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  • Testing Acrylic Dentures

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    Shany Schwarzwald
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    4. Testing Acrylic Dentures

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    21 views43 pages

    Testing Acrylic Dentures

    Uploaded by

    Shany Schwarzwald

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
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    IvV-VIl 2020-20121 Theme 4 Testing the partial removable acrylic denture (trial stage of treatment). Possible complications and methods of their removing. Clinical-laboratory stages of PRAD manufacturing: can vary depending on clinical situation. CLINICAL, — examination of the patient, diagnosis, plan of treatment, reprostivtic procedures (in case of necessity): teeth extraction, periodontal treatment, orthodontic realignment of abutmeat teeth, conservative and/or endodontic treatment of damaged teeth, getting impressions LABORATORY ~ manufacturing the models and wax bases with ‘occlusal rims CLINICAL — determining interjaws relationships LABORATORY - artificial teeth arrangement CLINICAL — trial stage of treatm: TABORATORY — final modelling the denture, gypsing in chiuvete, Preparation and introduction of acryl, polimerization, polishing the denture CLINICAL ~ final testing and imposing or insertion of the prosthesis in the oral cavity. Correction. Advises, The insertion stage of treatment or the try-in appointment is an important step in the fabricating process of partial removable denture. It is the stage that provide insertion of the denture on prosthetic field, confirm its fit and function, permit correction of occlusion, base and clasps position, shape and size and allows the patient to preview their new smile before it is finished. Using the information provided at the bite rim stage Try-in Verification/Aesthetic try-in Stages of trial denture probe a) testing the try-in denture on the model b) testing the try-in denture in the oral cavity The master cast Try-in appointment includes two stages 1, Extraoral examination of partial removable denture 1. Intra-oral examination of partial removable denture Extraoral examinatio! determination of possible technological errors and. inaccuracies in time of manufacturing the prosthesis and their removing (ell blemishes, traumatic features, metal part that could traumatise the oral tissues) pay attention to the thickness of the base, the quality of the surfaces, sharp edges and sagging plastic if there are defects caused by errors in the polymerization (porosity bass, "marble strip", the smell ofthe monomer) - prosthesis is subject to alteration correspondence of cole, size and shape of artificial teeth teeth clasps - their location, degree of fixation in the basis, the presence of sharp edges, ~ quality of artificial tecth arrangement, fixation ete. Qualitative determination of trial denture on the model fixed in simulator includes: ~ checking limits - checking possible present excess of wax and his removing - checking the colour, shape, size, quality of artificial teeth - arrangement of artificial teeth in the area of residual alveolar process = _ checking interdental contacts in ocludator or articulator with the help of articulation paper - checking position and correct manufacturing the clasps. To reduce the risk of cross-contamination The process of overlay (imposing) dentures can be divided into several stages = visual inspection of the prosthesis out of the mouth pay attention to the thickness of the base, the quality of the surfaces, sharp edges and sagging plastic ~ ifthere are defects caused by errors inthe polymerization basis, "marble strip", the smell of the monomer), the prosthesis is subject to alteration pay attention correspondence of color, size and shape of artificial teeth to natural teeth pay attention to clasps - their location, degree of fixation in the basis, the presence of sharp edges that need to be rouni After removing all detected deficiencies and disinfection of denture base -> impose the deture The reason of impossible introducing the denture on prosthetic bed can be: - imprecision profile of prosthesis margins - deformation of the basis - not qualitive preparation of trial denture. After visual detection of areas that not permit imposing the trial denture, their correction it should easily, effortlessly be input and output from the oral cavity, without balance, adhering tightly to natural teeth. Intra-oral examination - checking fit - checking extention, retention and stability - checking aesthetics - checking phonetic - checking the vertical component of the jaw relationship - checking the horizontal component of the jaw relationship etc. Intra-oral adaptation - using carbon paper that indicate the places that must be polished - correction of clusps (activation or dezactivation, their positioning in respectiv activ zone) - individualisation of occlusion - polishing inner surfaces for not to produce trauma of mucosa. Favorable anatomical conditions and factor of adhesion not completely solve all the problems of fixation of dentures that will require using mechanical devices, which are divided into direct and indirect. Direct retainers are located on the tooth and prevent vertical displacement of the prosthesis. In this group enter clasps, attachments. By location the retainers are divided into intracoronal and extracoronal. Intracoronal include some types of attachments, extracoronal - the clasps and attachment. Indirect retainers (continuous clasps, overlays, etc.) prevent overturning the prosthesis. Creating facial and functional harmony with anterior teeth a) When the muscles are correctly supported by a denture impulses coming to them from the CNS cause a shortening of the fibers that allows the face to move in a normal. manner b) Three factors affect the face in repositioning the arbicularis oris with removable denture: - the thickness of the labial flanges; - the anterioposterior position of the anterior teeth; - the amount of the separation between the mandible and the maxilla. When properly shaped dental arches and favorable vertical dimension Normal function of the facial muscle Normal facial expressions and proper tone of the skin If the patient has large undercuts present Checking the trial denture bases must be stable the borders of the trial denture base should be smooth, round and have no sharp edges the border should be shaped to conform to the depth and width of the sulci Correct choosing limits of denture with maximum using anatomical retention allows to provide good fixation and stability of the prosthesis and to increase efficiency of orthopedic treatment of partial absence of teeth. Essence of anatomical retention is in using anatomical structures on the upper and lower jaws, which can restrict the free movements of prosthesis during function of speech and cating. The well-preserved alveolar ridges of jaws, high vault of hard palate, maxillary tuberosities prevent horizontal displacement of prosthesis, increasing his stability. Maxillary alveolar processes prevent displacement of prosthesis forward. Denture base extension a) The labial and buecal extension: - Overextension will stretch the sulcus tissues and dislodge the denture immediate after its seating - Underextension leads to poor physical retention => usually is made a new final impression - Provision of the frena (labial and buccal) for adequate clearance b) Posterior extension - Should extend from the one hamular noth to the other along the vibrating line of the soft palate Retention and stability of trial-denture ‘When the mouth is opened the trail denture should stay in position. Requirements to clasps: 1. The dental segment should have close contact with tooth tissues, and his free end should be located in retention zone occupying not less then two third of mesio-distal part of vestibular surface. 2. The elastic segment should not be in contact with marginal periodontium of support tooth and should be located in above equatorial zone. 3. Fixing segment has specific retention form for fixing in the base of artificial removable denture. Refinement of the individual tooth positions ‘A) Maxillary central incisors ~ parallel to the profile line. Maxillary lateral incisors ~ cervically inwards. Maxillary canines — cervically outward B) Mandibular central incisors — cervically inward Mandibular lateral incisors — cervically outward Mandibular canine — cervically outward Spatulae test - for determinig the quality of contact of prosthesis’ base with the surface of prosthetic field (attempts to displace the wax composition with the top of spatullae by introducing it between the occlusal surfaces of lateral teeth of the both hemiarches while the pacient is keeping dental arches in maximum. contact). Control of fiziognomic aspect ~ colour, shape and size of artificial teeth ~ seg and placing of artificial teeth i others areas, and restoring dental are configuration + degree of visbility of incisors margin = smile line — = middle line Control of phonetic aspect is checked by pronouncing phoneme such as: T, D, F, V, §.S, L, K or the words with these phoneme. Their pronouncing d2pends on: - the height of artificial teeth, - their setting in the alveolar process, - its angle insertion in frontal area, ~ thickness and limits of denture base. If during pronunciation tae phoneme ,.T” is heard ,D” it means that the frontal artificial teeth are set too palatal, and on the contrary: if we hear,,D” instead of ,T” — the artificial frontal teeth are set too vestibular or the prosthesis base is too thick in the area of transversal palatal rugac. When ,,V” is similar to ,F” — the upper ‘frontal teeth are short, and if .F” is similar to .V"— they are long. Control of horizontal jonent ofjaw relationship Determination the quality of contacting and biting Clinical errors are most often arised in the determination of the centric relation jaw: ‘eam be caused by a number of reasons: bp eg ap Meena lyre feo real oe ‘defining the contre clusion reinstalling models in ericlatr, remodeling wax prosthesis cesian: = errors in determining the size of lower potion ofthe face: 4) increasing the height of the lower part ofthe fac: aesthetic disorders, extended face, ser omer aed ae eee ee a ' reducing the height of the lower portion ofthe face: aesthetic disorders - nasolabial lea we Tekis ered eenen as Oe coc ear ipa eed ech of facial profilecontiguation. a S ~ errors an be caused by uncontrolled shifting (cam) ocehsal im (especialy the on Tower jaw) atthe time of central occlusion determination: = deformation of wa bases with occlusal rims during determination of ceatal ‘clusion oe ental relation; ~ loosing comectons between wax basis and micousa of prosthetic feld in stage of fheing central occlusion or central relations = exors caused by compression of mucousa of aveoar bone ofthe upper jaw or alveolar pat of te mundible because of forsign pales eater UnIRE the basis ofthe swan since Exactness of correct determination the height of the lower portion of the face is made by determination of the nature of closing the lips, deepness of nasolabial folds. Possible errors in centric occlusion can be identified, which can occur because of both laboratory and clinical reasons. In the laboratory errors may be caused by: - using faulty articulator - arbitrarily increasing or decreasing the distance between the models in dentures modelling - careless or incorrect fixing gypsum models. Control of vertical component of the ja relationship ‘Special artention is paid to vertical dimension contol in case of interdental relation at the absence of tecth antagonists by using physiognomical and physiological tests. At the same time phonetic tes is done by asking the patient to pronounce the phoneme .S daring thatthe minimal distance between dental arches is set and that Ieads the maralible tothe condition of phisiological rest. (Checking the vertical component of the jaw relationship is made depending on presence ‘or absence of fixed vertical dimension: ‘rte occlusal vertical cimension is defined by the contact of opposing natural teeth (Gixed vertial dimension), the denture should be inserted and a check made that bot the natural tecth and the replacement tecth on the denare meet evenly at this vertical dimension. ‘Where the natural standing teeth do not meet st the occlusal vertical dimension (vertical ‘dimension isnot fixed), the denture should be inserted and checking is made even Contact ofthe artificial teeth and the natural teeth occurs ata vertical dimension which provides an acceptable valve of freeway space. Altering the existing Vertical Dimension of occlusion - diminished OVD - increased OVD Effects of excessively reducing the OVD (overclosure): - appearance (poor esthetics) - mastication ineficiency. ~ severe tooth wear ~ cheek biting - angular cheilitis - pain in the TMJ ~ Costen's syndrome How to altere the ex! ig VDO 1, Confirm the loss of VD by taking history, cephalometric examination, and the presence of excessive free-way space. 2, Increase the existing VDO temporarily by fabricating an acrylic resin occlusal overlay appliance in maximum. intercuspation, ensuring that 4mm of free-way space must exist. 3. 3.restore the desired VDO permanently with the help of fixed or removable prosthesis oaly aiter the physiologic responce ofthe patient to this appliance is positive pane | Qualitative determination of trial denture in the oral cavity includes examination of: - extention, retention and stability of the denture - clasps arms for non-traumatic placement relative to gingival margins of the teeth + dental-dental plural contacts (must be maximum between artificial and remained natural teeth) in position of central oeclusion ~ dental-dental contacts in functional occlusion must coresponde to the principles of dynamic occlusion ~ spatulae test = determination of phonetic restoration ~ determination of physiognomy restoration = control of vertical component of jaw relationship + cheching horisontal component of jaw relationship. Pr tion wri for the technician, c. I The colour and nature of the denture-base material to be used. Details of position and depth of any peripheral seal lines required as the borders of palatal connectors in an upper denture. Details of any areas which require relief (torus palatinus, gingival ares of standing teeth). Flasking The process of investing the cast and a waxed denture in a flask to make a sectional mould used to form the acrylic resin denture base. c Lower half (which contains the cast). 5 Upper half. 5 Cover/ Lid. Basic guides to developing facial and functional harmony: preliminary selection of the artificial teeth horisontal orientation of the anterior teeth vertical orientation of the anterior teeth inclination of the anterior teeth harmony in the general composition of the anterior teeth refinement of the individual tooth position the concept of harmony with sex, personality and age of the patient the correlation of the aesthetic and incisal guidance. Instructions to the patient are given about: ~ insertion and desinsertion of the denture (first time can be some

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