*Golden- NBDE II- dentures/ RPD/ fixed prosth

Retentive Clasp

engages undercut below height of contour
(gingival 1/3 of crown within the undercut- SUPRAbuldge)
*NOT a base metal alloy

Reciprocal Clasp

passively touch above height of contour
(middle 1/3 of crown)

Requirement of major connector

Rigidity (support)

2 main purposes of MAJOR connector

Rigidity (support), stability

what does reciprocating arm of clasp do?

1. counteracts retentive clasp
2. stabilization
3. indirect retainer

function of a rest

prevent displacement (resist vertical tissue force) / support

purpose of indirect retainer

- prevents displacement of denture base
- on oposite side of fulcrum

most important in denture retention

peripheral seal

primary retention for max denture
(main stress bearing areas)

residual RIDGES / palate
secondary- rugae

primary retention for mand denture
(main stress bearing areas)

buccal shelf
secondary- anterior lingual border

best indicator for success of a denture

ridge

extends 1-2mm beyond vibrating line

max denture

covers 2/3 retromolar pad

mand denture

DB flange is determined by...

Masseter

most important in denture retention

peripheral seal

combination clasp

wrout wire (retentive) and cast wire (reciprocal) clasps

what connects the major connector w/ the rest seats

minnor connector

Class I and II - indirect retention?

yes

Class III and IV- indirect retention?

no

for bilateral distal extension use..

indirect retention (bc it is TISSUE supported)

post extension of PPS is...

2mm beyond vibrating line (fovea palatini)

3 things to determine PPS

1. throat form
2. tissue type
3. fovea location

PPS in max denture will compensate for

polymerization and cooling shrinkage

why place PPS?

compensates for shrinkage

excessive depth of PPS results in...

unseating of denture

if the palatal vault is too deep, what happens to vibrating line?

the vibrating line is more pronounced and forward (anterior)

the higher the palatal vault =

the more abrupt and forward the vibrating line
(gives a NARROWER PPS area)

when do you remove palatal tori?

when it prevents seating of the denture and formation of the posterior seal

removing palatal tori will do what for the future of the PPS?

increase seal

palatal tori should be removed when...

if posterior to vibrating line- interfere w/ PPS

major connector design for large inoperable palatal tori (extending to soft palate)?

horseshoe

reason for splint after palatal tori removal

helps prevent hematoma formation

hinge axis:

face-bow

what does the face bow do?

translates the relationship of the max to the terminal hinge axis using a 3rd point reference

purpose of the plaster index?

preserve facebow transfer (so you don't have to take it again)

reason for altered cast technique when doing a distal extension RPD?
(Kennedy I, II)

support

Sibilant Sound

allows max incisors to nearly touch mand incisors

Sibilant sound is altered w/....

altered VDO

Fricative sounds are made by...

allowing max incisors to nearly touch the slightly inverted lower lip

what can't the pt. say if the upper anterior teeth are too superior and forward for the denture?

F and V

what sound is used to evaluate VDO?

S

what will the S sound do when checking VDO?

will bring the teeth slightly together ~1-1.5mm of separation = the closest speaking space

if the denture wearer says 'S' and the post teeth are touching... this mean?

there is excessive Vertical DO

if the denture wearer says 'S' and the max and mand teeth barely touch... this means

decrease VDO

denture fabrication w/ excessive VDO results in...

trauma to supporting/ underlying soft tissue

increased VDO can result in...

clicking

decreased VDO can result in...

cheek biting

M sound
(EMMA)

brings mandible to its rest position

burning sensation of lower denture caused by?

impingement of mental nerve

denture base type that is NOT light cured?

resin type

why don't you set denture teeth on the incline up towards the retromolar pad?

it will dislodge the denture

why should mand molar not be placed over the ascending area of the mand?

the occlusal forces over the inclined ramus would dislodge the mandibular denture

you just deliver a CD, the pt. comes back w/ generalized soreness along the ridges (no sore spots, nothing visible clinically)... whats causing this?

significant malocclusion (hyper occlusion)
- how to fix... adjust occ

pt. has worn denture for 19 yrs, and now has a lesion under denture... what do you do?

relieve denture in area/ re-evaluate in 2 weeks... if doesn't go away then biopsy (incisional)

main reason for removing denture at night

relieve bone/ tissues

when tx planning RPD what is the 1st attachment placed on the surveyor?

analyzing RDP

when tx planning RPD whats the 1st thing you do..

mount casts

best way to evaluate available space for rests?

mounted casts

pt. has denture that has made tissue inflamed, before making a new denture what do you do...?

apply tissue conditioner to existing denture

at what apt. do you check for sibilant sounds?

when verifying VDO (intermaxillary records apt)

a lingual denture is good if...

you have full movement of the tongue

if teeth on wax try in don't occlude like they did on articulator, what do you do?

remount, reset, retry

what is an issue for denture pts?

mand dentures

retention of saliva is impacted by?

saliva flow

saliva & denture
(Retention - peripheral seal)

relationship that leads to denture and tissue adhesion

thin watery saliva

better and aids in adhesion

a lot of saliva...

is better for retention

disadvantage of reduced salivary flow...

reduced denture retention

physiologic rest movement

when mand and all supporting muscles are in resting posture
*muscle guided position

no posterior teeth and wear on anterior incisal edge... why?

bc no posterior teeth

pt. feel fullness of upper lip after denture delivery... why?

overextended labial flange

which position depends on pt. posture

VDR

decreased VDO =

increased interocclusal and freeway space

angular chelitis is caused by...

- decreased VDO (over closure) / increased interocclusal space
- fungal infection

pt. has short lower face and sagging lips.. cause?

decreased VDO

cheek biting w/ dentures is caused by..?

- insufficient VDO
- not enough horizontal overlap of posterior teeth

you fit a new denture and pt. complains of cheek biting... what do you do??

grind buccal of lower teeth

clicking of denture teeth... cause?

excessive VDO (= too little VDR and inadequate resting space)

exam of denture pt. reveals that retromolar pad contacts max tuberosity at the VDO... what do you do?

reduce max tuberosity surgically only

immediate denture has undercuts and tuberosity... what do you do?

reduce the maxillary tuberosity surgically only

in an edentulous pt. the coronoid process can...

limit the thickness of the denture flange in the maxillary buccal space

when taking impression and the pt. is open what can interfere with full seating?

coronoid

coronoid process can displace upper denture if:

too bulky at max DB

when mouth is open this can dislodge denture

coronoid (mand denture--> masseter)

open mouth while max border molding...

coronoid process will block buccal extension

best way to prevent speech problems in CD?

keep teeth in same position

need to increase VD by 4mm in denture pt, what do you do?

take a new CR and remount

the condylar guidance is increased from 20 to 45 degrees, what do you do?

increase compensating curve (and decrease incisal guidance)

when setting condylar inclination on articulator.. what do you do w/ the pin?

remove it (lift it up)

incisal guide pin posision why checking protrusive.. why?

determines condylar guidance

reason for incisive guide table?

anterior guidance (lift pin 2mm)

best way to preserve anterior guidance?

translating the horizontal and vertical relationships onto the incisal table

what plane is most important on anterior guidance?

horizontal/ occlusal

pt. w/ class III will have mand incisal angle.....

decreased

case: lower natural anterior teeth, upper PFM anterior teeth... why do lowers have incisal wear?

heavy incisal guidance

lower and upper teeth at edge to edge position...

incisal guidance position

when same pt. does anterior guidance.. TMJ??

TMJ Translates

CD try in, protrusive excursion results in separation of posterior teeth (denture dislodging)... how to correct?

increase compensating curve

reline for Kenney Class I (distal extension)... you must first make sure...?

try in framework and make sure it is seated!

in max CD opposing mand bilateral distal extension (kennedy I) why is the anterior of the wax rim beveled?

length is good esthetically but there is not enough interocclusal space (inter arch length) @ that length

pt. has occlusal rims prepared and bevels the max... why?

length of occ rim is adequate but VDO is wrong

how should distal extension RPD fit in comparison to other RPDs?

passive clasp fit

best way to treat a tooth supported lower denture?

use metal copings to cover teeth

retruded tongue habit w/ full denture means what?

difficulty swallowing

denture border sitting on what muscle due to its orientation of its fiber...

masseter

posterior buccal extension of a mand CD is limited by..

masseter

what muscle can you impinge on w/ denture?

masseter

what muscle covers denture flanges and does not affect stability?

buccinator

the denture base completely covers what muscle?

buccinator

which muscle will not interfere w/ the denture base?

lateral ptergyoid

lower denture impression lingual area muscle

mylohyoid

which muscle helps border mold in the posterior lingual flange?

mylohyoid

lingual flange on lower CD is around which muscle?

mylohyoid

lingual flanges are affected by?

mylohyoid

what muscles determine lingual border of mand impression?

mylohyoid/ superior pharyngeal constrictor/ palatoglossus/ genioglossus

border molding of the lingual mand portion is done by what movement?

wetting of lips w/ tongue

you would relieve a mand denture in the area of buccal frenum to allow which muscle to function properly?

orbicularis oris

pt. present w/ restricted floor of the mouth, only 6 mand ant teeth and diastema/... which major connector do you use?

lingual plate w/ interruption in the palate @ the diastemas

RPD rocks when you apply pressure on either side of fulcrum line.. why?

indirect retainer

RPD pops off when you press on 1 side... why?

inadequate indirect retainer

insufficient indirect retention on RPD occurs when what happens?

distal extensions lift away from mucosa

multiple failures in FPD.. why?

poor framework design

what mechanical property effects permanent composition for RPD clasps

yield strength

base metal used for?

long span bridges (FPDs)

why do you use canine for incisal rest?

esthetics/ surface area/ cingulum

why is a rest designed on lingual surface of canine preferred to using an incisor?

less leverage is exerted against the tooth by the lingual rest

how do you protect roots under an overdenture

RCT w/ cast copings

what is not important for over-denture

clinical crown size

which teeth roots to retain under over denture?

mand canine
(canine, PM, incisor, molar)

endocrine involvement that is related to jaw deformity

acromegaly

if acromegaly is not controlled...

lower jaw protrudes

a pt. w/ acromegaly needs dentures... which arch will not fit

mand

denture pt. w/ a big ball around canine and PM..

neurofibroma

after suverying and designing which is the first step to do?

reduction of the axial for proximal plate

which kennedy class is a direct retainer very important?

II

describes a denture w/ bilateral edentulous space anterior to natural teeth...

kennedy IV

which type of kennedy does not have a modification

IV

corrosion resistant/ prevents corrosion

chromiun

what is expected from a high nobel meal?

no corrosion

what RPD denture frame metal causes allergy?

nickel

RPD metal most likely to cause allergic rxn?

nickel

pt. w/ completely edentulous maxilla and partially edentulous mand w/ preserved ant teeth

kelly/ combination syndrome

symptoms of combination syndrome

- denture anterior teeth don't show
- flabby ant ridge
- flabby and enlarged tuberosities
- lower ants extruded above occ plane
- atrophy of lower post ridge
- decreased VDO

which is not a symptom of combo syndrome?

increased VDO

ultimate goal for making UCD and lower RPD for pt. w/ combo syndrome?

balanced occlusion on both anterior and posterior teeth of mouth during centric relation

a flabby max ant ridge under a complete denture is frequently associated w...

retained natural mand anteriors

trisomy 21

down syndrome

down syndrome high or low caries risk?

low

midfacial hypoplasia/ deficiency

down syndrome

down syndrome manifestations

- small maxillas
- mid face deficiency
- prognathic mand
- Class III profile
- thickened tongues (macroglossia)
- delayed eruption
- microdontia/ partial anodontia/ short conical roots
- do not have higher caries risk
- DO have higher perio risk

what orthomanifestation does Turner syndrome and trisomy 21 associate with?

short midface

hyper- telorism

eyes wide apart
(increased distance between eyes)

hyper- telorism is seen in?

Crouzon's disease/ cleidocranial dysplasia/ gorlin/ down syndrome

which does not result in delayed development?

Trisomy 18 (Edward Syndrome)

fetal alcohol syndrome

anecephaly (absence of major portion of brain)/ mid face deficiency/ cleft lip

what causes problems in babies in embyro?

teratogen

teratogen

anything that messes w/ the fetal development (cause deformity/ birth defects)

synchondrosis

epiphyseal plate

at what age does mandibular symphisis close

6-9 months

sphenooccipital synchondrosis closure... what kind of tissue fills it in?

cartilage

condyle

intersititial growth

which undergoes closure latest?

sphenooccipital

synostosis

abnormal fusion of bones

craniosynostosis

early closure of suture between bones

Crouzon Syndrome

* Synostosis (abnormal fusion of bones)
*mid- face deficiency (max hypoplasia)
* ocular proptosis (bulging of the eye anteriorly out of the orbit)
*Beaten metal skull

Hunter Syndrome

- lack of enzyme iduronate-2-sulfatase (I2S)
- enlarged tongue
- mental retardation

Hurler Syndrome

- buildup of mucopolysaccharides

hunter and hurler syndromes have what in common

mucopolysaccaridosis- build up of GAGs

Papillon-Lefevre Syndrome

- palmar/ plantar hyperkeratosis
- severe perio disease
- premature loss of primary and permanent --> edentulous
- see in young kids!

Pierre Robin Syndrome

- cleft palate
- glossoptosis (downward displacement/ retraction of tongue)
- absent gag reflex
- Mircognathia
*smaller than normal mandible--> tongue falls back in the throat --> difficulty breathing

sturge webber syndrome

*vascular malformation (eye and hemangioma)
*port wine stain

alveolar bone is open over root

fenestration

'hole' in the bone that exposes the root?

fenestration

the loss of buccal or lingual bone overlying a tooth root

dehiscence

characteristic oval

dehiscence

each of the following osseous defects would be classified as infra bony except
(trough, dehiscence, hemiseptum, interdental crater)

dehiscence

what is NOT an endocrine gland?
(parathyroid, thyroid, adrenal, parotid)

parotid

give a child Vit D or Ca for?

Hypoparathyroidism

Tachycardia and Hypertension

Thyrotoxocosis Shock
(Hyperthyrodism)

sweating (heat intolerance), weight loss, tachycardia, fine hair

hyperthyroidism

graves disease (exopthalmos)

hyperthyroid

thyroid storm

hyperthyroid

weight gain, bradycardia

hypothyroidism

increase in alkaline phosphatase (ALP)

hyperparathyroidism

decrease in alkaline phosphatase (ALP)

hypophosphatasia

CGCG is seen in ps. w/....

hyperparathyrosidm
Brown's Tumor

osteoporosis is associated w..?

hyperparathyrodism

drug for hyperthyroid, doesn't let iodine bond to horomone

Radiated Iodine

drug for hypothyroid

levothyroxine

pheochromocytoma involves..

thyroid

pt. has high cholesterol, high BP, diabetes, MBI of 36... what problem does he have?

metabolic syndrome

normal % of fat intake per day

30%

fenestration/ dehiscence

most likely cause of failure in the pre-ceramic soldering technique is...

overheating the parts to be joined together

do NOT use GI resin cement for all ceramic restoration....

EXPANSION due to water absorption could crack porcelain
*Zirconia is exception

casting shrinkage of cobalt-chromium allows...

2.2%

HIGH compressive strength + LOW tensile strength

brittle

- higher melting point, yield strength, hardness
- lower specific gravity

GOLD properties

cast gold onlays > cuspal coverage amalgams

have higher compressive strength and more precise inter proximal contacts

thinnest portion of wax pattern...

in deepest part of the ring
(*attach sprue to thickest area of crown)

increased H2O of gypsum =

more setting time, less expansion and strength

Flux (Borax)

displaces gases, dissolves corrosive products, removes oxides from metal surfaces

anti-flux

graphite

shrinkage porosity in a gold casting is associated w/..?

sprue diameter TOO THIN --> back pressure porosity --> will get rounded margins

casting ring liner

compensate for casting metal expansion (uniform investment expansion/setting)

#1 reason crown doesn't seat

proximal contact

most important area to have thickness of metal on FPD connector area

occluso-gingival

where are retentive grooves placed on crown prep

interproximal

post length..

2/3 to 3/4 root or length of crown

PFM

metal CTE slightly higher than porcelain

20-40?m

space for cement

most traumatic effect on abutment/ cantilever

the more posterior position of the tooth the more force on cantilever

where to split FPD

between pontic and retainer

male/female abutments placed...

DISTAL of pier abutment, prevents mesial drifting

wrought wire clasp

flexible
*used for perio involved teeth

RPD rocking on fulcrum line

problem w/ indirect retainer

RPD fit

Passive

where does clap fit

infrabuldge

rigidity

major connector

lingual bar ____mm

needs 8mm

intermediate abutments aka

pier abutments

The PDL surface area of abutment teeth should be equal to or greater than the imaginary PDL of the missing teeth

Ante's LAw

what is contraindicated in upper with Combination Syndrome?

Complete denture upper

excess cement can cause

peri-implantitis

what controls the setting rate in Alginate

Trisodium phosphate

CR measures the

condyles

orients maxillary cast to skull via external auditory meatus to stabilize the bow

Arbitrary Facebow

HCL is what

Horizontal Condylar Inclination
30 degrees

articulator where condyles are part of the lower member

ARCON

casts poured from alginate are more accurately mounted with

wax records

casts poured from elastomeric materials are more accurately mounted with

elastomeric materials
ZOE paste or PVS

posterior determinant of occlusion

Condylar Guidance

Anterior determinant of occlusion

Incisal Guidance

Anterior guidance =

Incisal guidance + canine guidance

mechanical incisal guide table gives insufficient information to reproduce the ____ of natural teeth

lingual contours of maxillary anterior teeth

color change between soft and hard palates

Butterfly Line

muscle attachment for Mandibular labial frenum

orbicularis oris

muscle attachments for upper and lower buccal frenums

- buccinator
- orbicularis oris

mandibular lingual frenum muscle attachment

genioglossus

muscle attachment for maxillary labial frenum

NONE

Retromolar Pad contains 4 attachments

1) Pterygomandibular Raphe
2) Buccinator
3) Superior Pharyngeal Constrictor
4) Temporalis

analogous to coronoid process

masseteric notch