Title Clinical (Prosthodontics).pdf ✅

www.purebasic.com.bd | Dr. Sarwer Biplob Clinical Note 2020 | Prosthodontics | Pure Basic 1 Pure Basic Clinical Note 2020 Prosthodontics For FCPS Part-1, MS & DDS Admission Preparation Dr. Sarwer Biplob BDS. FCPS (ii). MS (Course) Oral & Maxillofacial Surgery Medical Officer Faculty of Dentistry, BSMMU Founder, Pure Basic www.purebasic.com.bd 0163 888 5050
www.purebasic.com.bd | Dr. Sarwer Biplob Clinical Note 2020 | Prosthodontics | Pure Basic 2 PROSTHODONTICS The various parts of a complete denture are: • Denture base. • Denture flange. • Denture border. • Denture teeth. Surfaces of a complete denture (1) Impression surface (2) Polished surface (3) Occlusal surface Anatomic teeth have a 33° cusp angle Non-anatomic or 0° or cusp less Teeth. Semi-anatomic Teeth: have cusp angles ranging between 0 degree and 30 degree. The cusp angles are usually around 20 degrees. They are also called modified anatomic teeth. Condition of the mucosa House classified the condition of the mucosa as: Class I: Healthy mucosa. Normal uniform density of mucosal tissue (approximately 1 mm thick). Investing membrane is firm but not tense and forms the ideal cushion for the basal seat of the denture. Class II: Irritated mucosa. It can be of two types: a. Soft tissues have a thin investing membrane and are highly susceptible to irritation under pressure. b. Soft tissues have mucous membranes that are twice the normal thickness. ClassIII: Pathologic mucosa. Soft tissues have excessively thick investing membranesfilled with redundant tissues. This requires tissue treatment. Saliva: All major salivary gland orifices should be examined for patency. The viscosity of the saliva should be determined. Saliva can be classified as: Class I: Normal quality and quantity of saliva. Cohesive and adhesive properties are ideal. Class II: Excessive saliva. Contains much mucus. Class III: Xerostomia. Remaining saliva is mucinous. Thick ropy saliva alters the seat of the denture because of its tendency to accumulate between the tissue and the denture. Thin serous saliva does not produce such effects. Xerostomic patients show poor retention and excessive tissue irritation whereas excessive salivation complicates the clinical procedures. create problems during teeth setting.
www.purebasic.com.bd | Dr. Sarwer Biplob Clinical Note 2020 | Prosthodontics | Pure Basic 3 House classified arch form as: Class I: Square Class II: Tapering Class III: Ovoid. Square arch Tapering arch Oval arch There is another classification for ridge contour. According to that classification, the maxillary and mandibular ridges are classified separately. Classification of maxillary ridge contour: Class I: Square to gently rounded. Class II: Tapering or ‘V’ shaped. Class III: Flat. Classification of mandibular ridge contour: Class I: Inverted ‘U’ shaped (parallel walls, medium to tall ridge with broad ridgecrest Class II: Inverted ‘U’ shaped (short with flat crest) (Fig. 2.27). Class III: Unfavorable • Inverted ‘W’ . • Short inverted ‘V’ • Tall, thin inverted ‘V’ . • Undercut (results due to labioversion or linguoversion of the teeth . Classification of soft palates Class I: It is horizontal and demonstrates little muscular movement. In this case more tissue coverage is possible for posterior palatal seal . Class II: Soft palate makes a 45° angle to the hard palate. Tissue coverage for posterior palatal Class I soft palate (10°). Class II soft palate (45°) [class I or class—II soft palates are associated with a flat palatal vault] Class III: Soft palate makes a 70° angle to the hard palate. Class III soft palate (70°) class—III soft palate is commonly associated with a V-shaped palatal vault. Mouth Preparation for CD 1.Adjunctive Care :During the healing period adjunctive therapies like the tissue massage, use of mouthwashes, etc. should be carried out. For patients with normal tissues, 48-hour rest with frequent tissue massage is sufficient. The patient should be advised to stop wearing the existing dentures. Tissue- conditioning materials can be used to reline the existing dentures to reduce tissue inflammation. 2. Removal of Retained Dentition ,3. Correction of Hypermobile Ridge Tissue 4.Removal of Soft Tissue Interferences 5.Removal of Hypertrophic Maxillary Labial Frenum 6.Removal of A Hypertrophic Lingual Frenum 7.Correction of Prominent Buccal Frenum 8. Removal of Papillary Hyperplasia 9.Treatment of Epulis Fissuratum 10.Removal of Ridge Undercuts 11. Management of Prominent Mylohyoid and Internal Oblique Ridges 12.Reduction of Maxillary Tuberosity
www.purebasic.com.bd | Dr. Sarwer Biplob Clinical Note 2020 | Prosthodontics | Pure Basic 4 13. Treatment of Sharp Spiny Ridges :• These ridges usually occur in the lower anterior region due to resorption of the labial and lingual cortical plates. • Ridge augmentation can be done. Usually dentures with large flanges are constructed to avoid load on the crest of the ridge. • Meyer classified knife edge ridges into three types: • Saw-tooth • Razor-like • Ridge with discrete spiny projections. All three ridges have a sensitive mucosal lining. Care should be taken to protect the mucosa. Excision of Tori:• Indications for removal of maxillary tori: a. Interference of speech b. Loss of posterior palatal seal c. Poor denture stability. 14. Vestibuloplasty: It is a surgical procedure to increase the vestibular depth. It can be done using one of the following techniques:Mucosal Advancement ,Secondary Epithelialisation ,Epithelial Graft Vestibuloplasty. Purpose of Making a Diagnostic Cast A diagnostic cast can be used for the following purposes: • To measure the depth and extent of the undercuts. • To determine the path of insertion of the denture. • To identify and plan the treatment for interferences like tori. • To perform mock surgeries for maxillofacial prosthesis. • To determine the amount of preprosthetic surgery required. • To evaluate the size and contour of the arch. • To get an idea about retention and stability offered by the tissues. • To determine the need for additional retentive features like over denture abutments, implant abutments, etc. Impressions can be classified Depending on the theories of impression making: • Mucostatic or passive impression • Mucocompressive or functional impression. • Selective pressure impression. 2. Depending on the technique: • Open-mouth technique. • Closed-mouth technique. 3. Hand manipulation for functional movements (Dynamic impression): Border moulding. 4. Depending on the type of tray: • Stock tray impression. • Custom tray impression. 5. Depending on the purpose of the impression: • Diagnostic impression. • Primary impression. • Secondary impression.