complete denture diagnosis & treatment planning this presentation includes images and text from...

Complete DentureComplete DentureDiagnosis & Treatment Planning Diagnosis & Treatment Planning Complete DentureComplete DentureDiagnosis & Treatment Planning Diagnosis & Treatment Planning

This presentation includes images and text from the UCLA/APC/Ivoclar Educational Curriculum

Medical HistoryMedical History Medical HistoryMedical History

Be efficient - don't need extensive history of Be efficient - don't need extensive history of relativesrelatives

Follow-up significant responsesFollow-up significant responses Note systemic conditions that impact on therapy Note systemic conditions that impact on therapy

(e.g. angina, hepatitis, Sjogren's syndrome)(e.g. angina, hepatitis, Sjogren's syndrome)

Be efficient - don't need extensive history of Be efficient - don't need extensive history of relativesrelatives

Follow-up significant responsesFollow-up significant responses Note systemic conditions that impact on therapy Note systemic conditions that impact on therapy

(e.g. angina, hepatitis, Sjogren's syndrome)(e.g. angina, hepatitis, Sjogren's syndrome)

Medical HistoryMedical History Medical HistoryMedical History

Obtain physician consultationsObtain physician consultations If some debilitating disease If some debilitating disease

– discuss with instructor discuss with instructor – to ensure acceptabilityto ensure acceptability

Obtain physician consultationsObtain physician consultations If some debilitating disease If some debilitating disease

– discuss with instructor discuss with instructor – to ensure acceptabilityto ensure acceptability

Dental HistoryDental HistoryDental HistoryDental History

How many dentures?How many dentures? How long worn?How long worn? Age of present set?Age of present set? Satisfaction with dentures?Satisfaction with dentures? Things patient likes - what they want Things patient likes - what they want

changedchanged

How many dentures?How many dentures? How long worn?How long worn? Age of present set?Age of present set? Satisfaction with dentures?Satisfaction with dentures? Things patient likes - what they want Things patient likes - what they want

changedchanged

Clinical Exam Clinical Exam Clinical Exam Clinical Exam

Routine clinical examRoutine clinical exam Routine clinical examRoutine clinical exam

Intraoral Exam Intraoral Exam Intraoral Exam Intraoral Exam

Examine one arch at a time Examine one arch at a time – Look, then writeLook, then write

Examine one arch at a time Examine one arch at a time – Look, then writeLook, then write

Intraoral ExamIntraoral ExamIntraoral ExamIntraoral Exam

General tissue healthGeneral tissue health– Mucosa Mucosa

• attached / non-attachedattached / non-attached– ColourColour– CharacterCharacter– DisplaceabilityDisplaceability

General tissue healthGeneral tissue health– Mucosa Mucosa

• attached / non-attachedattached / non-attached– ColourColour– CharacterCharacter– DisplaceabilityDisplaceability


Specific Anatomical considerations Specific Anatomical considerations – Examine systematicallyExamine systematically– Note significance Note significance

of findings to therapyof findings to therapy– Visual and tactile examVisual and tactile exam

Specific Anatomical considerations Specific Anatomical considerations – Examine systematicallyExamine systematically– Note significance Note significance

of findings to therapyof findings to therapy– Visual and tactile examVisual and tactile exam


MaxillaMaxilla– Form of maxillary arch affects Form of maxillary arch affects

retention retention – Advise the patient if retention will Advise the patient if retention will

be compromisedbe compromised

MaxillaMaxilla– Form of maxillary arch affects Form of maxillary arch affects

retention retention – Advise the patient if retention will Advise the patient if retention will

be compromisedbe compromised

MaxillaMaxillaMaxillaMaxilla

Posterior border of denture:Posterior border of denture:– Hamular notches Hamular notches

• Posterior denture border Posterior denture border • PalpatePalpate• Visually deceiving Visually deceiving


• Posterior denture border Posterior denture border • PalpatePalpate• Visually deceiving Visually deceiving



• Over extension - extreme painOver extension - extreme pain• Under extension - non-retentiveUnder extension - non-retentive• Must be captured in impressionMust be captured in impression


• Over extension - extreme painOver extension - extreme pain• Under extension - non-retentiveUnder extension - non-retentive• Must be captured in impressionMust be captured in impression


Posterior border of denturePosterior border of denture– Vibrating line Vibrating line

• Identified when patient says "ah"Identified when patient says "ah"• Junction of movable & non-Junction of movable & non-

movable movable soft palatesoft palate


• Identified when patient says "ah"Identified when patient says "ah"• Junction of movable & non-Junction of movable & non-

movable movable soft palatesoft palate



• If terminate on: If terminate on: – movable portion - displacementmovable portion - displacement– hard palate - no retentionhard palate - no retention


• If terminate on: If terminate on: – movable portion - displacementmovable portion - displacement– hard palate - no retentionhard palate - no retention


Vibrating lineVibrating line• Fovea - close to Fovea - close to

vibrating linevibrating line• Throat form can affect Throat form can affect

widthwidth

Vibrating lineVibrating line• Fovea - close to Fovea - close to

vibrating linevibrating line• Throat form can affect Throat form can affect

widthwidth

Palatal Throat FormPalatal Throat FormPalatal Throat FormPalatal Throat Form

IIII

IIIIIIIIIIIIIIIIIIII


• Flatter the soft palate, the broader the area of the vibrating line

• Flatter the soft palate, the broader the area of the vibrating line


Posterior border of denture:Posterior border of denture:– Pterygomandibular raphe Pterygomandibular raphe

• Behind hamular notches - Behind hamular notches - significant when prominentsignificant when prominent

• Have patient open wide as Have patient open wide as possiblepossible

• Can displace denture – Can displace denture – requires relief in extreme casesrequires relief in extreme cases

Posterior border of denture:Posterior border of denture:– Pterygomandibular raphe Pterygomandibular raphe

• Behind hamular notches - Behind hamular notches - significant when prominentsignificant when prominent

• Have patient open wide as Have patient open wide as possiblepossible

• Can displace denture – Can displace denture – requires relief in extreme casesrequires relief in extreme cases

GlandularGlandular tissuetissueGlandularGlandular tissuetissue

Posterior palatal sealPosterior palatal sealPosterior palatal sealPosterior palatal seal

Posterior palatine salivary glandsPosterior palatine salivary glands• Permits compression of tissues Permits compression of tissues • Improves adaptation of denture to Improves adaptation of denture to

compensate for shrinkage of resincompensate for shrinkage of resin

Posterior palatine salivary glandsPosterior palatine salivary glands• Permits compression of tissues Permits compression of tissues • Improves adaptation of denture to Improves adaptation of denture to

compensate for shrinkage of resincompensate for shrinkage of resin

Posterior Palatal SealPosterior Palatal Seal


Tuberosity Tuberosity – DisplaceabilityDisplaceability– Palpate for Palpate for

undercuts - if undercuts - if extreme, denture extreme, denture might not seatmight not seat

Tuberosity Tuberosity – DisplaceabilityDisplaceability– Palpate for Palpate for

undercuts - if undercuts - if extreme, denture extreme, denture might not seatmight not seat


TuberosityTuberosity – If enlarged with fibrous If enlarged with fibrous

tissue tissue • surgical reduction to surgical reduction to

make room for denturesmake room for dentures

TuberosityTuberosity – If enlarged with fibrous If enlarged with fibrous

tissue tissue • surgical reduction to surgical reduction to

make room for denturesmake room for dentures


Ridge formRidge form– U-shape bestU-shape best– Non-moveable bestNon-moveable best– Advise patient if poorAdvise patient if poor– Affects:Affects:

• retentionretention• stabilitystability

Ridge formRidge form– U-shape bestU-shape best– Non-moveable bestNon-moveable best– Advise patient if poorAdvise patient if poor– Affects:Affects:

• retentionretention• stabilitystability


Labial/Buccal vestibule Labial/Buccal vestibule – 2-4 mm width2-4 mm width– Zygomatic processZygomatic process

• can be prominentcan be prominent

Labial/Buccal vestibule Labial/Buccal vestibule – 2-4 mm width2-4 mm width– Zygomatic processZygomatic process

• can be prominentcan be prominent


Labial/Buccal vestibuleLabial/Buccal vestibule – Flat ridges Flat ridges

• maximize retention by maximize retention by accurately registering accurately registering the vestibulethe vestibule

Labial/Buccal vestibuleLabial/Buccal vestibule – Flat ridges Flat ridges

• maximize retention by maximize retention by accurately registering accurately registering the vestibulethe vestibule


Frena - check prominence:Frena - check prominence:– Buccal frenum Buccal frenum

• Usually broaderUsually broader– Thin labial frenumThin labial frenum

Frena - check prominence:Frena - check prominence:– Buccal frenum Buccal frenum

• Usually broaderUsually broader– Thin labial frenumThin labial frenum

Maxilla: Maxilla: MidlineMidlineMaxilla: Maxilla: MidlineMidline

Tori Tori Mid palatal sutureMid palatal suture

– Eliminate binding or Eliminate binding or fulcrumingfulcruming

– Discomfort, loss of Discomfort, loss of retention and possible retention and possible fracture of the denturefracture of the denture

Tori Tori Mid palatal sutureMid palatal suture

– Eliminate binding or Eliminate binding or fulcrumingfulcruming

– Discomfort, loss of Discomfort, loss of retention and possible retention and possible fracture of the denturefracture of the denture

Mandibular Support AreasMandibular Support AreasMandibular Support AreasMandibular Support Areas

Retromolar PadRetromolar PadRetromolar PadRetromolar Pad Alveolar ProcessAlveolar ProcessAlveolar ProcessAlveolar Process Buccal ShelfBuccal Shelf Buccal ShelfBuccal Shelf

Mandible Mandible Mandible Mandible

Ridge form more criticalRidge form more critical– Less surface area for Less surface area for

retentionretention– Moveable tongue & floor Moveable tongue & floor – Displacement if denture is Displacement if denture is

overextendedoverextended• Inform patientsInform patients

Ridge form more criticalRidge form more critical– Less surface area for Less surface area for

retentionretention– Moveable tongue & floor Moveable tongue & floor – Displacement if denture is Displacement if denture is

overextendedoverextended• Inform patientsInform patients

MandibleMandibleMandibleMandible

Retromolar pad Retromolar pad – Terminal border of the Terminal border of the

denture basedenture base– Compressible soft tissue Compressible soft tissue

• Comfort Comfort • Peripheral sealPeripheral seal

– Must be captured in Must be captured in impressionimpression

Retromolar pad Retromolar pad – Terminal border of the Terminal border of the

denture basedenture base– Compressible soft tissue Compressible soft tissue

• Comfort Comfort • Peripheral sealPeripheral seal

– Must be captured in Must be captured in impressionimpression


Buccal shelfBuccal shelf– Custom tray, border Custom tray, border

molded - should not molded - should not feel edge extraorallyfeel edge extraorally

– External oblique ridge External oblique ridge • do not cover do not cover • Alginate will almost Alginate will almost

always overextend always overextend • PPainfulainful

Buccal shelfBuccal shelf– Custom tray, border Custom tray, border

molded - should not molded - should not feel edge extraorallyfeel edge extraorally

– External oblique ridge External oblique ridge • do not cover do not cover • Alginate will almost Alginate will almost

always overextend always overextend • PPainfulainful


Labial/Buccal Labial/Buccal vestibule vestibule – Easy to overextendEasy to overextend– Check with minimal Check with minimal

manipulation of lipsmanipulation of lips

Labial/Buccal Labial/Buccal vestibule vestibule – Easy to overextendEasy to overextend– Check with minimal Check with minimal

manipulation of lipsmanipulation of lips


Masseter Masseter – affects distobuccal borderaffects distobuccal border– if more prominent - if more prominent -

concave border of dentureconcave border of denture

Masseter Masseter – affects distobuccal borderaffects distobuccal border– if more prominent - if more prominent -

concave border of dentureconcave border of denture


FrenaFrena– Labial and buccal frena Labial and buccal frena

• Narrow & wide respectivelyNarrow & wide respectively– Lingual frenum Lingual frenum

• Must allow for movement - or Must allow for movement - or displaces easilydisplaces easily

FrenaFrena– Labial and buccal frena Labial and buccal frena

• Narrow & wide respectivelyNarrow & wide respectively– Lingual frenum Lingual frenum

• Must allow for movement - or Must allow for movement - or displaces easilydisplaces easily

Buccal frenumBuccal frenum

LingualLingual frenumfrenum


Retromylohyoid fossa Retromylohyoid fossa – Need to captureNeed to capture– Especially with severely resorbed ridgeEspecially with severely resorbed ridge

Retromylohyoid fossa Retromylohyoid fossa – Need to captureNeed to capture– Especially with severely resorbed ridgeEspecially with severely resorbed ridge

Lateral Throat FormLateral Throat FormLateral Throat FormLateral Throat Form

Class Class IIIIII

Class IClass IClass IIClass II

MandibleMandibleMandibleMandible Mylohyoid RidgeMylohyoid Ridge

– PalpatePalpate • If prominent, may need reliefIf prominent, may need relief

Mylohyoid muscleMylohyoid muscle • Raises floor of mouth Raises floor of mouth • Differences between rest and Differences between rest and

activityactivity• Affects length of flangesAffects length of flanges

Mylohyoid RidgeMylohyoid Ridge – PalpatePalpate

• If prominent, may need reliefIf prominent, may need relief

Mylohyoid muscleMylohyoid muscle • Raises floor of mouth Raises floor of mouth • Differences between rest and Differences between rest and

activityactivity• Affects length of flangesAffects length of flanges

Mucosa in this region is poorly Mucosa in this region is poorly keratinized and prone to traumakeratinized and prone to traumaMucosa in this region is poorly Mucosa in this region is poorly keratinized and prone to traumakeratinized and prone to trauma

Mylohyoid ridgeMylohyoid ridgeMylohyoid ridgeMylohyoid ridge

Mylohyoid ridge can cause ulcers if it is a Mylohyoid ridge can cause ulcers if it is a sharpsharp

Mylohyoid ridge can cause ulcers if it is a Mylohyoid ridge can cause ulcers if it is a sharpsharp

Residual Ridge Resorption (RRR)Residual Ridge Resorption (RRR)


ToriTori– Rarely need surgery unless largeRarely need surgery unless large– May require relief once dentures May require relief once dentures

are delivered - advise patientare delivered - advise patient

ToriTori– Rarely need surgery unless largeRarely need surgery unless large– May require relief once dentures May require relief once dentures

are delivered - advise patientare delivered - advise patient


Genial tuberclesGenial tubercles– Bony insertion for the Bony insertion for the

genioglossus musclegenioglossus muscle– May be projecting May be projecting

above the residual above the residual ridge if there has been ridge if there has been severe resorptionsevere resorption

Genial tuberclesGenial tubercles– Bony insertion for the Bony insertion for the

genioglossus musclegenioglossus muscle– May be projecting May be projecting

above the residual above the residual ridge if there has been ridge if there has been severe resorptionsevere resorption

SummarySummarySummarySummary

Anatomy:Anatomy:– Affects complete denture Affects complete denture

retention & stabilityretention & stability– Should be captured in Should be captured in

preliminary & final impressions preliminary & final impressions – If poor, advise patientIf poor, advise patient– Exercise todayExercise today

Anatomy:Anatomy:– Affects complete denture Affects complete denture

retention & stabilityretention & stability– Should be captured in Should be captured in

preliminary & final impressions preliminary & final impressions – If poor, advise patientIf poor, advise patient– Exercise todayExercise today

complete denture diagnosis & treatment planning this presentation includes images and text from...

Documents

vibrating line slide

retention slide

width slide

acceptability slide

impression slide

tactile exam slide

vibrating line throat

sjogrens syndrome slide