Sinai University Final exam.

PRS 412
Faculty of Dentistry
Removable Prosthodontics Department 4 \ 6 \ 2014

Student’s Name: ‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬

Student’s ID: ………………………………………………………….....
I) For each of the following MCQs select the one most appropriate (15 Degree)
1. Indication of the over denture tooth supported are
a) Cases having few remaining teeth.
b) Mobile tooth up to grade III mobility.
c) Patients presenting with congenital defects as cleft palate.
d) All of the above.
e) a & c
2. Combination Syndrome is the characteristic features that occur when an completely
edentulous
a) Mandibule opposed by natural maxillary anterior teeth.
b) Maxilla opposed by natural mandibular posterior teeth.
c) Mandibule opposed by natural maxillary posterior teeth.
d) Maxilla opposed by natural mandibular anterior teeth.
e) None of the above

3. The disadvantage of the tooth supported over denture are.

a) Caries susceptibility.
b) Encroachment of the interocclusal distance.
c) Bony undercuts.
d) All of the above.
e) a & c.
4. Contraindications of over denture tooth supported are
a) In cases with poor oral hygiene.
b) Inadequate interarch distance.
c) Abutments exhibiting mobility, which exceeds grade II.
d) All of the above
e) a & b
5. Magnets attachment for implant supported over denture provides
a) Less resistance to vertical dislodging force.
b) Greet resistance to lateral force
c) Easily moved in horizontal direction
d) More lateral force is transmitted to the implant.
e) All of the above.
6. One situation with single dentures should be avoided.
a) Single mandibular denture made to occlude against natural maxillary teeth,
b) Single maxillary denture made to occlude against partially edentulous mandibular arch
c) Single maxillary denture made to occlude against full natural mandibular teeth,
d) a & b

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 Sinai University
Faculty of Dentistry
Removable Prosthodontics Department

e) a & c
7. Immediate denture is a denture which is.
a) Entirely constructed after the extraction of the teeth.
b) Inserted immediately after the extraction.
c) Cannot be evaluate its esthetics until the insertion appointment.
d) All of the above
e) b & c
8. The advantages of the immediate denture are
a) Healing period is faster and less painful.
b) Centric relation is easier to record.
c) Prevent the change in the tongue size
d) All of the above
e) b & c

9. In the socketed type of immediate denture the cast is excavated to approximately 1 mm on

a) The lingual side and flash with the gingival margin on the labial side.
b) The same depth at lingual and labial.
c) The labial side and flash with the gingival margin on the lingual side.
d) None of the above.
10. In case of upper single denture opposing severely tilted lower first molars and modification is
not possible. The first choice to overcome the occlusal disharmonies is
a) Selective grinding
b) Cast gold crowns, onlays, or a fixed bridge
c) Orthodontic repositioning
d) Root canal treatment and over denture is indicated.
e) Extraction is necessary.
11. The advantage of tooth supported over denture are
a) Preservation of proprioceptive response.
b) Preservation of alveolar hone.
c) Preservation of gingiva.
d) All of the above.
e) a & b
12. The usual cause of clicking of posterior teeth when a patient speaks is
a) Decreased vertical dimension of occlusion
b) Increased vertical dimension of occlusion.
c) Posterior teeth set too far lingually.
d) Posterior teeth set too far facially.
e) All of the above

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 Sinai University
Faculty of Dentistry
Removable Prosthodontics Department

13. To obtain maximum stability of a lower denture, the occlusal plane of the lower teeth should
be slightly
a) below the bulk of the tongue
b) Above the bulk of the tongue
c) At the mid distance of inter arch space.
d) None of the above.
14. The causes of tongue crumbing are all the following except
a) Posterior teeth set inside the ridge.
b) Molar teeth, which are too broad bucco-lingually.
c) Increased the Freeway space
d) Inwards setting of molar teeth.
15. Each of the following factors positively influences complete denture stability except.
a) Excessive interach space.
b) V-Shaped palatal vault.
c) Even occlusal contact.
d) Well-formed residual ridges.
16. A patient with a history of repeated denture fracture may have.
a) Rapid rate of residual ridge resorption.
b) Large broad frenal attachment.
c) V-shaped palatal vault.
d) a & b.
e) a & c.
17. Treatment of pain from V-Shaped ridge In the upper denture is by
a) Alveoloplasty followed by relining the denture
b) Relief over the crest of the alveolus.
c) Selective grinding
d) a & b
e) a & c
18. The cause of difficulty in swallowing may be due to
a) Extension of the upper denture on the soft palate
b) Excessive pressure in the rugae area,
c) Distally overextension in the lower denture in the lingual pouch.
d) All of the above.
e) a & c

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 Sinai University
Faculty of Dentistry
Removable Prosthodontics Department

19. Costen's syndrome may result from

a) Reduced vertical dimension.
b) High vertical dimension
c) V-shaped palatal vault.
d) All of the above
e) a & c
20. Lisping on pronouncing the consonants S, may result from
a) The anterior part of the upper denture, covering the hard palate, is thick.
b) The anterior teeth are placed too far back.
c) The anterior part of the upper denture, covering the hard palate, is narrow.
d) a & b
e) a & c
21. In V-shaped palate, which of the following is diminished.
a) Retention by adhesion.
b) Stability of the denture
c) Support of the denture
d) All of the above
22. Whistling on pronouncing the consonants S, may result from
a) The dental arch is too narrow.
b) The anterior teeth are placed too far posteriorly.
c) Cramped tongue.
d) a & b
e) a & c
23. Treatment case of V-shaped palate is
a) A cast metal plate.
b) Vestibuloplasty.
c) Careful blocking out of the V-Shape area on the model
d) All of the above.
e) a & c
24. Reason for the difficulty of case of flat lower ridge is
a) No resistance to lateral movement of the denture
b) Retention by adhesion is diminished.
c) Acrylic denture bases tend to warp during curing
d) All of the above.
e) a & b

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 Sinai University
Faculty of Dentistry
Removable Prosthodontics Department

25. Reason for the difficulty in case of V-Shaped palate are

a) Retention by adhesion is diminished.
b) Acrylic denture bases tend to warp during curing
c) Stability of the denture is diminished
d) All of the above.
e) a & b
26. The most suitable artificial teeth for flat ridge cases is
a) Zero degree teeth.
b) Anatomic teeth
c) Semi anatomic
d) 33 degree cusp angle teeth
27. Treatment of cases with knife-like lower ridge
a) Relief
b) Resilient lining
c) Alveoloplasty.
d) All of the above
e) a & c
28. A cause for denture dislodgement by eating is:
a) The use of anatomic teeth in balanced occlusion.
b) Cuspal interference.
c) Improper lip support.
d) The use of non-anatomic teeth in balanced occlusion.
e) Poor denture appearance.
29. A cause for denture dislodgement when opening the mouth is:
a) Well denture border extension.
b) Adequate tongue space.
c) Good peripheral seal.
d) Adequate amount and consistency of saliva.
e) Tight lips.
30. A cause for denture dislodgement when coughing or sneezing is:
a) Well denture border extension.
b) Inadequate tongue space.
c) Poor peripheral seal.
d) The explosive nature of coughing and sneezing.
e) Adequate amount and consistency of saliva.

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 Sinai University
Faculty of Dentistry
Removable Prosthodontics Department

31. A cause of clattered complete denture teeth is:

a) Too low vertical height.
b) Gross cuspal interference.
c) Well retained dentures.
d) The use of acrylic teeth.
e) Balanced articulation.
32. A cause of tongue biting is:
a) Insufficient overjet.
b) Good centric occluding relation.
c) Good tongue space.
d) Decreased tongue space.
e) Good overjet.
33. Which of the following should be treated by using a tissue conditioning material?
a) Immediate denture.
b) Maxillary single denture.
c) Irregular absorption.
d) All of the above
e) a & c
34. In tooth supported over denture design, endodontic therapy and amalgam plug is indicated
when there are
a) Normal coronal height.
b) Normal interocclusal distance.
c) Little or no loss of vertical dimension.
d) All of the above.
e) a & b
35. The advantages of interim partial denture construction as immediate denture are to.
a) Prepare the patient for complete dentures by first learning how to control the partial denture.
b) Provides posterior support reducing
c) Reducing the possibility of the development of a habitual posturing of the mandible.
d) All of the above.
e) a & b
36. In one stage extraction technique for immediate denture construction
a) All the remaining teeth are extracted and the denture fitted at one session.
b) All of the posterior teeth are extracted, the sockets are allowed to heal, then a complete
denture is made as an immediate replacement of the remaining anterior teeth.
c) Make a partial denture to restore the posterior teeth as an immediate replacement then the
remaining anterior teeth are added as immediate additions.
d) a & b

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 Sinai University
Faculty of Dentistry
Removable Prosthodontics Department

37. In two-stage extraction technique for immediate denture construction.

a) All the remaining teeth are extracted and the denture fitted at one session.
b) All of the posterior teeth are extracted, the sockets are allowed to heal, then a complete
denture is made as an immediate replacement of the remaining anterior teeth.
c) Make a partial denture to restore the posterior teeth as an immediate replacement then the
remaining anterior teeth are added as immediate additions.
d) a & b
38. Which of the following is false in regard to a problems of single denture:
a) Excessive load from the natural teeth
b) The occlusal form of the remaining natural teeth
c) Uneven occlusal plane.
d) Esthetic and phonetic problems due to the fixed positions of the mandibular teeth lead to
difficulty placement of the maxillary teeth.
e) Centric relation is easier to record.
39. For overcome the excessive load from the natural teeth to the single denture we should do
a) Maximum base extension within functional anatomical limits
b) Balancing occlusion.
c) Avoid broad inclined planes.
d) All of the above.
e) a & c
40. For overcome the esthetics problem for the single denture we should.
a) Use of a steeper posterior teeth.
b) Created deep vertical overlap.
c) Alteration of the clinical crowns of lower anterior teeth by selective grinding.
d) All of the above.
e) a & c
41. The most suitable teeth material used in single denture opposing natural teeth is
a) Porcelain teeth.
b) IPN resin teeth.
c) Acrylic resin Teeth.
d) All of the above.
42. In single mandibular denture made to occlude against natural maxillary teeth some
consideration should be given
a) Using a resilient liner in the mandibular denture.
b) Over denture tooth supported or implant supported can be used.
c) Using porcelain teeth.
d) All of the above.
e) a & b

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 Sinai University
Faculty of Dentistry
Removable Prosthodontics Department

43. The corrective procedures for burning sensation under new denture are.
a) Instruct patient in good oral hygiene
b) Avoid hot spicy foods.
c) For vitamins deficiencies prescribe vitamins A and B12
d) Prescribe a mild tranquilizer.
e) All of the above.
44. Treatment of repeated midline fracture of the upper denture cussed by alveolar bone
resorption is.
a) Surgical interference
b) Sufficient relief in the midline.
c) Metal plate.
d) Repair followed by relining of the denture
e) All of the above.
45. Reason for the difficulty of tight lip during complete denture construction are.
a) Instability of the lower denture due to the backward displacement caused by the lip pressure.
b) Vertical lift occurring in the premolar and canine region from the pressure modioli.
c) Loss of support
d) a & b
e) a & c
46. The suitable impression technique for flabby ridge (Abuse Tissues) is
a) Selective impression technique.
b) Muco-static impression technique.
c) Muco-compressive impression technique.
47. Treatment of tight lip during complete denture construction
a) Keep the occlusal plane low.
b) Adequate extension on the retromolar pads.
c) Keep the denture narrow across the premolar region.
d) All of the above
e) a & b
48. Treatment for large tongue cases during complete denture construction is.
a) Keep the occlusal plane low.
b) Anterior teeth should be set up slightly backward of the ridge.
c) Peripherally trimmed impression technique.
d) All of the above
e) a & c
49. Reason for the difficulty of tight lip during complete denture construction is instability of the
lower denture due to the backward displacement caused by the lip pressure.
a) True.
b) False.

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 Sinai University
Faculty of Dentistry
Removable Prosthodontics Department

50. The single complete maxillary denture opposing all or some of the mandibular natural teeth is
a very rare clinical situation.
a) True.
b) False.
51. In high vertical dimension small white patches are to be seen in the painful area, relief of the
denture over these white patches is the best treatment.
a) True.
b) False.
52. The burning sensation under new denture in the anterior third of the palate, may result from
pressure on the nasopalatine area.
a) True.
b) False.
53. Pain from reduced vertical dimension is associated with new dentures
a) True.
b) False.
54. Patients are most appreciative to over denture than conventional complete denture.
a) True
b) False
55. In over denture if for some reason overlaid teeth must be extracted, it cannot readily be
converted to accept the alteration "as relining".
a) True.
b) False.
56. The main problem with the overdentures tooth supported is the carious breakdown of the
overlaid teeth.
a) True.
b) False.
57. One of the disadvantages of one stage extraction technique for immediate denture
construction is a massive surgery is required.
a) True.
b) False.
58. The over extended border causes pressure on the underlying soft tissue covering the sulcus
a) True.
b) False.
59. Pain under denture may be due to trauma caused by heavy one sided pressure.
a) True.
b) False.
60. A cast metal plate may produce a more accurate fit for complete denture for V-shaped
palate.
a) True.

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 Sinai University
Faculty of Dentistry
Removable Prosthodontics Department

b) False.
Complete the following (5 marks)
 Define the following
Over denture
It is a complete denture that covers & resets on one or more remaining natural teeth, the roots of
natural teeth and or dental implant.
Immediate denture
o Immediate denture is a denture which is entirely constructed before the extraction of the teeth
and inserted immediately after the extraction of the teeth.
o A complete denture or RPD fabricated for placement immediately following the removal of
natural teeth. After healing, the denture can be relined and refitted to be used as a definitive
denture.
Single denture
complete denture opposing a dentate arch..……
 Mention three causes lead to inability to eat meat by patient wearing complete denture:
1. Flattening: of the cusps of the posterior teeth.
2. The use of cuspless posterior teeth.
3. Overclosure.
4. The use of acrylic posterior teeth due to their resilience and softness.
5. Unbalanced articulation.
6. Cuspal interference.
7. Inexperience.
 Mention three causes lead to nausea from wearing complete denture
1. Dentures slightly overextended.
2. Dentures underextended:
3. Thick posterior border.
4. Loose dentures.
5. Placing the upper teeth too far in a palatal direction and the mandibular teeth too far in a lingual
direction so that the dorsum of the tongue is forced into the pharynx during the act of swallowing.
 Mention three causes of repeated midline fracture of upper denture
1. Alveolar bone resorption and consequently, rocking of the denture.
2. Presence of torus, palatinus or insufficient relief of the middle area.
3. Teeth outside the ridge.

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 Sinai University
Faculty of Dentistry
Removable Prosthodontics Department

Give an account on

Causes and treatment of pain related to complete denture: (10 marks)

I. PAIN
1.Overextension of the periphery:
 The over extended border causes pressure on the underlying soft tissue covering the sulcus. It
can be visible in the mouth as hyperemia, red line or spot or as an ulcer.
 The best way to detect an over-extended area even if an ulcer hasn't developed yet is by coating
the periphery or fitting surface of the denture with pressure indicating paste, or a thin mix of
alginate and instruct the patient to perform a few functions
 The paste or alginate will be wiped off at the over extended area.
Treatment:

a. The over extended area should be trimmed with a stone, polished and reinserted. The procedure
is repeated until the patient feels comfortable.
b. Sometimes over-extension may be due to alveolar ridge resorption, in which case, construction
of a new denture is preferable.
2.Poor fit:
This can easily be detected by the poor retention, rocking, tilting and inability to seat the denture
accurately in any position.
Treatment:
New dentures, but the old ones can be worn in the meantime with a lining of tissue conditioning
material.
3.Insufficient relief:
The denture will usually rock on the hard area causing pain. The painful area is red and possibly
ulcerated.
Treatment:
Apply a very thin coating of diagnostic paste, or white tooth paste, to the area which requires
relief, insert the denture and on removal the area will be easily marked; bur away the part of the fitting
surface until adequate relief is obtained.
4.Incorrect jaw relationship:
This may be any one of the following faults, or a combination of them:

a) Wrong anteroposterior of relationship.

When centric occlusion does not coincide with centric relation, attempts to retrude the mandible, may
drag the denture against the mucous membrane causing pain.

Treatment:

 If only slight it can be cured by selective grinding

 If gross, new dentures will be required.

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 Sinai University
Faculty of Dentistry
Removable Prosthodontics Department

b) Uneven pressure:
Pain may be due to trauma caused by heavy one sided pressure and is then confined to the crest of
the lower alveolar ridge on that side; sometimes small white areas are to be seen, as in an opened vertical
height.

Pain may also be due to tilting of either denture, more usually the lower, and is then situated near
the buccal periphery on the side of excessive pressure and near the lingual periphery on the opposite side.
Diagnosis can be made as described previously.

Treatment:

 If detectable with a spatula, a new lower denture must be constructed,

 If it can be found with celluloid strips, then spot grinding will usually affect a cure.
c) High vertical dimension:
Small white patches are to be seen in the painful area. Relief of the denture over these white
patches usually gives immediate relief from pain, but within a few days the patient returns with the same
condition but differently situated. In nearly all cases of high vertical dimension the patient also
complaints that the teeth jar, clatter, are "in the way" or "too high" when eating and sometimes when
talking

Treatment:

New lower denture with a slightly decreased vertical dimension, if the occlusal plane of the upper
is judged to be correct, otherwise, new upper and lower dentures.

d) Reduced vertical dimension:

Pain from this cause is rarely associated with new dentures; it is almost always the result of loss of
vertical height through lower alveolar absorption. The pain is often indefinite in locating and frequently
resembles neuralgia of the cheek on one or both sides (Fig. 4).

5.Cuspal interference:
The dragging action resulted will cause pain with well-fitting dentures and also instability with
those having poorer retention. Hold the upper denture gently in place between the fingers and thumb that
are placed above the canine teeth, asking the patient to grind the teeth and the dragging can easily be felt.

Treatment:

Selective grinding is the most accurate method of correcting this error. If the interference is gross,
correctly articulated new dentures will be required.

6.Teeth off the ridge:

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 Sinai University
Faculty of Dentistry
Removable Prosthodontics Department

Pain from this cause is confined chiefly to the upper buccal sulci and maxillary tuberosities. It is
usually the result of setting the upper teeth far buccally in an attempt to overcome marked discrepancies
between the size of the upper arch and that of the lower.

Treatment:

New dentures, or sometimes only a new upper denture, with the teeth correctly placed and, if
necessary tilted or mounted to a cross bite.

7.Retained roots or unerupted tooth:

Treatment:

Extraction of the root or tooth followed by relining of the part of the denture at that area. If for
some reason extraction is contra-indicated, then relief may be given 'by easing the denture freely over that
area.

8.V-Shaped ridge:
Treatment:
In the lower, alveoloplasty followed by relining the denture is the treatment of choice.
In the upper, relief over the crest of the alveolus is often sufficient since the palate can usually
resist the masticatory stresses, the exception being the V-shaped palate.
9.Mental foramen:
If gross absorption of the alveolar and basal bone has taken place the foramen may come to lie
under the denture causing pain. The pain may be localized to the immediate vicinity of the mental
foramen, or it may be referred and is then felt as a neuralgic pain in the side of the face, or more rarely,
in the lips or chin. It can usually be diagnosed by locating the mental foramen and applying firm
pressure in that area which will cause some type of pain (fig. 6).

Treatment:

Relieve the denture so that the nerve cannot be subjected to pressure.

10.Irregular absorption:
Sometimes during alveolar absorption an area is formed which is rough, with a number of sharp
spicules of bone, and if the mucous membrane covering it is thin, pain will be caused by pressure on it .

Treatment:

Alveoloplasty of the affected area followed by relining that part of the denture, if necessary with a
soft lining.

11.Pathological conditions:

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 Sinai University
Faculty of Dentistry
Removable Prosthodontics Department

These conditions should be treated according to the condition and new dentures are usually
constructed.

12.Allergy:
Fortunately, it is very rare.

Treatment: New-dentures must be constructed in another material.

13.Rough fitting surface:

If a denture has been processed on a poorly poured model, small pimples will be found on the
fitting surface of the denture.

Treatment:

Remove the offending roughness from the denture.

14.Difficulty in swallowing (Tonsillitis) and sore throat:

The cause in the upper is extension on the soft palate with firm pressure and good retention, or
excessive pressure in the hamular notch, whilst in the lower it is overextension distally in the lingual
pouch.

Treatment:

The patient will usually know which denture is at fault and examination of the regions described
will show a slight redness. Reduction of the overextension is all that is required.

15.Severe undercuts:
Treatment:

The fitting surface must be cut away until the denture can be inserted comfortably but the
periphery must not be reduced in height. Often the flange will be too thin to allow sufficient to be
removed from the fitting surface and if this is the case the flange must be thickened by the addition of
more material. Should this adjustment ruin the retention, as is likely to be the case if much has to be cut
away, an alveoloplasty will be necessary followed by a new buccal or labial flange. This may cause
warpage with an acrylic denture in which case a completely new denture will| be the only remedy.

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 Sinai University
Faculty of Dentistry
Removable Prosthodontics Department

Good luck
Dr. Hassan saqr

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