unkown complete denture-1 (Muhadharaty).pptx

Prosthodontics

1. بسم الله الرحمن الرحيم

2. The Steps for dealing with completely edentulous patient in dental clinic. Complete Denture Diagnosis & Treatment Planning

3. Examination: is the investigation carried out for the purpose of diagnosis. Diagnosis : is the scientific evaluation of the existing condition. Prognosis: denture prognosis is a judgment or opinion of the prospects for success or otherwise in the fabrication and usefulness of the dentures. Treatment plan: The sequence of procedures planned for the treatment of a patient following diagnosis.

4. History and Examination Personal data Patient name Age/ Gender Address/ phone number Occupation

5. Dental History History of tooth loss: cause, Tim e, Edentulous period Reasons for loss of teeth: Periodontal disease Caries of teeth Other causes

6. Previous denture experience Reasons why patient needs new denture Examination of an Old Denture Wearer Esthetics, lip fullness, symmetry, amount of display during smiling, phonetics, teeth position, size, excessive wear Fracture, cracks, porosity, denture hygiene Occlusal vertical dimension (due to excessive occlusal wear, OVD may have reduced)

7. Beware of Patients Who Have A “Bag of Dentures” *

8. Reduced vertical dimension

9. Systemic Status Medical History 1.Arthritis 2.Diabetes 3. Anaemia 4.Radiotherapy 5.Neuromuscular disorder 6. Cardiovascular Disease.

10. Psychological Evaluation (House Classification of Denture Patients) Philosophical patient : well motivated, cooperative, calm , has the best mental attitude for accepting the denture& accept treatment with denture without question. Exacting (critical):dissatisfied with past treatment and do not accept advice , the are of demanding type. They need to be explained about details of treatment procedures .because of his poor education the dentist must re-educate him with firm control.

11. Hysterical patients: these patient have a negative attitude , emotionally unsteady, apprehensive and excited and will show unnecessary fear for dental service . prognosis of denture is unfavorable so additional confidence is mandatory to such patient and need psychiatric treatment. Indifferent patient: these patients show least concern with his dentist , not follow instructions , they often go without dentures for years. they have no desire to wear dentures. those patients have unfavorable prognosis.

12. Extra-oral Examination Face Form: Square Tapering Ovoid

13. Face Profile Normal Retrognathic prognathic

14. . Symmetry: Symmetrical/asymmetrical . Facial height: Decreased/normal/increased . Facial muscle tone: Normal/flabby/spastic . Color of hair: Black/brown/grey/white . Color of eyes: Black/brown/white/grey

15. Lips Length : short /average/ long Thickness: thin/average/ thick Smile line: Lip smile line Normal smile line High smile line

16. Extraoral Examination TMJ examination Palpation of the head & neck (lymph nodes & muscles)

17. Intraoral Examination Cheeks, tongue, floor of the mouth (FOM), maxillary tuberosity , hard palate, soft palate, arch relationship, residual ridge form, saliva, undercuts

18. Arch Form: U - shaped/ V- shaped

19. Residual Alveolar Ridge (Cross Sectional form) High well rounded Low well rounded Knife-edge Flat Depressed

20. Residual ridge relation Normognathic : Class I Retrognathic : Class II Prognathic : Class III

21. Interarch distance: 1. Adequate: Normal-16 mm-20 mm 2. Inadequate: It will cause mechanical interference leading to biological damage. 3. Excessive : it may be due to increased resorption of residual alveolar ridge. It results in increased leverage arm which implies damaging force on the support.

22. Undercut The favorable undercuts should be detected that aid in retention and the unfavorable undercuts should be planned for surgical correction.

23. Bony irregularities location: The irregularity should be palpated and the blanching of tissue over it is examined. Radiographic examination will be an Additional aid in differentiating the irregularities caused by bone and any residual tooth structure. Surgical correction should precede any prosthodontic treatment. . Retained root pieces: It can be confirmed by radiographic examination followed by surgical removal .

24. Mucosa attached / non-attached Colour Resilient: Ideal requirement . Hard/Unyielding: Unequilibrium of support . Inflamed: Very fragile . Hyperplastic /Displaceable: surgical treatment for elimination of hyperplastic tissue

25. Vault of the palate 'V' shaped or 'U' shaped. It could be either high vault or flat vault. The 'U' shaped palate is suitable in reference to retention and siability while the ' V'shaped palate causes deflective forces

26. Junction of hard and soft palate

27. Maxilla Tuberosity If enlarged with fibrous tissue surgical reduction to make room for dentures

28. Maxillary Tuberosity Palpate for undercuts - if extreme , denture might not seat

29. Saliva: Quantity Quality Scanty Serous/thin Abundant Mucous/thick Normal Mixed Amount : Normal: ideal for denture retention Excessive: make denture construction messy Reduced: reduced retention and increased soreness; salivary substitutes may be prescribed Consistency: Thin serous: provides an insufficient film for denture retention. Thick mucus: thick ropy saliva tends to displace denture.

30. Tongue Size Normal Large Frenal attachment : Maxillary/ mandibular 1. Normal 2. Close to the crest 3. Broad

31. Anatomical Landmarks of the Maxillary arch and Mandibular arch

32. Anatomical Landmarks of the Maxillary arch Palate Hard palate Soft palate Alveolar process Maxillary Tuberosity Incisive papilla Hamular notch Incisive papilla Rugae area Midpalatine raphe Labial Frenum Buccal Frenum

33. Maxilla Alveolar process The alveolar process is a process of the maxilla Alveolar ridge is the remnant of the alveolar process which originally contained sockets of natural teeth.after the natural teeth are extracted , the alveolar ridge is expected to resorb .

34. Maxillary Tuberosity :It is the most distal posterior portion of the maxillary alveolar ridge. Hamular notch : is a deep depression located posterior to the maxillary tuberosity . Hamular notches Over extension - extreme pain Under extension - non-retentive Must be captured in impression

35. Incisive papilla The incisive foramen is located in the midline of the hard palate immediately behind the central incisors. There is a definite prominence in the oral mucosa over the incisive foramen is called the incisive papilla. The papilla is a guide for determining the midline relationship of upper anterior teeth.

36. Rugae : are irregular ridges of fibrous tissue in the anterior one-third of the hard palate. Significances . It is concerned with phonetics. . It increases the surface area of the foundation and thus, supplements the values of retention. . It is denture-stabilizing area in the maxillary foundation Vibrating line: a line between the hard and soft palate ,this line falls between the two hamular notches. Fovea Palatinae : the two fovea are located on either side of the midline near the vibrating line.

37. Midpalatine Raphe or Median Raphe It is an area extending from the incisive papilla to the distal end of the hard palate along the sutural joint. Significance .The area of sutural joint is covered by firmly adherent mucous membrane to the underlying bone with little submucosal tissue. There is, therefore, no resiliency in this region and stress cannot be applied in this region. This is a stress relief area in the maxillary Edentulous foundation and consideration is needed for stability of maxillary denture.

38. Maxillary Labial Frenum ' Appears as a fold of mucous membrane extending from the mucous lining of the lip to/ towards the crest of the residual alveolar ridge on the labial surface. Clinical considerations . Sufficient allowance should be created during final impression procedure and in the completed prosthesis because over riding the function of the frenum will cause pain and dislodgement of the denture. . During the impression making procedure, the lip should be stretched horizontally outwards for the proper recording of the frenum .

39. Maxillary Labial Vestibule It extends on either side of the midline from labial frenum anteriorly to the buccal frenum posteriorly . It is bounded laterally by the labial mucosa and medially by the maxillary residual alveolar ridge. Reflection of the mucous membrane superiorly marks the height Clinical consideration: For effective border contact between denture and tissue, the vestibule should be suitably filled with impression material.

40. Maxillary Buccal Frenum Appears as a single fold or multiple folds of mucous membrane reflection area to or towards the slope or crest of residual alveolar ridge. Clinical significance . During final impression procedure and in the final Prosthesis, sufficient allowance should be created for the movement of frenum because over riding the function of the frenum will cause pain and dislodgement of the denture. . During the impression procedure, the cheek should be reflected laterally and posteriorly

41. Buccal Vestibule It is bounded anteriorly by the buccal frenum , laterally by the buccal mucosa and medially by the residual Alveolar ridge. CIinic al consideartions During the impression procedure the vestibule should be suitably filled with impression material for proper border contact between denture and the tissue. . When the denture flange properly occupies the Vestibular space that is distal and lateral to the alveolar Tubercules the stability and retention of the maxillary denture is greatly enhanced

42. Anatomical Landmarks of Mandibular arch The Residual Alveolar Ridge The support for the lower denture is provided by the mandibular residual alveolar ridge and the soft tissue covering it. Buccal Shelf Area Significance :It is the primary stress bearing area in the mandibular foundation

43. Mandibular Labial Frenum It is the fold of mucous membrane extending from the mucous lining of the mucous membrane of the lips towards the crest of the residual alveolar ridge on the labial surface. Clinical considerations . During the impression procedure, the lip has to be reflected anteriorly and horizontally. . During impression procedure and in final prosthesis allowance should be made in the form of a notch to prevent over-riding of function, which may result in laceration of the tissue

44. Mandibular Labial Vestibule It is bounded anteriorly by the labial frenum , posteriorly by the buccal frenum , laterally by the labial mucosa and medially by residual alveolar ridge. Clinical considerations: For effective border contact between the denture and tissue, the vestibule should be suitably filled with impression material during the impression procedure.

45. Mandibular Buccal Frenum It is the fold of mucous membrane extending from the mucous membrane of the buccal mucosa to / towards the crest of the residual alveolar ridge on the buccal surface. It may be single or multiple.

46. Mandibular Buccal Vestibule It is bounded anteriorly by the buccal frenum , posteriorly by the massetric notch area, medially by residual alveolar ridge and laterally by buccal mucosa. Clinical consideration This space constitutes an area be suitably filled by impression material during impression procedure .

47. Masseteric Notch Area Ii is immediately lateral to the retromolar pad and continues anteriorly to buccal vestibular sulcus . Significance: It is an area where the masseter muscle in function (anterior fibers) may push against the distal part of the buccinator muscle Clinical consideration . It is due to the contraction of the masseter that a depression is formed at the distobuccal corner of the retromolar area.

48. Mandible Retromolar Pad It is a pear shaped body at the distal end of the residual alveolar ridge. It is also known as the retromolar triangle. Significance . Represents distal limit of the mandibular denture. . It has muscular and tendenous elements lying underneath

49. Retromolar Pad CIinical considerations . Helps in maintaining the occlusal plane. . Divide the retromolar pad into anterior 2l3rd and posterior 1/3rd . Posterior height of occlusal rims should not cross the anterior 2l3rd Teeth should not be placed on the retromolar pad because of its inclined plane, which will act as a dislodging factor with the forces being inclined anteriorly.

50. Mandibular Lingual Frenum CIinical consideration . Sufficient allowance should be given in the impression and the final denture to prevent over-riding of function of the frenum . . During impression procedure, the patient should touch the tip of the tongue to the incisive papilla region

51. Sublingual Crescent Area The anterior portion of the lingual sulcus is commonly called the sublingual crescent area. It is the part of the floor of the mouth‘ covering the sublingual gland Significance: It has specialized innervations. Clinical consideration: Over extension of the denture in this area causes burning sensation

52. Mandible External Oblique Ridge Do not extend dentures to this ridge

53. Mandible Mylohyoid Ridge Origin of mylohyoid muscle which influences length of lingual flange Can be prominent, and/or sharp, requiring relief

54. Mandible Lingual Tori Raised bony structures May require relief when covered by a denture Thin mucosa can ulcerate easily

55. Thank You