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Complete Denture Diagnosis & Treatment Planning

Complete Denture Diagnosis & Treatment Planning. This presentation includes images and text from the UCLA/APC/ Ivoclar Educational Curriculum. Medical History. Be efficient - don't need extensive history of relatives Follow-up significant responses

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Complete Denture Diagnosis & Treatment Planning

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  1. Complete DentureDiagnosis & Treatment Planning This presentation includes images and text from the UCLA/APC/Ivoclar Educational Curriculum

  2. Medical History • Be efficient - don't need extensive history of relatives • Follow-up significant responses • Note systemic conditions that impact on therapy (e.g. angina, hepatitis, Sjogren's syndrome)

  3. Medical History • Obtain physician consultations • If some debilitating disease • discuss with instructor • to ensure acceptability

  4. Dental History • How many dentures? • How long worn? • Age of present set? • Satisfaction with dentures? • Things patient likes - what they want changed

  5. Clinical Exam • Routine clinical exam

  6. Intraoral Exam • Examine one arch at a time • Look, then write

  7. Intraoral Exam • General tissue health • Mucosa • attached / non-attached • Colour • Character • Displaceability

  8. Intraoral Exam • Specific Anatomical considerations • Examine systematically • Note significance of findings to therapy • Visual and tactile exam

  9. Intraoral Exam Maxilla • Form of maxillary arch affects retention • Advise the patient if retention will be compromised

  10. Maxilla • Posterior border of denture: • Hamular notches • Posterior denture border • Palpate • Visually deceiving

  11. Maxilla • Posterior border of denture: • Hamular notches • Over extension - extreme pain • Under extension - non-retentive • Must be captured in impression

  12. Maxilla • Posterior border of denture • Vibrating line • Identified when patient says "ah" • Junction of movable & non-movable soft palate

  13. Maxilla • Posterior border of denture • Vibrating line • If terminate on: • movable portion - displacement • hard palate - no retention

  14. Maxilla • Vibrating line • Fovea - close to vibrating line • Throat form can affect width

  15. Palatal Throat Form Maxilla I II III • Flatter the soft palate, the broader the area of the vibrating line

  16. Maxilla • Posterior border of denture: • Pterygomandibular raphe • Behind hamular notches - significant when prominent • Have patient open wide as possible • Can displace denture – requires relief in extreme cases

  17. Posterior Palatal Seal Glandulartissue • Posterior palatine salivary glands • Permits compression of tissues • Improves adaptation of denture to compensate for shrinkage of resin Posterior palatal seal

  18. Maxilla • Tuberosity • Displaceability • Palpate for undercuts - if extreme, denture might not seat

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

  20. Maxilla • Ridge form • U-shape best • Non-moveable best • Advise patient if poor • Affects: • retention • stability

  21. Maxilla • Labial/Buccal vestibule • 2-4 mm width • Zygomatic process • can be prominent

  22. Maxilla • Labial/Buccal vestibule • Flat ridges • maximize retention by accurately registering the vestibule

  23. Maxilla • Frena - check prominence: • Buccal frenum • Usually broader • Thin labial frenum

  24. Maxilla: Midline • Tori • Mid palatal suture • Eliminate binding or fulcruming • Discomfort, loss of retention and possible fracture of the denture

  25. Mandibular Support Areas Retromolar Pad Buccal Shelf Alveolar Process

  26. Mandible • Ridge form more critical • Less surface area for retention • Moveable tongue & floor • Displacement if denture is overextended • Inform patients

  27. Mandible • Retromolar pad • Terminal border of the denture base • Compressible soft tissue • Comfort • Peripheral seal • Must be captured in impression

  28. Mandible • Buccal shelf • Custom tray, border molded - should not feel edge extraorally • External oblique ridge • do not cover • Alginate will almost always overextend • Painful

  29. Mandible • Labial/Buccal vestibule • Easy to overextend • Check with minimal manipulation of lips

  30. Mandible • Masseter • affects distobuccal border • if more prominent - concave border of denture

  31. Mandible • Frena • Labial and buccal frena • Narrow & wide respectively • Lingual frenum • Must allow for movement - or displaces easily

  32. Lingualfrenum Buccal frenum

  33. Mandible • Retromylohyoid fossa • Need to capture • Especially with severely resorbed ridge

  34. Lateral Throat Form Class III Class II Class I

  35. Mandible • Mylohyoid Ridge • Palpate • If prominent, may need relief • Mylohyoid muscle • Raises floor of mouth • Differences between rest and activity • Affects length of flanges

  36. Residual Ridge Resorption (RRR) Mylohyoid ridge Mucosa in this region is poorly keratinized and prone to trauma Mylohyoid ridge can cause ulcers if it is a sharp

  37. Mandible • Tori • Rarely need surgery unless large • May require relief once dentures are delivered - advise patient

  38. Mandible • Genial tubercles • Bony insertion for the genioglossus muscle • May be projecting above the residual ridge if there has been severe resorption

  39. Summary • Anatomy: • Affects complete denture retention & stability • Should be captured in preliminary & final impressions • If poor, advise patient • Exercise today

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