E).
42. Patterns of Resorption - Mandible
Mylohyoid ridge Continued calcification of the
attachment of the mylohyoid muscle
leads to the development of a sharp
bony projection on the lingual surface.
The mucosa overlying this region is
poorly keratinized and prone to
perforation secondary to trauma from
complete dentures.
43. Pattern of Resorption - Maxilla
Labial plate
Following extraction,
resorption is from buccal-
labial towards the lingual.
Result: Some compromise of stability and support.
44. Patterns of Resorption - Maxilla
Continued resorption leads to loss of vertical height of the alveolus.
Result:
a. Significant compromise of stability of the denture.
b. Pseudo-class III jaw relation.
c. Secondary affect – compromised retention because of
compromised stability. Peripheral seal of the denture is more easily broken
because there is little resistance to lateral displacement of the denture
during function.
45. Combination Syndrome
It produces a very specific pattern of resorption of the maxilla.
It is caused by edentulous maxilla opposing dentate mandible where
anterior dentition has been retained and where the denture has not been
properly balanced.
Note steep anterior guidance. There are no contacts in working,
balancing or protrusive when the patient goes through the chewing cycle.
As a result, during the chewing cycle , the denture tips anteriorly,
compressing the mucoperiosteum of the premaxilla, leading to resorption
of the bone of the premaxillary area.
47. Mandible – Similar Phenomenon Observed
Resorption can be so severe as to require augmentation with bone grafts
in order to prevent pathologic fracture of the mandible.
48. Measures to Prevent or Slow Resorption
.
1. Well adapted and properly extended dentures with
properly designed and executed occlusion.
2. Retention of residual tooth roots in key locations.
3. Use of osseointegrated implants
Retained roots and osseointegrated implants are useful because they
absorb much of the occlusal load locally, thereby preventing compression
of the periosteum and in turn preventing resorption of the adjacent bone.
49. A Preventive Measures
Retained root tips (A) and
Osseointegrated implants
B (B, C)
The denture rests on the
implants or root tips.
Compression of the
C mucoperiosteum is minimized,
preventing resorption of the
underlying bone.
50. Preventive Measures
Note tissue bar connected to the implants
Bar facilitates retention, stability and
provides support in the anterior region.
51. Other Factors – Frenum Attachments
Frenum – Folds of mucus membrane containing fibrous
connective tissue (A) (arrows).
A B
Frenum are of little consequence. However, they may limit
denture extensions (B) (arrows) or make seal difficult to
maintain, and occasionally affect the retention of the maxillary
denture.
52. Other factors – Frenum attachments
Lingual frenum Mandibular frenum.
If they are prominent they
may affect denture
extensions, particularly
the lingual frenum
Buccal frenum
53. Floor of Mouth Posture and Tongue Position
A Floor of mouth posture and
tongue position (depth of
retromylohyoid space) affect
stability and retention.
Favorable anatomy as seen
B here (A, B,) permits
development of a longer
lingual flange.
Result: Improved stability and
retention of the mandibular denture
54. Favorable Floor of Mouth Posture
Impressions and dentures made for patients with
favorable floor of mouth posture and favorable
(anterior) tongue position. Note length of lingual
flange. Stability and retention are enhanced.
55. Unfavorable Floor of Mouth Posture and
Retruded Tongue Position
Patients with unfavorable floor of mouth posture and tongue
position (A, B). The tip of the tongue has lost its definition
and is retruded and the floor of the mouth is elevated.
A B
Result: Length of lingual flange of the denture will be limited, compromising
stability, retention and the ability of the patient to control the lower denture.
56. Determining Floor of Mouth Posture
Carefully examine the
retromylohyoid space to
determine the floor of mouth
57. Solutions - Retruded Tongue Position and
Unfavorable Floor of Mouth Contour.
1. Dentures retained with osseointegrated implants
Result:
a. Improved retention. Note denture snaps onto retention bar.
b. Improved stability (from the implants and the tissue bar).
c. Improved support (anteriorly).
d. Better control of the bolus (tongue no longer must position denture and control
the bolus simultaneously).
58. Solutions - Retruded Tongue Position and
Unfavorable Floor of Mouth Contour.
2. Skin graft vestibuloplasty
This surgical procedure
has been used to
overcome problems
Residual Skin grafted areas
keratinized
caused by a retruded attached mucosa
tongue position,
unfavorable floor of mouth
posture and a narrow
residual zone of
keratinized attached
tissue.
Muscle attachments in the floor of the mouth are lowered and the zone of attached
keratinized tissue is widened with the skin graft.
a.Result: Improved stability and retention of the denture because the
lingual flange is lengthened.
b.Result: Improved support, because the zone of attached keratinized
tissue is dramatically widened.
60. Posterior Palatine Salivary Glands
The presence of these
glands permit compression
of the tissues helping to
overcome poor adaptation of
Glandular tissue the denture in this area
secondary to shrinkage of
Posterior palatal the acrylic resin during
seal area processing. Peripheral seal
of the denture is thereby
maintained.
61. Posterior Palatine Salivary Glands
When making impressions this area of tissue is compressed, allowing us to
compensate for shrinkage of the acrylic resin during polymerization and
movement of the denture base during function.
Result: Tissue adaptation of the denture is maintained and therefore peripheral
seal and retention of the maxillary complete denture is maintained.
When these glands atrophy, the tissue become less compressible making
it more difficult to obtain and maintain peripheral seal.
62. Posterior Palatal Seal Area
Shrinkage of acrylic resin is also accounted for by
scoring the cast in the postdam area (arrow).
63. Salivary Flow and Retention
Low flow rates
• Difficult to achieve and maintain
peripheral seal of the maxillary
denture
• Compromised adhesion and
cohesion.
64. Saliva as a Lubricant
Low flow rates
• Primarily affects the mandibular denture
bearing surfaces.
• Results in more friction at the mucosa-
denture interface as the mandibular
denture slips and slides over the denture
bearing surface during function.
65. Neuromuscular Control
• Some patients have the ability to manipulate
their lower denture and control the bolus
simultaneously, regardless of the quality of the
design and construction of the denture.
• Many patients with good neuromuscular control
can overcome unfavorable bearing surface
contours and anatomy and chew efficiently with
their complete dentures and the converse is also
true.
66. Tissue Factors Affecting Support
Mandible: Maxilla:
• Retromolar pad • Amount of keratinized
• Alveolar ridge contours (the mucosa
broader the more support) • Alveolar ridge contours
• Amount of attached • Palatal shelf area and
keratinized mucosa (the contour
more present the better
the support)
• Buccal shelf area (the more
access and the greater
the surface area the
better the support
67. Tissue Factors Affecting Stability
Mandible: Maxilla:
• Alveolar ridge height • Alveolar ridge height
• Floor of mouth contour • Presence of well formed
(favorable vs. unfavorable) maxillary, moveable
• Tongue position denture bearing
(anterior vs. retruded) surface tissues
• Neuromuscular control tuberosities
• Presence of flabby, • Presence of flabby
moveable denture
bearing surface
tissues.
68. Tissue Factors Affecting Retention
Mandible: Maxilla:
• Shape of the palatal vault (peripheral
Primary Factors: seal)
• Tongue position • Drape of the soft palate - House
• Floor of mouth posture classification (peripheral seal)
• Neuromuscular control • Quality and quantity of saliva
(peripheral seal)
Secondary Factors • Compressibility of posterior palatal seal
• Peripheral seal area (peripheral seal)
• Adhesion • Presence of well shaped tuberosities
• Cohesion • Height of alveolar ridge (resistance to
lateral displacement)
74. Prognosis based upon:
• Bearing surface anatomy, tongue
position and floor of mouth posture
• Neuromuscular control
• Denture history
• Psychological classification
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