Professional Documents
Culture Documents
Remember: The palatoglossus, superior pharlalgeal constrictor, mylohyoid, and genioglossus muscles
are influential in molding the lingual border ofthe mandibular impression for an edentulous patient.
Import.nt: The most important consideration in checking custom trays for accurate border molding is
stability and lack of displacement.
Note: The custom tray for a final mandibular or maxillary complete denture impression should have a
sprcer with stops to insule that th€ tray will be seated in proper relationship to the arch and that there
will be adequate room for the impression material. The space is created with wax covered by aluminum
foil over the master cast pdor to forming the tray.
The primary difference between border molding with a ZOE impression matcrial and border molding
with modeling plastic is that the zoE impression material must be border molded during one inser-
tion and within the setting time of the mate al opposed to two insertions with modeling com-
oound.
-as
. To increase the capacity of underlying struchrres to withstand the stress due to biting
force and to improve appearance
. To increase the capacity of the underlying structures to withstand the stress due to
biting force and to increase the effectiveness ofthe seal
Remember: Mandibular denn[cs do not rely on suction from a pcriphcral scal for retention /ds do marillary den-
|r,"es, but rather on dcnturc stabiljty in covcring as much basal bonc as possiblc $ithout i'rpinging on thc musclc
attachmcnts. Thc active bord€rmolding perfonned bythc lips, chccks, and tonguc determines the peripheral areas
ofa mandibular arch, thus establishirg ma{imal basc bonc covcrage.
Limiting structurcs ofthc mrndibular dcnturc:
. Mandibular lnterior labial area: thc action of the mentalis musclc and the mucolabial fold dctcrmincs thc cx-
tcnsion ofthe denture flangc jn lhis arca.
. Mandibular labial frenum: lhis band offib.ous conncctive tissue hclDs attach thc orbicularis oris musclc. Thc
sizc ofthis s(ructurc limits thc cxtcnsion ofthc dcnturc bordcr. thc thickncss oflhc dcnturc basc, and aflects thc
position olthc mandibular tccth.
. Buccal vestibule: is infiucnccd by the buccinator musclc which has musclc fibcrs that run in an obliquc dircc-
tion and thcrcforc bave littlc displacing aclion- Propcr cxtcnsion into this arca provides the best support for thc
mandibular dcnturc. Tlis arca is rcfcrred to as thc buccrl shelf.
. :|Iasscter area: thc dcnturc is limited in a latcral dircction by lbc action ofthc massctcr musclc.
. Retromolar padi marks thc distal termination ofcdcntulous ridgc. This structurc nccds to bc covcrcd fbr sup-
pon and rctcntion. By doing lhis thc intcgrity ofbonc in lhis arca is maintaincd and allows for support.
' Lingurl frenum: thc proper bordcrs must bc cstablished with movemcnts ofthc longuc whcn bordcr molding.
Thc gcnioglossus musclc inlluenccs lhe length ofthc flangc during normal movcmcnts ofthe tongue.
. Sublingual gland sreai maximum cxtcnsion dcsircd without ovcrcxtcnsion.
' \ll lohtoid area: thc flangc in this arca must accommodatc the movcmcnt ofthc mylohyoid musclc in swallow-
ing
. Retromllohloid area: this area is limitcd posteriorlyby thc action ofthc palatoglossus musclc and inferiorly by
rhr lingual slip ofthc superior constrictor musclc. Ifthcsc musclcs arc impingcd upon, thc paticnt may dcvclop a
sora throat. Notei This is often ahc most diflicult are to manaqc.
Recontouring of the healing ridge progresses rapidly for four to six months and does
not become stable in fonn until l0 -12 months post extraction. Due to this, immediate
dentures become progressively more ill-fitting. They should be relined five months and
ten months after delivery in order to compensate for contour changes. Note: This is a gen-
eral timeline; each case needs to be evaluated monthly and, if necessary, relines
performed.
A reline is indicated on any denture when the diagnostic information indicates that a re-
line rvill effectively solve the patient's chief complaint when the denture base
-
adaptation is the major defect in the prosthesis. A reline is contraindicated when there is
excessive overclosure of the vertical dimension a large decrease in veftical
dimension. In this case, new dentures are indicated -at the proper vertical dimension.
Note: When apatient wears a complete maxillary denture against the six urandibular an-
terior teeth, it is very common to have to do a reline every so often due to the loss of
bone structure in the anterior maxillary arch by a flabby maxillary anterior
ridge. -evidenced
. 3 hours aiier delivery
. Gagging
. Cheek biting
. Reduced taste
. Speech aberrations
The basic sequence ofthe clinical procedure for a 24 hour recall appointment is:
l. Remove the dentures from the mouth.
2. Thoroughly examine the mouth.
3. Ask the patient about the areas oftissue trauma which have been obseryed.
4. Pemit the patient to describe additional complaints.
*** After collecting all ofthe diagnostic information, the dentist can determine the source
ofthe problem and the cure.
Remember: During the first few days following the insertion of complete dentures, the
patient should expect some difficulty in masticating most foods and excessive saliva
-
*hich is due to reflex parasympathetic stimulation ofthe salivnry glands. Over time this
u ill subside and become normal.
Posterior teeth edge to edg€ Reduce the facial surfaces olmandibular molars to
create proper horizontal overlap
l. Lip biting may be due to reduced muscle tone and/or a large anterior hori-
\otes zontal overlap.
2. Tongue biting may be caused by having posterior teeth too far lingually.
. Facial to the ridge
. lncisive foramen
. Palatal mucosa
. Hamular notch
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Coplaight O 20ll-?012 - Denral Decks
Setting anterior teeth directly over the ridge usually causes poor esthetics of dentures.
Also, it is important to have accurate adaptation ofthe border seal and adequate bulk of
the maxillary facial flange for good esthetics. Vertical dimension ofocclusion affects the
lip support as well.
For most patients, the labial surface ofthe central incisor should be approximately 8 mm
anterior to the center ofthe incisive papilla. The labioincisal onethird ofthe maxillary
central incisors should support the lower lip when the teeth are in occlusion.
Important: The long ares of the maxillary central incisors should be perpendicular to
the occlusal plane; the long axes of the maxillary lateral incisors should have an asyrn-
metric mesiodistal inclination.
Remember: Maxillary central incisors are the most important teeth when esthetics is
under consideration. Their placement controls the midline, speaking line, lip support and
srniling line composition. Note: Placement of maxillary anterior teeth in complete den-
tures too far superiorly and anteriorly might result in difficulty in pronouncing "f'and "v"
sounds.
Important: Leaming to chew satisfactorily with new dentures requires at least 6-8 weeks.
This time is spent on establishing new memory patterns for both facial and masticatory
muscles.
Residual ridges can be ruined by the use of denture adhesives and home-reliners.
Therefore. patients should be specifically warned about their uses. These agents can mod-
ifl the position ofthe denture on the ridge and result in change ofboth vertical and cen-
tric relations.
The tr€Ntment plan for a patient indicates thst both manilibular and maxi.llary
immediate dentures are to be fabricated. The ideal wav to do this is:
. Fabricate the maxillary and mandibular imrnediate dentues at the same time
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Coplright O 201 I 201?, Denial Decls
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Cop)righr C 201 l'2012 - Dental Decks
The main reason for this is to avoid setting the maxillary teeth to the likely malpositions
of the remaining mandibular teeth
Important: Ifthe master casts are altered in an immediate denture procedure (e.g., elim-
ination ofgt"oss undercuts), it is advisable to construct a second denture base that is trans-
parent (called a surgicol stent or template). This surgical stent is placed over the ridge after
the teeth are exhacted. Pressure points and undercuts are readily visible and surgical ridge
conection can be performed.
Remember: The duplication ofthe master cast used for the construction ofthe surgical
template to be used at the time of immediate denture insertion is best rnade after wax
elimination and after the cast is trimmed.
Note: A major advantage with immediate dentures is being able to duplicate the
position of the natural teeth.
Important: The patient should understand both the cause ofthe tissue deterioration and
the eventual outcome ifthe process is not arrested.
Other procedures recommended as aids in the treatment ofabused tissues include mas-
sage and warm saline rinses.
. The psychological comfort ofavoiding the loss ofall teeth
. The continuous functional feedback for the neuromuscular system from proprioceptors
in the periodontal membrane
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Coplaiglit O 201 l-2012, Dmtal Decks
. B, P, and M sounds
'11
It is not always necessary to cover a root beneath an overdenture, however, ifa root is
not covered, the exposed surfaces are highly susceptible to decay, The oral hygiene of
the patient must be impeccable to prevent the decay ofthese roots.
Note: Retained roots are the most common findings when taking routine panoramic
radiographs of patients who wear complete dentures (rol necessarily overdentures).
Important: The general rule for retained root tips with no radiolucency and the corti-
cal margin ofbone intact is that they can remain in place; however, the patient should
be informed oftheir presence. They should be removed if the cortical plate is perforated
and/or the PDL or radiolucent area is getting larger
Important: To evaluate vertical dimension, have the patient pronounced the s sound; the in-
terincisal sepantion should be I to 1.5 mm. This is known as the closest sp€aking space.
Remember:
. Ifthe teeth are positioned too far lingually, the "t" will tend to sound like a "d." Ifthe teeth
are positioned too far labially, the "d" will sound more like a "t."
. An increased occlusal vertical dimension can result in clicking ofteeth.
. The primrry role ofanterior leeth on a denture is:
. To incise food
. Occlusion
. Esthetics
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Coplright O 201l-2012, Denral Decks
. Fibrous tuberosities
. The maxillary denture teeth that were used are too short
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Coplrigh O 20ll-2012 - Dental Deck!
Spaces, lapping, rotation, and color changes can bejudiciously used to create a natural
appearance. Note: Proper lip support is provided by the facial surfaces of teeth and
sirnulated attached gingiva.
Setting the anterior teeth either too far lingually or facially to satisfy esthetic concems
should not be done. When selecting teeth, pre-extraction records are very valuable.
Maxillary and mandibular anterior teeth should not contact in centric relation.
The outline ofanterior teeth should harmonize with the form ofthe face:
. Convex profile faces should have a similarly convex labial surface ofanterior teeth
. Broader contact areas ofteeth look more natural on dentures as they seem more com-
patible with advanced age
Note: In general, functional needs overshadow those ofesthetics when selecting pos-
terior teeth. Do not set mandibular molars over the ascending area ofthc mandible
because the occlusal forces in the area will dislodse the mandibular denture.
The patient's chiefcomplaint will be looseness ofthe maxillary denture. Thcy will also state thal they
can no longer see their upper teeth on the denture. These signs and symptoms are caused by a lack of
postcrior occlusion.
Important: A patient wearing a maxillary complete denture and a mandibular bilateral distal-ex-
tension removable partial may show:
. Decreased vertical dimension ofocclusion
. A prognathic facial appearance
\ote: \\ftcn a complete maxillary dcnture opposes natural mandibular anterior tecth. the marillary tn-
terior ridge often becomes very flabby.
Rememberi The best impression technique for an edentulous patient with loose, h)?erplastic tissue in
rhe maxillary anterior region is to register the tissue in its passive position.
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Cop)right O 201l-2012 - Dental Deks
. Residual ridges
. Palatal rugae
. Incisive papilla
. Maxillary tuberosity
. Buccal vestibule
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Cop)'righr O 20ll-2012, Dental Decks
The ease and accuracy ofthe border molding depends upon:
l. An accurately fitting cuslom tray
2. Control of bulk and temperature ofthe modeling compound
3. A thoroughly dried tray
The custom tray fabricated on the preliminary cast is trimmed approximately 2 rnm short
of the mucosal reflection and frenae. This is done by first checking the borders in the
mouth and then trimmed down. This will allow a uniform thickness of 2 mm of model-
ing compound when borders are molded. Proper border molding results in contours re-
sembling the final form ofthe denture. However, the primary indicator ofthe accuracy
of border molding is the stability and lack ofdisplacement oftray in the mouth.
Border molding is completed in two stages. In the lirst stage the molding should ap-
proximate the borders but should be slightly overextended. Excess compound is trimmed
from inside and outside ofthe tray. The remaining modeling compound is then refined by
repeating the process. The final form ofthe border molding should represent an accurate
impression ofthe peripheral tissues. The modeling compound should have a smooth, al-
most polished appearance.
After border molding is cornpleted, some areas ofthe modeling compound should be re-
lieved because the tissues are extremely displaceable and have probably been distorted
during the border molding process. These areas include around the maxillary labial
frenum and over the retromolar pad areas.
Remember: Modeling compound (plastic) has a relatively low thermal conductivity.
*** The primary support areas of the maxillary complete denture are thc residual ridges (the
ntatillan and palatine bones),
lmportant: In the mandibular arch, the primary support area is the buccal shelf because of its
bone structurc and its right anglc relationship to the occlusal plane. Proper extension into this area
is necessary- to more widely distribute the load ofmastication. The residual ridges iflarge and broad
can also be considered as lhe primary suppofl areas.
Remember:
. The secondary peripheral seal arca for a mandibular complete denture is thc anterior lin-
gual border
. Ifyou are labricating a mandibular complete denture for a patient with a knife-edge ridge,
you need maximal extension of the denturc to help distribute the forces of occlusion over a
Iarger arca
Important: The most important factor for providing retention for complctc dentures is the pe-
ripheral seal.
An overertended distobuccal corner of a mandibulrr denture
will push agrinst which muscle during function?
\-
. Zygomaticus
. Orbicularis oris
. Temporalis
. Masseter
'|6
Coplaighr e 20ll'2012 - Dental Decks
The buccinator muscle lies under the denture flange in this area but the fibers run an-
teroposterior in a horizontal plane and their action is weak; the anterior fibers of the
masseter muscl€ pass outside the buccinator at the distobuccal comer ofthe mandibular
denture and will push against the buccinator during function causing dislodgement.
Important: When the posterior maxillary buccal space is entirely filled with the den-
ture flange, the coronoid process may interfere with the denture upon opening of the
rrouth. This will cause dislodgement olthe maxillary denture.
L The superficial layer ofthe masseter muscle originates from the zygomatic
process of the maxilla and inserts at the angle and lower lateral side of the
ramus of the mandible.
2. The pterygomandibular raphe lies between the buccinator and superior
constdctor muscles.
Dislodgement indicates overext€nsion and the border molding process should be refined
in the offending area. Common areas ofoverextension ofthe mandibular impression are
the labial and the truccal. This is suspected when the impression raises as the mouth is
opened.
The most critical area in the border-molding procedure for a maxillary denture is the
mucogingival fold above the maxillary tuberosity area. This area is extremely important
for maximal retention. Other critical areas are the labial frena in the midline and the
frena in the bicuspid area. Overextension in these areas often leads to decreased reten-
tion and tissue irritation.
\ote: Pressure areas on the impression surface ofdentures is checked with PlP. Use dig-
ital pressure only, one denture at a time. Special attention should be given to the hard
palate and the mylohyoid ridge areas.
. The inclination ofeach condyle
. Centric relation
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Copyright O2011,2012 - Dental D€cks
'|9
Coptrigir @ 201 1,201 2 , D€nral Decks
A face-bow is a caliper-like device used to record the patient's maxilla / hinge axis rela-
tionship (opening and closing axis).It is also used to transfer this relationship to the ar-
ticulator during the mounting of the maxillary cast. Ifthe face-bow tratsfer procedure is
properly done, the arc ofclosure on the articulator should duplicate that exhibited by the
patient. This hinge-axis face-bow transfer enables alteration in vertical dirnension on
the articulator
Note: When altering vertical dimension (either through restorations or with dentures),
casts should be mounted on the hinge axis.
When the maxilla,4ringe axis relation is transfened to the fully adjustable articulator, it
may be necessary to obtain the precise tracing of the paths followed by the condyles. A
pantograph is an instrument which carries out this task with the help of two face-bows.
One is attached to the maxilla and the other to the mandible using a clutch that attaches
the teeth in their resDeclive arches
When fabricating dentures, there are two methods used to preserve the face-bow
transfer:
l.Taking a plaster index ofthe occlusal surfaces of a maxillary denture before re-
moving the denture from the articulator and cast (see picture below).
2. Placing a piece of 10x wax on the occlusal surfaces of the mandibular teeth and
closing the articulator in centric relation. Chill the wa.x, drop the incisal guide pin to
touch the incisal guide table (do not change).
Important: The plaster index method is the preferred method due to possible distortion
ofwax.
[tlaxillary Oenture
Plastor lndex Cast
. Faulty tooth position
. Faulty occlusion
20
Cop}tiSh O 201 I -20 12 - Dental Decks
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Coplaighr O 201 l-2012 - Dentat Deck
Spcech problcms due to faulty tooth position can be avoided by placing thc dcnturc tccth as close as possible to thc
position ofthc natural tccth. Note: Thc most cffcctivc timc to lcst for phonctics is at thc timc oflhc wax try-in oithc
t.ial dcrture frlrr rs l/s!d f thefourth appointmett). Faulty palatal contours can bc co.rcctcd by trial and crror Add
wax to incrcasc contours and rcducc as nccdcd to improvc articulation ofsounds. Note: Paticnts who have becn eden-
tulous for many years oficn havc more distorted spccch than thosc \r'ho havc bccn cdcntulous lbra shorllimc. This
is usually duc to a loss oftonus ofthc tonguc musculaturc.
Cliniciar obs€'ves that incisal Maxillary teetl mal be sct loo Eval a& Iip suppod and
€dg6 of naxillart incisors far labially overall apperance of anterior
co act lhe lower lip I mm or te€rh as dley ar€ positioo€d.
moE labial to lhe wet/dry Reset to a more lingual posr-
of lower lip when "F ' tion as need.d- Incisal edge of
& "1f'lomds are nade maxillary incisors lhould con-
racl thr wat/dfy junciion Just
lingual to it during producrion
olthe "F'& "V" sounds
At the first appointment after insertion ofcomplete dentures, the presence olgeneralized
soreness on the crest of the mandibular ridge is most likely due to improper occlusion
(premature occlusdl contqcts). To identify these, the best method in the mouth is to use
disclosing wax that is slightly warmed. Insert the wax bilaterally and bave the patient
close into centric. The prematurities will show up as windows in the wax' Once centric
is complete, be sure to check eccentric movements.
Important: Acrylic spicules, inaccurate denture bases and trapped food can all cause ul-
cers as rvell. Ifan acrylic spicule is found, it should be reduced. Ifan inaccurate denture
base is suspected, it should be relined.
r -.- 1. After relining dentures, ifa patient constantly retums for adjustments due to
;:.iot{] sore spots on the ridge, check the occlusion. The relining procedure may have
'@f changed the centric relation contacts.
2. Errors in occlusion may be checked most accurately by remounting the den-
tures on the articulator using remount casts and new interocclusal records.
Remember: Casts mounted with an interocclusal record are mounted more ac-
curately if the material used is selected according to the accuracy of the casts
bing articulated (casts produced with iteversihle hydocolloid are more accu-
rateb) mounted with wtu records, and casts obtained with elastomeric materi'
sls are more accurately mounted with elsstomeric registration materials or
zinc and eugenol paste).
. Frankfort's plane
. Camper's line
. Fox plane
22
Copright O 20l l-2012 - D€ntal D4ks
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Coplrighr O20ll-2012 - Dental D€cts
Occlusion rims are the resultant product after adding base plate wax to a record base
in order to approximate the tooth position and arch form expected in the completed den-
ture,
l. A good slarting point for determining the vertical length ofthe maxillary oc-
clusion rim is a point approximately 2 mm below the upper lip when it is re-
lared.
2. When recording centric relation for a removable partial denture, the occlu-
sion rirn should be attached to the completed partial denture framework in-
stead ofa record base as used with a complete dentue.
3. Ifat the tooth try-in appointment the teeth need to be adjusted to correct the
centric occlusion, the best way to do this is to take a new centric relation record
and remount.
Acrylic resin used for denture repairs should be under 20-30 psi air pressure while being
processed to help eliminate porosities. These porosities, ifpresent, will usually occur in
the thickest part ofthe denture. Self-cured resins are generally used for repairs instead
ofheat-cured resins because the risk of distorting the denture is less.
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Cop).righr O 201 l-2012 - Denlal Decks
. The face-bow is a caliper-like device used to record the patient's maxilla,/hinge axis
relationship (opening and closing axis)
. If the transfer is done properly, the arc of closure on the articulator should duplicate
that exhibited by the patient
. The face-bow transfer is used to transfer the maxilla/hinge axls relationship to the
articulator during the mounting ofthe maxillary cast
25
Coplriglt C 201 l-2012 Dmtal Decks
Other drawbNcks of immediate dentures:
.Increased post-ins€rtion care, including relining or remaking the denturcs. Contour changes occur in
the healing residual ridge for 8-12 months.
.Incrersed post-delivery soreness. The combination of post-extraction pain and denture related trauma
often produces greater discomfoit during the first few days following insertion.
. Greater compl€xity ofclinical procedures. Forexample, bordermolding and final impressions are more
difficult when natural teeth remain.
. Higher total cost of treatment Ther€ is an increased expense due to the need for relines and repeated equi-
libration of the occlusion.
Advanlag€s of immediate dentures:
. Continuously acceptable esthetics. Immediate dentures are esthetically advantageous in that the palient
is never without either natural or artificial teeth.
. Improved speech adrption. Immediate dentures rcquire only one period ofspeech adaptation, whereas
conventional denture trcatment requircs two; one afierthe teeth are extracted and anothcr after thc dentures
are delivered.
' Protection of the extraction sites frcm trauma, Denhrres act as a typ€ ofbandage over the clot filled sock-
ets.
. Continuously acceptabl€ masticatory function. The patient retains some semblance ofchewing ability
during the healing process.
. Prevention oftongue enlirgement. When naiural teeth are lost and not replaced, the tongue tends to ex-
pand into the available space.
To help the patient get through the fiIst day ofwearing immediate dentures, instruct him to do the following:
. Do not remove the dentures . Retum in 24 hours
. Eal soft foods
Recommended trvo-step schedule ottooth rcmoval;
. First stepi extract all posterior teeth except a ma-rillary first prcmolar and its opposing tooth. This leaves
a posrerior "stop" in order to maintain the vertical dimension ofocclusion.
. Second step: after the posterior rcsidual ridges exiibit acc€ptable clinical healing, the second phase of
rreament, that ofdenture fabrication, can begin. The anterior teeth will be extracted at the time ofdcnnrrc
lnsertlon.
*** This is false; it is a record used to orient the maxillary cast to the hinge axis on the
articulator.
J
"",f {.
;
"t
T = Tragus ofear OC = Outer canthus of the eyes
Several varieties of arbitrary face-t ows are available. All are based on an average lo-
cation ofthe hinge axis and will yield an enor of2 mm or less in the majority ofpatients.
Arbitrary rotational centers are generally located over measured points on the face or by
some type of earpiece. One average measurement (above picture) places the rotational
point 13 rnm anterior to the distal edge of the tragus of the ear' along a line from the
superior-inferior center ofthe tragus to the outer canthus of the eye. The condylar styli
of the face-bow are then placed directly over the dots.
. Is placed 3 mm posterior to the vibrating line
. Is not necessary when fabricating a complete denture on a patient with a flat palate
. Will vary in outline and depth according to the palatal form ofthe patient
26
CopriShr C 201 I 'l0l: - Dental Decks
. Pterygomaxillary notch
. Vibrating line
. Hamular process
. Fovea palatinae
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CopFighr O 201l-2012 - D€nlal Deks
Posterior Palatal Seal
The posterior palatal se|l is completed before the final arangement ofthe posterior teeth because this firal
arrangement is a laboratory procedure and is done in the absence of the patient. The anterior lilre that indi_
cates the location ofthe poste or palatal sealis drawn on the cast in fiont ofthe line indicating the end ofthe
denture. The width ofthe posteriorpalatal sealitselfis limited to a bead on the denture that is I to 1.5 mm high
and 1.5 mm broad rt its base. A greater width creates an area oftissue placement that will have a tendency
ro push the denture downward gradually and to defeat the purpose ofthe posterior palatal seal ln other words,
rhe posterior palatal seal should not be made too wide.
A !'-sh|ped grcove I to 1.5 mm deep is carved into the cast at the location ofthe bead. A large, sharp scmper
is used to carve it, passing through the hrmuler notches and across the palate ofthe cast. The $oove will form
a bead on the denture that prcvides the posterior palatal seal. The b€ad will be I to 1.5 mm high, 1.5 mm
wide at its base, and sh|rp tt its apex. The depth ofthe grooves will be determined by the thickness ofthe
soft tissue against which it is placed and will establish $e height of the bead.
Note: Excessive depth ofthe posterior palatal seal will usually result in unseating ofthe
denture.
Remember: The posterior palatal seal will vary in outline and depth according to the
palatal form of the patient.
. Retrognathic appeaxance
. Narrowing of lips
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Cop}Tighr O 201 1,2012 - Dertal Decks
r ln rhc nnraaloin
. In the metal
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Copyrighl O 20ll-2012, Dent.l Decks
It must bc emphasized that one or more of these items are also frcquently encountered in per-
sons with intact dentitions because the compromised facial support of the edentulous state is
not the cxclusive cause of thc morphological changes. Patient's weight loss, age, and hcavy
tooth attrition manifest orcfacial changes suggestive ofcompromised, or absent, dental support
for the overlying tissues.
Pre-extraction guides for selecting afiificial teeth from edentulous patients include:
. Photographs: provide general information about width and possibly outline fonn.
. Diagnostic casts: the form of the teeth can be very well judged from previous diagnostic
casts ofnatural teeth , if available (check with the patient's prerious dentist).
. Intra-oral radiographs: the size and form can be d€termined but beware because radi-
ogmphs can be distorted and usually are larger images ofthe tccth.
. The teeth of close relatives: when no other means are available to get an idea about the
form, size and shade of teeth to be used for thc denture of an edentulous patient, records of
son's or daughter's teeth can give a clue. lt may also help in the arangement ofteeth as well
. Extracted teeth: sometimes patients keep their cxtracted teeth, which could be an excellent
source and aid to delineatc the form ofthe teeth, thus helping in the selection process.
1. Degenerative joint disease is frequently scen in denture wearen but this may be
age related rather than the state ofthe dentition.
2. The recording of centric relation is considered as an essential starting point in
the design ofthe artificial denture.
3. ln complete denture prosthodontics the position ofthe maximum planned in-
tercuspation of teeth or centric occlusion, is established to coincide with the pa-
tient's centric relation.
One of the major reasons for the acceptance ofporcelain fused to metal restorations is
its greater strength and resistance to fracture. The combination of porcelain and metal,
fused together, is stronger than porcelain alone. Because true adhesion occurs, the bond
strength is such that failure or fracture will occur in the porcelain farther than at the
porcelain-metal interface.
Rememb€r: Porcelain is much stronger under compressive forces than it is when sub-
jected to tensile forces by the opposing teeth. Porcelain fracture in all-ceratnic restorations
can be avoided by keeping the angles ofthe pr€paration rounded.
. Porosity
. Thickness
. Surface area
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CopFight C 201 l-2012 - Dental Decks
. A limited number ofedentulous areas which would not otherwise be more satisfactorily re-
stored with a removable partial denture
. The need to prevent the over-eruption ofopposing teeth and the ddft of teeth neighboring
the edentulous space
. The presence of suitable abutment teeth favorable crowr/root ratio, adequate alveolar
support, absence ofapical pathology, etc. -
. Esthetics
. Patient motivation, including time availability
. Clinical and technical ability
A good solderjoint between 2 castings requires clean surfaces and fr€e electrons pres-
ent on the surfaces.
Note: The bonding ofthe solder is contingent upon wetting ofthejoined surfaces by the
solder, and not upon melting ofthe metal components.
Cleanliness is the most important prerequisite ofsoldering, since the soldering process
depends upon wetting ofthe surfaces to achieve bonding. Fluxing is the oxidative clean-
ing ofthe area to be soldered. Fluxes are used to dissolve surface impurities and to pro-
tect the surface from oxidation while heating. Note: Fluxing is also performed on molten
metal alloys during the casting ofa crown or partial denture framework.
l. If the clinical and technical skills ofthe dentist do not match the demands
\ote+ ofthe case, fixed bridgework should not be undertaken because a failed bridge
'.;** . is likely to be more detrimental to dental health than a failed removable partial
d€nture.
2.Unless specifrcally contraindicated, fixed restorations are always the treat-
ment of choice.
3. Fixed bridgework can be used in conjunction with removable partials. Ex-
ample: A patient with a couple ofmissing anterior teeth and no posterior teeth.
Treatment could be fixed bridgework in the anterior and a partial denture re-
placing posterior teeth.
4. Although somewhat controversial, the literature recommends that you should
not splint natural teeth and implants in a fixed partial denture. Implants
have no periodontal ligament and so do not have the same capacity to ab-
sorb shocks as do natural teeth (they have dffirent mobilityb). When this
bridge is subject to occlusal loading, the difference has been shown to be
detrimental to the natural teeth as well as cause bone loss around the im-
Dlants.
. Periodontal disease
. Recunent caries
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Coplrigh O 201 l-2012 - Dental Decks
All of the following are indications for porcelain veneers EXCEPT one,
Whieh one is the -EXCEPZOfr?
Advantages of using a post and core as opposed to a post crown when restoring en-
dodontically treated teeth:
. The marginal adaption and fit ofthe restoration is independent on the fit ofthe post
. The restoration can be replaced at some time in the future, ifnecessary without dis-
turbing the post and core
. Ifthe endodontically treated tooth is to serve as a bridge abutment, it is not neces-
sary to make the root canal preparation parallel with the line of draw ofother prepara-
tions it can be treated as an independent abutment
-
The post and core, when used, is made separate from the final restoration. The crown is
then fabricated and cemented over the core just as a restoration would be placed over a
preparation done in tooth structure.
For teeth with little or no clinical crown that have roots with adequate length, bulk, and
straightness, a post and core can be utilized. For posterior teeth with less extensive de-
struction ofcoronal tooth structure, or for those possessing less favorable root conhgura-
tions. a pin retained amalgam or composite core can be used.
*** Other contraindications to porcelain veneers include: traumatic occlusal contacts, un-
favorable morphology, insufficient tooth structure, and insumcient enamel.
. Two
. Thiee
. Four
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Cop,.righl O2011,2012 - Denral Decks
. Maxillary premolar
. Mandibular premolar
. Mandibular molar
. Maxillary molar
35
Coplright @ 201 I -20 12 - Dental Deck
Important: One factor that limits th€ length ofthe pontic span is the abutm€nt teeth's ability to accept the ad-
ditional occlusal load while providing adequatc support to the cemented fixed partial denturc. Ant€'s law stales
that the root surface arca ofthe abutment tcelh supported by bone must equal or surpass the root surface area
ofthe teeth being replaced with pontics.
An edentulous spacc involving four adjacent te€th otherthan four incisors is usually best treated lvith a re-
movable partial denlure. [f more than one edentulous space exists in the same arch, even though each of
thcm could be individually rcstorcd with a bridge, it may be dcsirable to restore them with a removabie par-
tial denture. This is especially true ifthe spaccs arc bilateral and each one involves two or more missing teeth
Third molars can rarely be used as abutments, sinc€ they fiequently display incomplete eruption; shon, fused
roots; and a marked mesial inclination in the absence ofa second molar Note: Diverging multirooled, curv€d,
and broad labiolinglal roots are prefened over fused, single, conical, and round circumferential roots.
Remember:
. Splinling adjacent abumlent teeth in a fixed bridge is primarily done to improve the distrit ution ofthe
occlusal load,
. In order to maintain and protect the health ofthe gingival tissues and prcvent recession, lhe correct con-
tour of the cro$n's gingival one-third to one-fifth and interproximal areas are most impofiant in the final
restoratioD,
.An anterior fixed bridge is contraindicated when there is considerable resorption ofthe r€sidual bridge.
A removable panial denrure would be indicated in this case.
. Horizontal loads 1ol &,c"t on natural or abutmcnt teeth are most deslructive to the pcriodontium.
. Abuimenls with hatfor l€ss ofbone support and loss ofattachment have a poor prognosis.
. \\'hen replacing the maxillary or mandibular canine, the central and lateral should be splinled to prcvent
lateral drifting oflhe fixed bridge.
. Aburment teeth must align to a common path of insertion (/o/ orvious reasons when lryng lo seat lhe
hrklge).
. Short root-to-crown r^lio (less lhan./:21 with conical roots should be avoided as abutmenls.
. \atural reeth exert more force than an RPD or complete denture when opposing a fixed bridge
. Ideaff)--, rhe supportive surface area (peiodontium) of lhe abutment teeth should be equal to but not
leis than !ha! ofthe teeth to be replaced
This design preserves the lingual surface and is indicated for restoring mandibular mo-
lars with damaged buccal surfaces and intact lingual surfaces. It is also useful on teeth with
severe lingual inclinations where large quantities oftooth structure would be destroyed if
a full veneer crown were to be used.
The standard thre€-quarter crown is a partial veneer crown in which the buccal sur-
face is left uncovered. It is the most commonly used form ofthe partial veneer crowns.
A patient with a high cari€s index, short clinical crowns, and minimal horizontal over-
lap would not be a candidate for partial veneer crowns. The restoration ofchoice would
be a full metal-ceramic crown,
Note: R€tention and resistance forms in full coverage preparations on short molai:s can
be enhanced by placing several vertical grooves or boxes.
According to the ADA classification for alloy systems used
for metal-ceramic restorations. noble allovs:
36
Copyright O 201l-2012 - Dental Decks
. \\'ithin the sulcus at least 1.0 mm and away from the free gingival margin without
encroaching on the biologic width
. Supragingival whenever possible (at least 0.5 mm from the free gingival ntargin) to
allow for hygienic cleansing
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Cop)righr O 20ll-2012 Dental Decks
ADA classification for alloy systcms uscd for metal-ccrumic rcstontions
. High noble alloys (old tem was pre.ious netal)t > 60o/n noblc rr'ctal contcnt (gold > 40%)
. Nobfe alloys (o// ter"r, tr^r senripreciout metal): > 2570 noblc mclal contcnt ( o gold rcquircd)
. Base metaf affoys foll term was nonptecious metal): < 25y. notle fielzl conlent (tro god requile,l)
Remember: Noble alloys (gold, plaainuD\ and po adium) do not oxidize on casting. This featurc is important in a
mctal substmte so that oxidation althc metel-porcehin interface can be controlledby thc addition oftracc clcmcnts
to thc metal (silicon, ituiiun, and iridiunl .
Porcclain adhercs to mctal primarily by a chemical bond, A covalent bond is cstablished by sha;ng 02 with thc cl-
cmcnts prcscnt in thc porcelain and the mctal alloy. These clemcnts includcsilicon dioxidc (SlO, in lheporcclain and
oxidizing clcmcnts such as indium, tin, and gallium in thc mctal alloy.
*** There is general agreement among dentists and researchers that optimum fixed pros-
thetic restorations will display supragingival finish lines.
Such positioning is quite often not possible because ofesthetic or caries considerations.
Subsequently. the margin must be placed subgingivally. Ifa margin needs to be placed sub-
gingivally, the major concem is not to extend the preparation into the attachment appa-
ratus. Ifthe margin does extend into the attachment apparatus, a constant gingival irritant
has been constructed and ultimatety the crown will fail. In this case, the tooth should
have had crown lengthening performed on it prior to final crown preparation.
Rememb€r: It is important to maintain the biological width (the combined width of the
connective tissue attachment and thejunctional epithelium, which averages approximately
2 mm).
The most important criterion for a gingival margin on a crown preparation is that its
position is easily discemible be able to recognize it easily. Note: The most com-
-must
mon complaint oflab technicians regarding a PFM prosthesis is improper margins in the
impression.
Rememb€r: The optimum margin for a casting is an acute edge with a nearby bulk of
metal. This acute edge or angle can be easily bumished to improve its fit.
Note: A butt joint, as gpified by a shoulder, is the poorest type offinish line that can be
used with cast metal restorations.
When casting conventional gold rlloys, which type
of investment mat€rial is used?
. Silica-bonded investments
. Phosphate-bonded investments
. Gypsum-bonded investments
. The metal and porcelain must have compatible melting temperatures as well as com-
palible coe{ficient of thermal expansions
. The metal's melting temperature should be at least 300-500"F higher than the fusing
temperature of the porcelain
. The metal coping should preferably have sharp surfaces to prevent shrinkage of the
porcelain
. In function, glazed porcelain on the occlusal surface removes 40 times as much ofthe
opposing tooth structure than gold
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Coplright O 201 l-2012, Denral Decks
A dental inyestment is a refractory material that is used to surround the wax pattern during the
procedure of fabricating thc metallic p€rmanent restoration. It forms the mold into which the
alloy is cast after the wax has been eliminated.
An investment material to be used for a casting mold should expand on setting and heating to
compensate for the shrinkage of molten metal as it solidifies. Metal casting alloys have diffcr-
ent melting ranges pure metals and alloys of eutectic composition have a melting point.
The melting range-only
of gold casting alloys (aprox. 900'Q is lower than that of Co-Cr alloys
(aprox. 1350'C), Therefore, investment materials used for gold casting alloys arc sometimes
different from those used for Co-Cr alloys. The investment material should be ofa suitable con-
sistency for adaptation to the wax model and have a reasonable setting time. To withstand the
temperatures required for the casfing process there should be no distortion, no decomposition;
thc investment should not fragment or disintegrate under the impact ofthe molten metal: the ma-
terial should be porous to allow the escape ofair and gases and the investment should be easily
removed from the casting after cooling.
Classification of Dental Investment Materials
. GJ-psum-bonded investments: binder is gypsum (calcium sulfate hemihydrate). Used'
when casting conyentional gold alloys containing 65yo to 75y. gold at temperahrres near
1.100'c.
. Phosphate-bonded investments: binder is a metallic oxide and a phosphate. Two lypes :
Ti pe I is used when casting base metal alloys for rnetal-ceramic crowns and Type II is used
for removable partial denhrre frameworks. Are capable of withstanding high temperatures
/abote 1,100"C).
. Silica-bonded investments: binder is ethyl silicate. Not used much today.
The refractory material for thcse invcstments is either quartz or cristobalite. This material pro-
lides the thermal expansion for the investment. Note: The expansion of the investment pro-
vides a larger mold to compensate for the subsequent contraction ofthe alloy.
*** This is fals€; the metal coping must have all of its surfaces smooth and rounded to pre-
vent porcelain shrinkage.
Note: The purpos€ ofthe metal coping is to ensure the fit ofthe crown and to maximize the
strength ofthe porcelain veneer.
Important points to remember conceming the metal coping or substructure ofa metal-ce-
ramic ctown:
l. The metal must have proper thickness (0.5 mn) very important
2. The outerjunction ofporcelain to metal should be- at a right angle (to avoid burnishing
oJ the metal and subsequent f-acture of the porcelain).
3. All ofthe porcelain should be supported by metal.
When deliv€ry cast restorations, the following sequence should be used: (l) check the in-
temal surface fit (2) adjust the proximal contacts and pontic-ridge relationship (3) check the
maryinal integ ty (4 )check the stability (ifit is a bridge) (5) check the axial contours and last
but not feast, (6) check the occlusion (centric qnd eccentrtic contacts).
Important: If your margins were all closed at the metal try-in appointment and when the
crown came back from the lab they are all open, check the contacts. They are probably too
ttght (over-bulked porcelain).
' ' . -. I . Porcelain that is baked onto a high-fusing gold alloy may exhibit a green discol-
;'Note{ oration due most likely to contamination of the metal by copper traces.
W 2. The best measure ofthe potential clinical performance ofa casting alloy is its
ADA c€rtification.
. Eniances resistarce form when buccal-tolingual forces are applied
. Relieves the functional cusp from additional stresses when the restoration is loaded in
the long axis ofthe tooth
40
Copynghr O 201 l':012 - Detual Deks
The preparation for a full veneer crown is begun with occlusal reduction. There
should be clearance on the functional cusps and rbout _
on the non-functional cusps.
. L5 mm; 1.0 mm
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CoplriSht O 201 1,2012, Denial Decks
The functional cusp bevel is an area ofreduction over the functional cusps that allows for cxtm
thickness ofmetal in this area ofhealy occlusal contact in centric occlusion as well as in lateral
movcments. The functional cusps are those that oppose thc ccntral fossae ofthe t€eth in the op-
postte arch (buccal cusps on mandibular teeth, lingual cusps on ma-tilldry teetu.
Thc primary reason for choosing a r/4 crown over a full cast crown is tooth structure is spared.
Other advantages to the use of partial veneer restorations (three-quarter & seven-eighths
crowns).
. A great deal ofthc margin is in an area accessible to the dentist for finishing and to the pa-
tient for cleaning.
. Less ofthe restoration margin is in close proximity to the gingival crevice, thus lessening
the opportunities for periodontal irritation.
. Can be more easily seated completely during cementation.
. with at least part ofthe margin visible, complete seating ofa partial veneer crown is more
easily verificd by direct vision.
. Ifit is evernecessary to conduct an electric pulp test on the tooth, a portion ofenamel is un-
vcneered and accessible.
.. , 1. The path ofinsertion ofan anterior three-quarter cro*'n parallels the incisal l/2
,\orec to 2/3 of the labial surface, not the long axis of the tooth. For a posterior three-
,"-;* quarter crown it parallels the long axis ofthe tooth.
2. A pin modified three-quarter crown can preserve the facial surface and one prox-
imal surface. This is preferred in cases which require repairing of severe lingual
abrasion on incisors and canines, avoiding other more destructive options like full
veneer metal-ceramic restorations.
Thjs reduction is done to eliminate undercuts and create space for suffcient metal to ensure adequate
strength ofthe crown.
Remember: In preparing a tooth for a metal-ceramic crown, it is necessary to create space for 0.5 mm
ofmetalpfus at lcast 1.0 mm ofporcelain lpreferably 1.5 mu) to cnsure adequate strength and optimum
esthetics of the ceramic material. Snpporling (fuhctiotlal) cusps require 2 mm of the reduction The
opposing walfs should convcrge no more than lO degtecs (6 degree tapet is reconmended). A chamfer
finish line /0.i l?r, and a1l maryins should be placed supragingivally when possible.
The same amount ofoverall tooth reduction is needed for a metal-ceramic crown as for an all-cerarnic
cro*n / L 5-2.0 nn). Howevet for all-cersmic restorations, the preparation needs to be well-rounded
\\ irh no shrrp angles to avoid porcelain liacture.
\ote: The most frequent causc of failure of a crown (reganlless ofa,hich ,*pe) is the lack of attention
ro rooth shape, position, and contacts.Important: For gingival health, the conect contour ofinterprox-
imal gingival areas and the gingival third are most important.
Important: Gold is regarded as a more favorable material for the occlusal surface as its wear charac-
reristics are more in harmony with enamel; porcelain is considered to bc the cause ofaccelerated wear
of the opposing dentition. Gold would certainly be preferred for the restoration ofocclusal surfaces in
rhe presence ofa tooth-grinding h.bit.
.. l. Axial contours should correspond to the emergence prolile (usually flat or concave) of
:{oteCl the tooth.
2. The buccolingual dimension of a cast restoration is usually determined by the occlusal
ja*
morphology oflhe opposing tooth.
3. Occlusal point contacts between opposing teeth arc preferred to broad, flat occlusal con-
tacts to Dlevent weaf.
4. Type I and II gold alloys are uscd for inlays.
5. The most commonly used type ofgold for all-metal crowns and bridges is TyPe III.
Which ofthe following best describes 'rstrain hardening't
or 'rwork hardeningrt?
42
Coplright O 20ll 2012 - Denral Decks
. A metal is elevated to a temperature above room temperature and held there for a
length of time
43
Coplrishr O 20ll'2012 - Dental Decks
In polycrystalline metal, dislocations (defects) tend to build up at the grain bound-
aries. Also, the banier action to slip at the grain boundaries causes the "slip" to occur
on other intersecting slip planes. Point defects increase and the entire grain may
eventually become distorted. Greater stress is required to produce further "slip" and
the metal becomes stronger and harder. The process is known as strain hardening
or work hardening. The latter term is derived from the fact that the process is a re-
sult ofcold work ( i.e., deformation at room temperature, in contrast to the effect of
working at a higher temperature, such as in forging). The ultimate result ofstrain
hardening, with further increase in cold work, is fracture.
The phenomenon ofcold work and strain hardening is familiar to everyone. For ex-
ample, one way to cut a wire is to bend it back and forth rapidly between the fingers.
When all the slip possible has occurred, the wire fractures.
Important: The surface hardness, strength, and proportional limit of the metal are
increased with strain hardening, whereas the ductility and resistance to corrosion are
decreased. However, the elastic modulus is not changed appreciably.
It is usually performed when complete gold crown is cast and immediately quenched in
a
u ater. This softens the alloy, making it more malleable for frnishing procedures.
Important: To achieve a softened condition for a Type III dental gold alloy, the casting
should be quenched in water immediately or within 30-40 seconds ofbeing made.
44
Cop)righr O 20ll-2012 - Dental Decks
. Be perpendicular to the incisal one-half of the labial surface rather than the long axis
of the tooth
. Be parallel to the incisal one-halfto two-thirds ofthe labial sudace rather than the long
axis ofthe tooth
. Be parallel to the cervical one-third ofthe labial surface rather than the long axis of the
tooth
45
Cop)'righr C 201 l'2012 - Dental D€cks
Dowel cores do not require as much expansion as do crowns. So even though they are
cast with Ag-Pd alloys (alloys that require a high temperature for expansion) , a gypsum
bonded mold is used and heated to only 1200'F. Type I, II, and III Gold alloys can also
be cast in g]?sum bonded investmen! material.
The substructures for metal ceramic crowns ard Type IV Gold requires heating above
2100'F. These are invested in phosphate bonded material. Any alloy with a casting
temperature in excess of 2100'F (115f" C) shouldbe cast in an invesfinent with a binder
other than gypsum. High temperatures cause decomposition of calciurn sulfate in the
gypsum binder with the resultant release ofcontaminating sulfur into the mold.
The metal-ceramic alloys must have a high melting range so that the metal is solid well
above the porcelain baking temperatures to minimize distortion (sag) ofthe casting dur-
ing porcelain procedures. A high sag factor will lead to distortion of bridge spans when
the porcelain is fired. Remember: When casting a cedain alloy, make sure you use a cru-
cible that has not been used for other allovs.
*** Important: If the path of insertion is made parallel to the long axis ofthe tooth, the
labio-incisal comer will be sacrificed and an unnecessary display of gold will result.
Two factors that must be dealt with successfully to produce an anterior % crown with a min-
imat display ofgold:
l. Path of insertion and groove placem€nt
2. Placement and instrumentation of extensions
. Proximal extensions must be done with thin diamonds and hand instruments from a
lingual approach to minimize the display ofgold. They should be extended facially to a
cleansable area without destroying the facial contour ofthe tootlt.
Note: The anterior three-quarter crown is not used as fiequently today as it once was. Un-
sightly and unnecessary displays of gold in poor examples of this restoration have made it
less popular with the public and dentists alike. However, the standard three-quarter crown
on a maxillary anterior tooth need not show large quantities ofgold ifprepared correctly.
. The length ofthe abutment teeth can be accurately gauged
. The presence ofperiodontal pockets and the crown-to-root ratio of potential abutment
leeth
46
CopFight O 20ll 2012, DentalDecks
. With regard to the ease of cleaning and good tissue health; proper pontic design is
more important than the choice of material used in fabricating the pontic
. The contour and nature ofthe pontic contact with the ridge is very important
. The area ofcontact between the pontic and the ridge should be small
. The portion ofthe pontic approximating the ridge should be as concave as possible
.The pontic should exert no pressure on the ridge (pdssive contact with no blanching
ofthe tissue)
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Cop)righr (, 201I -2012 - Dental Decks
*** Important: The presence ofperiodontal pockets and the crown-to-root ratio ofpotential abut-
ment teeth cannot be determined by studying diagnostic casts. You need to do an exam and have
x-rays in order to obtain this information.
More information that can be obtained by studying the diagnostic casts:
. It allows an unobstructed view ofthe edentulous areas and an acaurate assessment ofthe span
length, as well as its occlusogingival dimension.
. The curvature ofthe arch in the edentulous region can be determined, so that it will be pos-
sible to predict whether the pontic(s) will act as a lever arm on the abutment teeth.
. A thorough evaluation ofwear facets, their number, size, and location is possible when they
are viewed on casts. Excessive wear on occluding surfaces ofteeth usually results from a dishar-
mony between centric occlusion and cenhic relation.
*** This is false; the portion ofthe pontic approximating the ridge should be as conv€x as pos-
sible.
Pontic design and selection directly impact periodontal health. Pontics should contact kera-
tinized attached tissue and rest passively, free ofpressure, to prevent ulcerations and plaque
buildup. Pontic designs with concayities (such as the saddle-shaped pontic), are difiicult to
clean because oftbe depression on their inner surface is inaccessible to conventional methods
oforal hygiene. Egg- or bullet-shaped pontics are the easiest to clean because they are con-
vex in all aspects and contact the residual ridge at a single point.
Most important: Whatever pontic is used, it must be properly designed to prev€nt an un-
healthy response to the underlying ridge mucosa. The pontic must:
. Be nonporous, smooth, and have a polished surface
. Make passive pinpoint contact with the gingival tissue
. Not be concave in two directions
. Be readily cleanable by the patient
. Be narrow€r at the expense of the lingual aspect of the ridge
. Be on as straight a line as possible between the retainers to prevent any torquing ofre-
tainers or abutnents.
Important: Excessive tissue contact has been cited as one ofthe major causes of failure of
fixed bridges.
Glazed porcelain, polished gold, unglazed porcelain, and polished acrylic are prefened in
that order for their acceptability to the soft tissue.
. J: I
.l:l
. 1:2
.l:l
a8
Cop)nght @ 201 1,201 2 , D€ntal Decks
. Sodium pyroborate
. Alum
. BoraK
. Silica
49
Coplright O 2011,2012, Dental Deck
This high a ratio is rarely achieved, however, and a ratio of 2:3 is a more realistic
optimum. A ratio of l:1 is the minimum ratio that is acceptable for a prospective abutment
under normal circumstances.
The crown-to-root ratio alone is not adequate criteria for evaluating a prospective abu!
ment tooth. Root configuration is an important point in the assessment ofan abutment's
suitability from a periodontal standpoint. Roots that are broader labiolingually than they
are mesiodistally are preferable to roots which are round in cross section. Multi-rooted
posterior teeth with widely separated roots will offer better periodontal support than
roots which converge, fuse, or generally present a conical conhguration. Single-rooted
teeth with an irregular configuration or with some curvature in the apical third ofthe root
are preferable to the tooth which has a nearly perfect taper. Root surface area of the
prospective abutments should also be evaluated.
Soldering flux dissolves surface oxides and allows the melted solder to wet and flow onto the
adjoining allow surfaces. It is composed of sodium pyroborate (5 5%.), borax (35%.), and sil-
rca ( 10%) .
In addition to the usual reducing and cleaning agents incorporated in a flur, a flux used for
soldering stainless steel or cobalFchromium alloys also contains a fluoride to dissolve the
passivating film supplied by the chromivm (chromium osidey'lz). The solder will not wet the
metal $ hen such a film is present. Potassium fluoride is the most common agent.
Soldering is thejoining ofmetal components by a filler metal, or solder, which is fused to each
ofthe pans beingjoined. To be biologically and mechanically acceptable, a solderjoint should
be circular in form and occupy the region ofthe contact area. The strength ofthe solderjoint
is increased by increasing the height ofit (as opposed to the wldlr. Not€: The recommended
distance /i|ldrlr/ between the parts to be joined should be 0.25 mm.
Cleanliness is the prime prerequisite ofsoldering. Corrosion products, such as oxides and sul-
tides that are present as a result ofthe casting process, interfere with bonding. Flux is placed
on the surfaces to be soldered before they are heated. When it melts, the flux displaces gases
and removes conosion products by either combining with them or reducing them. The flux
in tum is displaced by the solder, which can now form an interface with and bond to the sur-
face being soldered.
Note: Antiflux is a material used to outline the area to be soldered in order to restrict the flow
of solder. The most common antiflux is a soft graphite pencil. Iron oxide (rouge) may also
be used.
. The saddle-ridgeJap pontic
. An ovate pontic
. A conical pontic
50
Cop}tghr O 20ll-2012 - Denlal Deck
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Coplright O 20ll 2012, Dental Decks
The pontic is the suspended member ofa fixed bridge that replaces a missing tooth. This
tooth substitute must provide patient comfort, convenient contours for hygiene, and be
esthetic, if indicated.
Most Common Pontic Designs:
. The sanitary @1,glenic) pontic design leaves pontic and the ridge.
a space between the
Is most commonly used where esthetics are not important (nonqppearance zone, pos-
terior mqndible). Convex in all areas.
. The saddle-ridge-lap pontic design looks most like a tooth. Covers the ridge labi-
olingually with a large concave contact. Impossible to clean, should not b€ used.
. The modified ridgeJap pontic design uses a ridge lap for minimal ridge contact.
Gives the illusion ofbeing a tooth, but possesses all convex surfaces for ease ofclean-
ing. This design is the one of choice for pontics in the appearance zone (where es-
thetics are important) for both maxillary and mandibular bridges.
Conical pontic: rounded (rop) and conical (bottom). Suited for molars without esthetic re-
quirements (in non-appearance zone).
Olat€ pontic: a sanitary substitute for saddle-ridge-lap design. Set in the concavity ofthe
ridge hllicl is eilher ptesent or surgically made)that gives the appearance that it is grow-
ing from the tooth.
"t li.rcasins a cement's po$dcr,lo,liquid ratio decrcases thc solubility ofrhe ccmcnr.
Lutins agents /.prrdrrt:
. Zinc phosphaae cement: onc ofthc oldesr and most widcly uscd ccmcnts, zinc phosphatc ccmcnt is thc stan-
Jrd rlirinst $hich nc$ ccmcnts arc mcasulcd. Advantages: Iong rccord ofclinical acceprability, high compres-
.:': strcngth. acccptably thin film thickncss. Disadvantages: low initial pH which may lcad to poslccmentation
.:rr:trr rtr'. lack ofan abilily to bond chcmically to tooth structure and lack ofan anlicariogenic cflcct.lmportant:
Z:n. phosfhatc ccmcnt is mixcd using thc "frozen slab" rcchniquc which grcarly cxtcnds thc working timc fb.t,
J ' .ak h as 340'i;). Note: Tlc pH of ncwly mixcd zinc phospharc ccmcnt is |ndcf 2 ( tbo lalers ol vtnish m sl
;.)ep!ieloraftlertoprotectthepulp)blJtnscslo5.9within24boursandisncarlyneutralat.l8hours.Thcfilm
ra:.kn.ss ofzinc pbosphatc is about 25 !rm-
. Zinc pohcarbor]late cement: also known as zinc polyacrylarc ccmcnq was one of the first chemically adhe-
site denial mate.ials. Thc adhcsivc bond is primarily to cnamcl although a wcakcrbond io dcntin aiso forms. This
:. Ju. ro rhe faci that bonding appcars lo be the rcsult ofa chelation rcaction bcrwccn the carboxyl groups of rhc
.J:x.nt and calcium in thc tooth structure; hencc, tlrc more highly mincmlizcd Ihc tooth structure, rhe sronger the
:{nd.\drsntsges:kindlothepulp,chcmicallybondslotoorhstrxchrre.Disadvantagestshortworkingtimc,rc,
;urrss scparalc tooth conditioning stcp prior to ccmcnlation. Note: il is more viscous whcn mixed and has a shorle.
\rrking timc than docs zinc phosphate cement.
. Class ionomercement: Advantages: chemical bond ro cnamcl and dentin, anticariogenic cflcctlrcleases
Iu,
,rr,1r. cocllicicnt oftbcrmal cxpansion similar to that oftooth structurc, high comprcssivc strcngth, low solubil-
:n Disadvantages: low initial pH which may lead to postccmentation scnsiriviry. scnsirivity ro both moisturc
.onramination and dcsiccation. Notet Its mcchanical propcrties arc supcrior to zinc phosphatc and polycarboxy-
. Resin-modified glass ionomerluting agents; have propcnics similarto glass ionomcrccmcnts. but have higher
5trenglh and lower solubility. Note: Thcy should not bc uscd wilh all-ccramic rcstorations dues to rcports ofcc-
r3nlic fracturc, most likcly thc rcsult ofcxpansion from watc. absorprion.
. Resin luting agentsr arc unfillcd resins that bond to dentin, which is achicved with organophosphonatcs,
/2-1,)-
dro]reth\ I ttrcthacrylate IHEMAII, or 4-mcthacryloyloxycthyl trimellirarc anhydridc (4-Mf,TA). Advanrrges:
hr!h comprcssivc strcnSth, low solubility. Disadvant.ges: irritating cfl'ects on thc pulp, high film thichcss p -?J
1]r'l. Note: As a gcncml nrlc, rcsin cements are thc bcst choice for luting ccramic rcstorarions_
Important: Thc film thickncss at thc margins shouid be minimizcd to rcduce the solubility of the luting agenr.
Tl.ough c|rcful tcchnique, a marginal adaptation below l0 pm can bc obrained consistcntly. Noter Factors that in,
.r.asc the cement spacc for crowns include (l) thc usc ofdic spacers (2.)incrcased expansion ofthc investmcnt mold.
. Zinc phosphate
. Zinc polycarboxylate
. Glass ionomer
. Shoulder
. Chamfer
Microleakage Very low High High to very Low to very low lligh to very
high high
l.
Cemenrs do not rdd to the retentive chamcteristics ofa crown. Ccmcnts act by increasing the fric-
tional rcsistance between tooth and restoration. Thc ccmcnt prcvcnts two surfaccs from sliding. Al-
though they do not prcvcnl onc surtacc from bcing liftcd from another
2. A toolh should bc wiped dry before cementation ofa crown as opposcd to drying the tooth with al-
cohol and warm airto dccrease the possibility ofpulp damagc.
3. Always apply cement to both the rcstoration and tooth.
4. One way to rcducc thc potential for post-cementation sensitivity with zinc phosphate and Slass-
ionomcrccmcnts is to use a resin based descnsitizeron thc prcparcd tooth p.ior to luting.
5. Cement film thickncss is dependent upon powder-to-liquid ratio, powdcrparticle sizc, and pressure
gencratcd dunng seating of the casting.
However, in practice this finishing line is difficult to read on both the impression and die and may lead
to inaccurate extension and also distortion ofthe wax pattem, and subsequent casting, as a result ofthe
thin wax. It also offcrs the least margid.l strength to the casting-
The chamfer prepamtion is the preferred linishing line for cast gold restorations. The resultant cast-
ing has sufficient marginal strength; at the same time it allows the slidingjoint at its periphery to mini-
mize the gap between the tooth and preparation, thus rcducing the thickness of the cement. A
well-prepared chamfer margin combines the advantage of an easily definable margin, on both the im-
pression and die, with minimal tooth prcparation.
The shoulder preparation is the finishing line of choice for porcelain jacket and tll-ceramic crown
preparations, The edge strength of porcelain is low; therefore, a butt joint is required. The shoulder
provides resistancc to occlusal forccs and minimizes stresses in the porcelain. The margin can be easily
read on both the impression and die. The main disadvantage is that any inaccuracies in the fit ofthe
cro$n Nill be reproduced at thc margin, resulting in an increased thickness ofcement.
Tle should€r with a bevel allows a sliding fit to occur at the margin and therefore may be used on thc
proximalbox ofinlays and the occlusal shoulder ofthe mandibular three-quarter crowns ltmayalsobe
used for the labial margins ofmetal-ceramic crowns. Providing these margins are placedjust in the gin-
gival crevice, little display ofmetal will be noted.
Four Tlpes of High-Gold Alloys:
l. ADA t-ype I highest gotd content, 83o/o noble metals. Intended for small inlays. Easily bumished
due to high ductility.
2. ADAtype II: $eatcrthan 78olo noble metals. Intended for larger inlays and onlays. Can also be bur-
nished.
3. ADA type UI: greater than 75o% noble mctals. Intended for onlays and crowns Capable ofbeing
heaFtreated.
4. ADA type Iv: greatcr than 7570 noble metals. Intended for bridges and removabJe partial dent-
ures Also capable ofbeing heat-treated. Hardest ofhigh-gold alloys.
. The diameter of the sprue pin should be equal to or greater than the thickest portion
of the pattem
. The diameter of the sprue pin should be equal to or smaller thar the thickest portion
ofthe pattem
. The diameter of the sprue pin should be equal to or greater than the thinnest portion
ofthe pattem
. The diameter of the sprue pin should be equal to or smaller than the thinnest portion
ofthe pattem
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Cop'.righr O 2011-2012, Dental Decks
.Akey
. A keyway
A 10 gauge sprue pin can be used on most patterns, while the l2 gauge is used on small
premolar pattems. The sprue should be attached to the wax pattem at its point ofgreatest
bulk and at an angle (45) that will allow the incoming gold to flow freely to all portions
of the mold. Spruing at a thin area of the pattem can produce the same result as using a
sprue that is too small back porosity. This is caused by turbulence in the flow
ofthe molten metal which-shrink
in tum creates a shrinkage void, or suck-back porosity.
Note: Low investment permeability and insullicient wind-up of the casting machine
may also cause this shrink back porosity.
The most commonly used nonrigid design consists ofa T-shaped key that is attached to
the pontic and a dovetail keyway placed within the retainer. The path ofinsertion ofthe
key into the keyway should be parallel to the pathway of the retainer not involved with
the keyway.
Its use is restricted to a short span bridge, replacing one tooth. It is indicated when re-
tainers cannot be prepar€d to draw together without excessive tooth reduction. Pros-
theses rvith nonrigid connectors should not be used ifprospective abutment teeth exhibit
significant mobility.
Important: When abutment teeth are in normal alignment and have good bone support
tcanine and /irst molar.r), the connectors of choice are solder joints.
. 90 degree, 1.0 mm shoulder
. Bevel
. Chamfer
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Unlike thc metal-ceramic .estoration, which will accept any marginal design (a bevel, chamfer, or
shoulder), marginal tooth prepamtion for the all-ceramic crown or porcelainjacket crown must
be a shoulder foptrn ally 90 degrees and 1.0 mm).
There are indications and contraindications for all-ceramic crowns, and violating these will com-
promise the success of a restoration. All-ceramic crowns generally are accepted to be superior
esthetically, but their lack ofa metal substructure makes them inherently weak, As a result, they
are rarely indicated for use on posterior teeth, and are not indicated at all for anterior teeth in a
Class III edge-to-edge relationship, where the occlusal forces can subject them to fracture. There
are few acceptable instances where all-ceramic crowns may fuuction as irxed partial denture abut-
ments, such as during the replacement ofanterior teeth when a favorable anterior guidance occlusal
scheme exists.
The main reason for the use of porcelain jacket crowns and all-ceramic crowns is superior es-
thetics. These tlpes of crowns have the capability to mimic the optical properties ofthe natural
tooth. However, the guidelines for usage, such as tooth preparation, are more critical and in gen-
eral more complicated than for the metal-ceramic restorations. ln general, it is advisable to use
these more esthetic crowns only in the anterior segment, where esthetics is the dominant factor.
Dilferent materials used in the fabrication ofa full crown require dilferent marginal designs:
. All-ceramic or porcelain jacket crowns
. \Ietal ceramic with porcelain extended -shoulder
to maryinal edge
. Vetal ceramic with metal collars shoulder with beYel-shoulder
or chamfer
. Full gold crown bevel (feather edge) or chamfer
-
*** This is a contradiction to electrosurgery r€cession may be marked following the use of
this p.ocedure. -gingival
Objectives of electrosurgery:
. Coagulation
. Hemostasis
. Access to cavosurface margin
.Reduction ofthe inner wall ofthe gingival sjulcts (removal ofa thin layer ofcrevicular gingiwl tis-
sue)
Electrosurgery, although considered by many to be a more radical means ofrefiaction ofgingival tis-
sues. is an acceptable method. It functions by passing small curents ofelectricity through the gingival
rissue, causing the cells to desiccate, or scorch. Electrosurgery usually results in sorne delayed healing
because ofthe lack of proper clot formation. It is very good at stopping hemorrhage. Note: Too low a
current in an electrosurgical electrode can be detected by tissue drag.
Important points about elechosurgery:
. Use pfastic instruments (nirror explorer, erc) instead of metal to prevent buming and tissue de-
struction of the surface contacted.
. Rapid, single, light strokes should be used with the electrode
. 5 secotrd intervlls should be used when cutting
. The electrode should not contact metallic restorations or tooth skucture (may cause ineversible
pulp damage).
Great care must be employed when performing electrosurgery as the potential exists for
serious damage to the PDL and surrounding bone, resulting in loss ofattachment ofthe tooth.
Note: elechosurgery is not recommended for thin attached gingiva.
Important: Electrosurgery is contrai[dicated in patients using medical devices such as cardiac pace-
make$, a trancutaneous electrical nerve stimulation (TENS) :urit, or an insulin pump, and in patients
with delayed healing.
if you look at bfue color obiects (drupes, charts, wall-color or any
othet object arcund,) while selecting the shade, it will help to
accentuate tbe ability to discriminate yellow shrdes.
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Coplright O 201 l-2012' Dntal Dech
. Equate
. Contract
. Expand
59
Cop)'right O 201 I 2012 - Denial Decks
Shade selection sequence:
. Use the same shade guide as given by the manufacturer
. Match the shade before you do any preparation ofthe tooth
. Remove all distractions (e.g., Iipstick, dark glasses, heavy make-up, etc.)
. Quick rubber cup and paste prophylaxis can make shade selection more accurate
. Position yourselfbetween the patient and the light source
. When observing, do not gaze for greater than 5 seconds at a time. Prolonged gazing
decreases the ability to discriminate colors and shades
. Proceed by process of elimination. Exclude first, shades which are too light or dark
. Half-closed eyes can increase the sensitivity of retinal rods to better choose the
"value" ofthe color
Remember: "Blue" fatigue accenhrates "yellow" sensitivity. This means that ifyou look
at blue color objects (drapes, charts, wall-color or any other object around) while se-
lecting the shade, it will help to accentuate the ability to discriminate yellow shades.
Four mechanisms play arole in producing an expanded mold and thus compensating for
the solidification shrinkage ofthe alloy.
l. Setting expansion: results from normal crystal growth. In air, it is about 0.4% but it
is partially restricted by the metal investment ring.
3. Wax pattern expansion: the wax pattem is warmed while the investment is still
fluid. The heat may come from the chemical reaction of the investment itselfor the
s'ater bath in which the casting ring is immersed.
4. Thermal expansion: occurs when the investment is heated in the bum out oven. It
also serves to eliminate the wax pattem and to prevent the alloy from solidifing be-
fore it comoletelv fills the mold.
. Mesiobuccal margin is positioned slightly distal to the middle ofthe buccal surface
. Distobuccal margin is positioned slightly mesial to the middle ofthe buccal surface
. Mesiolingual margin is positioned slightly distal to the middle ofthe lingual surface
. Distolingual margin is positioned slightly mesial to the middle ofthe lingual surface
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. Predominantly glass
. Polycrystalline
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coplrishr @ 201 l-2012 - Dertal Decks
A partial crown is a cast restoration made entirely from metal and covers more than half
but not all ofthe tooth's clinical crown. A partial crown is named according to the frac-
tional amount ofthe clinical crown it covers. Examples are the half, three-quarters, foul-
fifths, and seven-eighths crowns. In most instances, the facial surface ofthe tooth is not
disturbed for esthetic reasons.
The seven-eighths crown design is especially effective either as a single tooth or an abut-
ment restoration on maxillary molar teeth where both proximal surlaces are involved as
well as the distal buccal suface ofthe tooth. In many instances, the mesio-buccal cusps
of maxillary first and second molars can be preserved for esthetics and still provide ade-
quate extension to include extensive areas ofdestruction.
Seven-eighths crown:
. It can be used on any posterior tooth
.Esthetics is good since the veneered distobuccal cusp is obscured by the mesiobuccal
cusp
. Distobuccal finish line is easy to access, which makes preparation easier to do. It also
makes cleaning ofthe margins easier for the patient
. \4ore coverage than the standard 3/4 crown which improves its resistance
. Especially useful when the distal surface has caries or decalcification
. Serves as an excellent abutment for a bridse
Metal ccramic restorations have been available for more than three decades. This type ofrestora-
tion has gained popularity from its predictable perlomance and reasonable esthetics. Despite its
success, the demand for improved esthetics and the concems regarding the biocompatibility ofthe
metal has lead to the introduction ofall-ceramic restorations.
Two concepts help in simplifying the understanding of dental ceramics: First, ceramics fall into
three main composition categoriesl
. Predominantly glass
. Particle filled glass
. Polycrystalline
Second, ce.amics can be considered as a composite material, in which the matrix is a glass that is
lightly or heavily filled with crystalline or glass particles.
Predominantly glass: have a high content ofglass making this type of dental ceramic highly es-
thetic. This type is the best ir mimicking the optical properties ofenamel and dentin. Optical ef-
fects are controlled by manufactures by adding small amount of liller paniclcs.
Particle-filled glass; filler particles are added to the glass matrix to improve the mechanical prop-
enics. Fillcrs can be crystalline particles ofhigh-melting glasses.
Polycrystalline: this type ofce.amic contains no glass. Atoms are packed into regular crystalline
arrangement making it toughcr and less susceptible to crack propagation. lt is important to under-
stand the lact that highly esthetic ceramics are predominately glass, and ceramics that exhibit high
strength are generally crystalline.
Note: It is important to understand the fact that highly esthetic ceramics are predominately glass,
and ceramics that exhibit high strength are generally crystalline.
. Nickel
. Cobalt
. Chromium
. Silver
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Cop).righl O 20ll-2012 - Dental Decks
CS tr'irrad Drtrs*lr,
. Polymethyl methacrylate
. Polyethyl methacrylate
. Pol)'vinyl methacrylate
. Polyacryl methacrylate
Metals are classified as noble elements based on their lack of chemical reactivity. The
noble metals include gold, platinum, palladium, and other inert metals. Alloys with less
than 25olo noble elements are called base metals. Note: Silver is not considered noble;
it is reactive and improves castability but can cause porcelain "greening."
Remember: Noble metals are precious, but not all precious metals re noble (i.e., sil-
ver).
Base metal (nickel, chromium and cobalt) alloy advartages are principally found only
in their strength and low density.
Remember: The nickel in the composition ofbase metal alloys is responsible for ductil-
iq of the alloy. It is also measured as a percentage of elongation and determines how
much margins can be closed by bumishing. Chromium produces a passivating film for
conosion resistance and cobalt increases the rigidity ofthe alloy.
Provisional restorations:
Requirements:
. Provide pulpal protection
. Positional stability
. Occlusal function
. Easily clcancd margins
. Strength and retention
. Esthetics
\l€thods of fabric.tion:
. Prefabricated: Uscd for single tooth restoration (e.g., anatonic netal crown fon,$, deu celuloid shells and
t.rothol orcd polr@rbonate crovns).
. Custom-made: uscd for single and multi -unit lixed b.idges-There are a variety of tcchniqucs for f'abricating thc
mould used to form the outcr surface ofthc custom provisional rcstoraljon /i.e., take an inpression prior to prcpar-
ing te€th fiIh algilnte. elastomenc i tpression material or use tle .liagnostic &st ond clear lhetmoplastic resi
natrix [wcuunt fon'ing machineJ).The innc' s[rface will be providcd by the preparation.
. Type II
. Type III
. Type IV
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Copyn8hr O 20ll-2012 - Denkl Decks
. This process results in better powder mixing and reduced chance for air bubbles
. The powder is added to the water to avoid using more than one bowl
Dental gypsum products are made up of hemihydrate particles whose size' shape, and
porosity differ for each material. These gypsum-based powders require different
amounts ofwater for mixing because the different particle shapes produce different pack-
ing efficiencies that affect the amount ofexcess water required for making a suitable mix-
ture.
llixing:
. lVater/powder ratio: the water/powder ratio is an important factor in detennining
physical properties. When a high proportion ofwater is used, the powder particles are
farther apart. This results in less expansion with a retarded setting time and a weaker
product. Dental plasters generally require about twice as much water compared to
stones. Plaster has a higher setting expansion thar does stone.
. \\'ater temperature: generally, the cold€r the water, the longer the setting time
. Spatulation: rapid spatulation for a time equal to normal hand mixing for 1 minute
accelerates setting time and produces greatest strength. Do not spatulate to the point
$ here the mixture starts to harden. This will produce a cast that is much weaker.
. Accelerators and retarders (modifiers):
- Retarder: borax. sodium citrate
- Accelerators: gypsum, potassium sulfate, NaCl 28%
Remember: The setting expansion ofany gypsum product is a function ofcalcium sul-
fate dihydrate cystal growth. Some is the result of thermal expansion.
. Beta-hemihy&ate and dental stone has gamma-hemihydrate
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Cop"iSh O20ll-2012 - Dental Decks
. Minimize distortion
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Cop)'righr O 20ll'2012, Dertal Decks
The principal constituent of the dental plasters and stones is the calcium sulfate
hemihydrate. Depending upon the method of calcination, different forms of the
hemihydrate can be obtained alpha or beta hemihy&ate. The beta-hemihydrate
-eitherofParis, and these crystals are characterized by their
is more popularly known as plaster
sponginess and irregular shape in contrast to the alpha-hemihydrate f.r/one) crystals!
which are more dense and have a prismatic shape. When the alpha-hemihydrate is mixed
with water, the pro dtrct obtained (dental stone or die stone) is much stronger and harder
than that resulting from beta-hemihydrate (plaster). The chiefreason for this difference
is that the afpha-hemihydrate powder (stone) reqrires much less gauging water when it
is mixed than does the beta-hemihydrate. The beta-hemihydr^te Q)lqster) requires more
water to float its powder particles so that they can be stirred, because the crystals are
more irregular in shape and are porous in character.
Note: All glpsum products that are reacted with water form calcium sulfate dihydrate
as a reaction Droduct.
Using a vibrator when pouring models helps to eliminate ar bubbles (trapped air).This
produces a more accurate, usable model. Another way ofpreventing entrapment ofair is
to place the proper amount of water in the mixing bowl first and then sift the model
plaster or stone into the bowl. When mixing dental plaster or stone, any ofthe following
$,ill cause the gypsum product to set faster spatulation, a lower water-pow-
-incr€ased
der ratio, and using a mixture of water and ground-up set g'?sum particles to mix with
the plaster or stone.
Once the impression is poured, it should be allowed to harden for 45 minutes to I hour
(or until cool to the touch) before removing the cast from the impression.
If nodules of stone appear in the occlusal pits ofa stone cast, it is most likely due to the
entrapment ofair during the insertion and seating ofthe tray.
lrJote: All types of gypsum products are weaker in tensile strength than compressive
strength.
. Heating g)?sum in an open vessel at 150'C
-160'C
. Heating gypsum under steam pressure in an autoclave at 120'C
-150.C
. By boiling gypsum in a 30olo aqueous solution ofcalcium chloride and magnesium
chloride
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Copr.right C 201 l-?012 - Dental Decks
' Dr. Lozier r€quested that you mix alginat€ and take an imprcssion,
Whil€ measuring the water, you got involved in a conversation with
your patient and did not notice how cold it was. This oversight will:
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Cop)'right O 201l-2012 - Dental Decks
*** This process produces particles that are porous and inegularly shaped. Note: It is
the weak€st gypsum product.
Heating gypsum under steam pressure in an autoclave at 120'C - 150'C produces dental
stone. This process produces particles that are uniformly shaped and less porous.
Boiling glpsum in a 30o% aqueous solution olcalcium chloride and magnesium chloride
produces high strength (improved) die stone. This process produces the least porous
and strongest particles.
All gypsum products come ftom the mineral gypsum, which is the dihydrate form of
calcium sulfate. During heating, (the manulircturing process), water is lost and g)?sum
is converted to the hemihydrate form of calcium sulfate (p owder). When water is added
to the powder, a chemical reaction takes place and the hemihydrate is converted back to
the dihydrate form of calcium sulfate.
l. When mixing gypsum products always sprinkle the powder into the water.
liotel This results in better powder mixing and reduces the chance for air bubbles.
2.When gypsum products are mixed with water, heat is given ofl This is called
an exothermic reaction.
3. Exposure ofa stone cast to tap water should be minimized because eroding
ofthe cast will result.
***The best method to control the gelation time ofalginate impression materials is to alter the tem-
pemture ofthe water used in thc mix. The higher the tempemture, the shorter lhe gelation timc,
the lower the temperature, the longer the gelation time. The mix is usable regardless ofwater tem-
penture as long as there is adequate ['orking tim€.
Changing thc water/powder ratio and the mixing time will alter the gelation time, but thesc mcth-
ods also impair ce ain properties ofthe matcrial. Too little ortoo nuch waterwill weaken the gel.
Undermixing may prcvent the chemical action from occurring evenly; overmixing Inay break up
the gcl.
Calcium sulfate (/re reactol in alginate), is not so soluble in watcr that is entircly consumed be-
fore gelation is con'lpleted. Therefore, the set mass becomes an entanglcment of calcium alginate
fibrils around residual sodium alginate sol, filler and water. The residual sodium alginate has thc
nasty habit ofreadily giving up water /.t),reresis) or gaining water (imbibitiotl). For accurate results,
thc cast should be poured imrnediately.
. L When taking an alginate impression fo. a partial denture, it is best to apply somc al-
\ores ginate directly on the teeth to eliminate bubbles and saliva from the rest seat prcparations.
2.lnaccuracies in imprcssions can be caused by fracture ofthe fibrils during gelation.
' .3. Tray adhesivc should ahvays be used to prcvent distortion at the time ofremoval.
4. The greater the bulk lhat the alginatc has, the more favorable the surface area:vol-
ume ratio and the lower the susceptibility to water loss or gain and, therefore, unwanted
dimensional change.
5. The tray sltould be removed 2 to 3 minutes after Selation.
6. The impression should be rinscd and disinfected with glutaraldehyde or iodophor
befbre pounng.
7. Pouring with ADA type lV or V stone is recommended.
. Irreversible hydrocolloids
. Polysulfides
. Polyethers
. Condensation silicones
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Copyright O 201 1 ,201? - Dertal D€cks
. Polysulfides
. Condensation silicones
. Polyvinyl siloxanes
. Polyethers
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Coplright O 20ll-2012 - Denial Deckr
Polyether materials are dimensionally unstable in the presence of moisture. These materials are the most
rigid frt,r?s, and most dillicult to remove fiom the mouth. Note: Whcn removing the impression, break the
seal and rock slightly to prevent tearing.
Composition of polyether impression materials:
. Base: amiDe teminated polyether polymer
. Cross-linking agent: an alkyl-aromatic sulfonate
. Catalysrs: glycol-based plasticizers
. Filler: colloidal silica
*** Polyeth€$ are two-component materials. The base includes apolyether, silica filler and a plasticizer The
accelerator contains a crossJinking agent. When mixed, a nrbber is formed by a cationic polymerization
process. Cationic polymerization is very similar to addition polymerization, except that instead ofa free rad-
ical, a cation fporirlyc ior, is the reactive molecule. \o reaction by-product is produced. Polyethers have ex-
cellent dimensional stability. They ar€ also t.uly hydrophilic, resulting in superior wettability.
. Excellentdimedsiolal . Set material very stiff . Most impr€ssion6 Take care not to
stability whell dry . Difficult to remove break teeth when
from mouth separating casls
. Short settirg tirne . Tears easily
. Dimensionally stable if . Limited shelflife
more lhan one cas! is poured . May adhere to teeth
. Slable ev€n ifpoured 24 . Demonstmtes imbibi-
hours after taking impres- tions
aion . Unpleasant taste
. Automix available . Short working time
These materials record surlace detail well and have excellent elastic propenies but a low tear strength. They
arc less expensive ihan polyvinyl siloxanes fdddition silicones) ard polyethers.
\\'hv poor dimensional strbitity? The principal reaction, which takes place during setting ofthis material, is
a condensation reaction and hence called condensation silicone. It occurs by elimin tior (evaporation) of
eth) l or methyl alcohol. This is also responsiblc for shrinkage ofthe material and resultant poor dimcnsional
itabilit\'.
l. Reaclion is sensitive to heat and moisture f'eill reduce working snd setting times).
2. Do not mix initially by haod (allergic rcaction to catalyst may occur).
. Dimensionally unstable
. Sets quickly
. Sets hard
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'\
The popularity of agar impression m Oevercible hyfuocalloid)
is timited by the:
^teriz.l
)
. High cost
73
Cop).riglft C2011,2012 - Dmtal D€cks
*** This is fals€; ZOE impression paste is dimensionally stable
ZOE impression materials were once very popular. Today, however, ZOE materials have been
replaced by newer materials, such as polywinyl siloxanes, condensation silicones and poly-
ethers.
Components of ZOE impression paste:
. Calcium chloride (CaCI): ftncttons as an accelerator ofthe setting time
. Oil ofcloves: contains 70-850/o eugenol. It is sometimes used in preference to
eugenol because it reduces the buming sensation in the soft tissues ofthe mouth.
. Mineral or {ixed v€getable oil: plasticizer, aids in masking the action of eugenol as an
irritant
. Resinous balsam: often used to increase flow and improve mixing properties
. Rosin: facilitates the speed of the reaction which results in a smoother, more homoge-
nous mix
The setting reaction that occurs is a typical acid-base reaction to form a chelate. This reaction
can take place either in solution or at the surface of the zinc oxide particles. The chelate is
thought to form as an amorphous gel that tends to crystallize, imparting increased strength to
the set mass.
. --.... 1. The dimensional stability ofa zinc oxide-eugenol impressionis most likely tobe
..'Note{,; affected by failure to use a custom-made impression tray.
' ',i*tl: 2 . The setting time of a zinc oxide-eugenol impression paste may be acc€l€rated by
adding a drop ofwater to the mix.
3. The setting time of a zinc oxide-eugenol impression paste may be r€tard€d by
adding inert oils (olive or mineral oils) during mixing.
4. Ifthe paste is too thin or lacks body before it sets, a filler----such as a wax or an
inen powder (lanolin, kaolin, etc.) may be added to one or both of the original
pastes
The use of agar impression material does require special equipment. The rcproduction is excellent, and the im-
pression is easy to pour compared to elastome c imprcssion mat€rial.
Reversible hydocoltoid is an impression material that changes its physical state ftom a sol to a gel and then
back to a sol.
Composition of reversible hydrocolloids:
. 85% water
. l2'.I5r/. agar (agar is an organic substance deri|ed from seaweed)
*** ofbomx fbr rtrerglr), potassium snlfate (improves gvsum r&r/dce/ and sodium tetrabomte
Traces
. Calcium sulfate
. Potassium alginate
. Tri-sodium phosphate
. lt will be grainy
. It will be distorted
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Coplrighr O 2011,2012 - D€ntal Decls
Alginate materials (incversible h,vdt'ocolloid) are the most widely used impression ma-
terials. They are termed irreversible impression materials because they will not reverse
to a sol once they react and become a gel. Indications: diagnostic casts, not suitable for
final impressions. Examplcs: Ieltrate (Dentsply / Caulk), COE Alginare (GC Americal
Problem Cause
. Polysulfide
. Reversible hydrocolloid
. Vinyl polysiloxane
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Coplrighr O 201l-2012 - Dental Decks
. Polyether
. Polysulfide
. Polyvinyl siloxane
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Polyvinyl sifoxanes (addition silicohes.) are the most widely used and are the most accurate of the
elastic impression materials. They have less polymerization shrinkage, low distortion, fast recovery from
deformation and a moderately high tear strenglh. Most ofthe pol;vinyl siloxanes can be pourcd up to
one week after impression making and are stable in most sterilizing solutions. Important; Tle sulfur
in latcx glovcs and in ferric and aluminum sulfate retraction solution will retard the setting ofaddition
silicone materials. Also, addition silicones are temperature sensitive in temperature will
shorten the working and sefting times.
-increases
Composition of polyvinyl siloxanes /addition si[icones):
. Base: silicone polymer
. Catalyst: chloroplatinic acid
. Filler: colloidal silica
. Scavengers: platinum or palladium /acr as scavengers for the hydrogen gas releosed)
1. The addition reaction that occurs with pol''vinyl siloxanes is terminated with a vinyl group
\otes, and crosslinked with hydride groups activated by a platinum salt catalyst No reaction by-
: products are developed, but hydrogen gas release may occur ifa reaction betwem moisture
and rcsidual hydrides ofthe base polymer occurs. The result is a cast with small voids ifthe
impression is poured too soon after removal from the mouth.
2- Stiffness ofthc matcrial makes removal ofthe trav difficult.
- lowest to highest
. alginate, agar, polysulfide, condensation silicone, poly'vinyl siloxanes,
polyether
- best to worst
. polyvinyl siloxanes, polyether, polysulfide, condensation silicone,
hydrocolloids
- best to worst
. hydrocolloids, polyether, hydrophilic pollnr'inyl siloxanes, polysulfi de,
hydrophobic pol)'vinyl siloxanes, condensation silicone
- best to worst
. hydrocolloids, hydrophilic polyvinyl siloxanes, polyether, polysulfide,
hydrophobic pol)'vinyl siloxanes, condensation silicone
- most to least
. polyether, polyvinyl siloxanes, condensation silicone, polysulfide,
hydrocolloids
- greatest to least
. polysulfide, polyvinyl siloxanes, polyether, condensation silicone ,
hydrocolloids
. Polyether
. Polysulfide
. Reversible hydocolloid
. Pol)'vinyl siloxane
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Cop)righr O 201l-2012 - Dental Dek
. Polyethers
. Polysulfides
. Silicones
. Irreversible hydrocolloids
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Coplright C 201l-2012 - Denial Decks
Reversible Irreversible Conderrsador! Pollainyl
Hydrocolloid Ilydrocolloid Polysulfide Silicor. Siloxane Polyether
Boil, temper, Pourder, urater 2 pastes 2 pastes or 2 pastes 2 pastes
slore paste/liquid
\ote: Reversible and irreversible hydrocolloids have the advantage of wetting oral surfaces
\\ ell. but they have very limited dimensional stability because they include as much as 85%
$ater in their composition.
Remember: The setting time ofalginate is controlled by the amount of sodium phosphate
that is present. Sodium phosphate serves a retard€r in this reaction, which means it
slows down the process. As long as sodium phosphate is present, it will react with solu-
ble calcium ions. Once all the sodium phosphate has reacted, then the sodium alginate re-
acts with the remainins calcium ions and calcium alginate is formed.
. Gelation
. Hysteresis
. Syneresis
. Imbibition
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Imbibition occurs when the impression absorbs water, which expands the dimensions of
the impression. When this occurs, the impression is no longer accurate. Shrinkage will
occur in alginate impressions, even when they are placed under 100% relative humidity.
The shrinkage and exudation of water is called syneresis.
Important: While taking an impression with alginate, it is advisable that the tray be
placed in the mouth after all critical areas are wiped with alginate. Critical areas are
buccal to the maxillary tuberosities and retromylohyoid space. Rest seats and guide planes
should be covered with alginate as well as any other soft tissue undercuts.
1. Gefation is the term given to the setting process (c/rrrglng afrom sol to a gel)
Iotes of hydrocolloid material.
2. Hysteresis refers to a material's characteristic ofhaving a melting tempera-
ture different from its gelling temperature.
Mixing the alginate material rapidly will cause setting to occur more rapidly.
Decreasing the water to powder ratio will cause alginate to set up more rapidly (affects
consistenc.,^ of the mit is much thicker v'hen less v'ater is used).
-mix
Note: The mandibular alginate impression is taken first since gagging is more likely to
occur when taking the ma"xillary impression. For the maxillary impression, the posterior
portion of the tray is seated first, then the anterior portion. This helps to prevent the
alginate material from being squeezed out of the tray, back torvard the patient's throat
hrhich may cause gagging).
Alrvays remove alginate impressions in one quick movement, with a snap. This helps to
decrease permanent deformation.
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Copyrighr O 201 1,201 2 - Dental Decks
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Copltighr O 20ll-2012 - Dental Decl6
The simplest method ofclassifoing impression materials is by key properties: rigid' water-bas€d, and elas-
tomeric. Of the rigid rlpes, impression plaster was the first material us€d for both edentulous and denolous
imprcssions, it is no longer used for impressions. Impression compound is used for single tooth impressions
where there are no undercuts. zinc oxid€ eugenol (ZOE) is used for edentulous impressions.
Water-brsed systems include alginate fil,"e1,ersible lrydrocolloid) and ag^r-^g r (reversible hydrocolloid).
Both types ofmat€rials are inherently unstable because wat€r is 85oZ ofthe composition. They are v€ry eas-
ily distort€d during syn eresis (loss of$'ater to lhe air or surrounding envirokmenl) or ifibibition (ahsorption
ofwaterfron the air).
Elastom€rs are rubbery polymers that are capable ofclastic deformation fiom undcrcut areas to produce a
complet€ impression for dentate situations. There are four major types (pollsullide, condensation silicone,
pol),ethe\ and pol\'ri nll si loxane).
Characteristics of elastomeric impression malerials:
. Bas€: packaged as a paste in a tube, as a cartridge, or as putty in ajar
. Catalyst: also kno$.n as lhe acceleratot is packaged as a paste in a tube, as a cartridge, or as a liquid .
With all elastomers, a custom tray should be fabricated with a plastic material. This tray
should be rigid, have occlusal stops to avoid permanent distortion during polyrrerization
and be coated with an adhesive. With hydrocolloid impre ssiors (ctlginate),a greater bulk
of material produces greater accuracy, however, the thickness of rubberlike materials
should not only be less, but should be evenly distributed. lmportant: Let adhesive that
is applied to the tray dry completely. If it is wet, impression material may pull away.
The accuracy and reliability of an elastic impression is controlled by the tray in which
it is taken. The best tray is one that is custom-made for each patient. In most cases, it is
best to take a complete arch impression, which will provide maximum reliability.
. Poured immediately
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CoplriSh O 201 1,2012 - Dmtal Decks
.Initiator
. Polymer
. Monomer
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Coptrighr O 20ll-2012, D€nral Decks
Polysulfides have good flow properties and high nexibility and tear str€ngth. These materials show the
strongest resislance to tearing, but as a result, impressions can distort when removed from areas where deep
undercuts are prcsent. They have a long working time and a relatively long polymerization time, which may
add to patient discomfort. Their rcsistance to deformation is low. Generally, the use ofthis material demands
the construction ofa specialllray (custom tray) in order to control polymerization shrinkage by thc use ofa uni-
form thickness ofimpression mat€rial. Note: The polymerization ofpolysulfides is exothermic and is acccl-
erated by an increase in the temperature or humidity.
: '. - - .. . 1. Acrylic resins will expand when immersed in water and become distorted when dried out
:NoteJ;2.shrinkageofanacrylicr€sinoccu$but€xcessiveshrinkagemayoccuriftoomuchmonomer
, i tliqurll is added to the polymer lpov'derJ. The volumetric monomer-to-polymer ratio is l:3.
..&1 3. The polynrerization reaction of methyl methacrylate is €xothermic out heat
-gives
4. Inhibitors are added to the monomen to aid in preventing polymerization during storage.
5. Cross-linking contributes greatly to the strength ofthe polymer
6. H€al-cured materials: heat is used as an accelemtor to decompose benzoyl peroxide frre ,ri
t alol) into fre€ radicals, These fiee radicals initiate the polymerization ofMMA into PMMA Th€
pol]'rnerization process continues as new PMMA is formed as a matrix around residual PMMA
powder particles.
7. Self-cured (auto-cured, cold cureA materials: a chemical activator such as dimethyl-p_
tofuidine flvri., is a lertiory amine) is ?dded to the monomer fMM,'r' This chemical activator
causes decomposilion of the b€nzoyl peroxide (lhe initiator) into free mdicals. These f.ee radi_
cals initiate the polymerization ofMMA and PMMA. Tle polymerization process continues the
same as in heat-curing materials.
8- The pofymerization range is the temperaturc mnge, approximately 60"C (l1f F) to 77"C
f17rP-F), at which the major part ofpollmerization occurs in a heat-cured resin.
9.The heat-cured resins have less residual monomer and a higher molecular weight than the self-
cured resins; therefore, they are stronger. They also have superior color stability.
Z\
An edentulous patient has slight undercuts on both tuberosities and also on the
faclal ofthe &nterior maxilla. To construct a satisfactory maxillary complete
denture, you should reduce which ofthe following?
* ,
. All undercuts
. None ofthem
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CoplYigh O 201 1,201: - Denlal Decks
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CoplriShr O 201l-2012, Derral Decks
Undercut tuberosities will interfere with the seating ofthe denture.
Explanation of answer: Maxillary anterior undercuts are very cornmon and present no
special problems unless accompanied by large bilateral posterior undercuts. Even this sit-
uation can usually be managed by reducing the inner surlace ofthe denture lateral to the
tuberosities.
The maxillary sinus appears to enlarge throughout life if it is not restricted by natural
teeth or dentures. As the sinus enlarges, the tuberosity moves downward. Ifthere is no con-
tact with the retromolar pad at the vertical dimension ofocclusion, the tuberosity must be
reduced.
If a fow tuberosity is not removed before constructing new dentures (C/C), an acciden-
tally underextended mandibular denture will probably be made and limited space to po-
sition posterior teeth will occur.
The temporomandibularjoints are considered to be the most complex joints in the human
body because they must provide for rotational movements, sliding movements (trqnskr-
to\) motion) and an infrnite range ofcombined movements and functions, unlike any other
joint in the body.
When the mouth opens, two distinct motions occur at thejoint. The first motion is rota-
tion around a horizontal axis through the condylar heads. The second motion is transla-
tion. The condyle and meniscus move together anteriorly beneath the articular eminence.
ln the lower (condyle - articular disc) compartment, only a hinge-type or rotary mo-
tion can occur. This rotational or terminal hinge-axis opening oflhe mandible is possi-
ble only when the mandible is retruded in centric relation with a conscious effort by the
patient or by the dentist's control. Note: A pure hinging movement is possible only in the
terminal hinge position.
Remember: The TMJ is a ginglymoarthrodial joint fn eaning that it glides and rotates),
permitting both hinge-like rotation and sliding (gliding) movements. Ginglymus means
rotation, and arthrodial means freely movable.
. Arcon articulator
. Nonarcon articulator
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Copyrighr O 20ll-2012 - Denral Decks
. Epinephrine
. Zinc chloride
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Copright @ 20ll-2012 - Denhl Decks
Thc capability of the articulator to closcly simulatc the movcments ofthc mandiblc is dcpcndcnt upon thc ajustabil-
ity ofthc articulator elemcnts.
f,lements of an articular;
. Horizontal axis of rot|tion: variability ofthc position ofthc horizontal a\is ofrotation in rclationship to thc max-
illary dental cast
. Condylar incliration/fossa components: variability ofthc anglc ofthc cmincntia, dircctionaL guidance of thc
supcrior, postcrior. and medial walls ofthc fossa, and ability to simulatc lalcrotmsive
'novemcnt
. Inter Condyl|r distance: adjustability ofthe distancc bctwccn ihc vcrlical axcs ofrotation
. Bennett , ngle/Bennett movement:adjustability ofthc anglc and capability ofsimulating sidcshift movcmcnt
. Incisal guidance: adjustability and ability lo simulatc the aoterior guidancc ofthc natural dcntilion
Types ofArticulators:
. Cl^ss | sinple hi ge).-The movcmcnt ofthese articulators is limitcd to inaccuratc hinge opcning and closing
arcs about a fixcd axis. The maximum intercuspation position is the only position that can be reproduced. Casts
are arbitrarily mounted without use ofa facebow
. Cl^ss ll (rlrbitrary nllrc -Plane line): Evolvcd from the Class I articulator dcsign, thesc aniculators arc capa-
ble oflatcral movement. Some are capablc ofvariablc location oflhc horizontal a{is ofrotalion //, et, arc li.tl si:e
and capable o.f acceptitg a facebo\,), but a1l of this tlpe have fixed, arbitrary condylar inclination scllirrgs. verti-
cal axcs ofrotation settings, and Bcnnctt Anglc. No adjustment ofthcsc posterior elcmcnts is availablc. Some
havc a provision for incisal guidance.
. Cl^.s lll (Seni-adiusta6le): These a(iculators can simulate lateral, protrusivc a d llcnnett movcnents to vary-
ing degrces. By utilizing a facebow and intraoral maxillo-mandibular records, thesc articulators can bc pro-
grammed to sinrulate thc curvi linear anatomical movcmcnts. Thcrc are cssentialiy two designs ofscmi-adjustablc
articulators. Onc which has thc guidance ofcondylar movcmcnt in thc maxillary menbcr and the centers ofaxial
roration in thc mandibular member This dcsign is termed arlon articulators. Thc ton-arcon arliculator dcsign has
rhcsc elements reversed lower members arc rigidly attachcd. Theocclusal planc is relatively fixed
lo rhc occlusal planc of -lhcuppcrand
the nrandibular casl. Note: Arcon arc more accurate fbr fabricating fixed rcstorations,
Nhile nonarcon providc casicr control in sctting tceth for complet€ 8nd partial dentures.
'Cl^ssly (filh adjustarle/: This class ofarticulatom accepls registration ofall anatomic dctcrminant ofocclusal
morphology, and mosrcloscly simulates the movement dircctcd by thcsc controls. Thc postcrior clcmcnts ofthcsc
controls are dircclcd and adjusted by an cxtm-oral tcchnjque called a p.ntogr{phic rcgistration. This class tvill
accept a "hinge axis. kinemstic transfer bow. The incisal guidancc cl]n closely simulatc thc paths ofthe natu-
ral dcntirion. This class is fully utilizcd in cxtcDsivc rcstorative procedures, as rvcll as adjunct to diagnostic dctcr_
minations of lcmporomardibular joint dysfunction f?iMJr.
Epinephrine causes local vasoconstriction, which in nrm results in transitory gingival shrinkage Epincphrine
impregnat€d cord has been shown to produce minimal physiologic changes uhen placed in an intact gingival
sulcus. Howeve( there is evidence ofincreased heart rate and elevated blood pressure when the cord is applied
ro the severely lacerated gingival sulcus. For those patients with medical conditions such as certain tlpes of
cardiovascular disease or hyperthy'roidism, or a kno\r'n hyPersensitivity to epinephrine, a cord impregnatcd
with alum should be substituted.
Note: Zinc chforide is caustic and causes delay€d healiDg lcdute.t ,?ecrosis ofthe sulcular ePitheliu and the
adjacenl lq:er ofconnecliv? lissre). Therefore, it should not be used in impregnatcd cord-
. Surgical modes:
- El€ctrosurgery: when cord will not produced the desired gingival displacement, this method can be
used.
. Hamular notch
. Maxillary tuberosity
. Fovea palatini
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CopFShr O 20ll-2012 - Dental Deck
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Coplriglrt O 201 I -20 l2 , Dental Dects
*** It is a thin, curved process that serves as the superior attachment of the pterygo-
mandibular raphe. This raphe is a tendon between the buccinator and superior
constrictor rnuscles.
The hamular notch is a thin cleft between the maxillary tuberosity and the hamulus. The
vibrating line is an imaginary line drawn across the palate that marks the begiming of mo-
tion in the soft palate when an individual says "ah". It extends from one hamular notch to
the other. At the midline, it usually passes about 2 mm in front ofthe fovea palatinae.
Remember: The distal end ofthe maxillary denture must cover the tuberosities and ex-
tend into the hamular notches. Overextension at the hamular notches will not be tolerated
because of pressure on the pterygoid hamulus and interferences with the pterygo-
mandibular raphe. When the mouth is opened wide, the pterygomandibular raphe is pulled
forward. Ifthe denture extends too fff into the hamular notch. the mucous membrane cov-
ering the raphe will be traumatized.
The fovea palatinae are indentations near the midline ofthe palate formed by a coales-
cence of several mucous gland ducts. They are always in soft tissue, which makes them
an ideal guide for the location ofthe posterior border ofthe denture.
Palatal tori are bony enlargements located at the midline ofthe hard palate. They occur
in approximately 20% ofthe population and are more prevalent in women than men. They
usually reach maximum size in the third or fouth decade. Because the torus is usually cov-
ered by thinner and less resilient mucosa than the residual ridge, it may act as a fulcrum
and cause rocking ofthe ma"rillary denture.
Because the soft tissues over the torus are generally thin and have a poor blood supply,
post-operative healing is slow. It is best to cover the opemted site with a surgical stent lined
with a sedative dressing. Ifa patient is having all oftheir maxillary teeth out at one time,
it is best to also remove the tod at the same time.
Note: Palatal tori are usually not removed for denture fabrication whereas mandibular
tori are usually removed prior to denture fabrication. The following conditions warrart re-
moval ofpalatal tori, ifit: (1) impinges on the soft palate (2) is so large that it fills the vault
and prevents the formation ofan adequate dentue base (3) is undercut (4) extends so far
posteriorly interfering with the posterior palatal seal (5) is psychologically disturbing to
the patient (cancetphobia) .
. It will make the patient feel better
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Coplright O 20ll-2012 - Dental Dech
. A vitamin B deficiency
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Coplaight O 201 I 2012 - Dental Decks
Treatment may include:
. Tissue rest
. Soft reline ofexisting dentures
. Change in denture habrts (not wearing them 24 hours a dav)
. Surgical removal oftissue (y'ti.rsaes changes are extensive)
Note: Mandibular tori, sharp pron.rinent mylohyoid ridges, and epulis fissuratum should
also be evaluated for surgical removal trefore the iabrication ofnew dentures is begun.
\ote: The best impression technique for a patient with loose hyperplastic tissue is to reg-
ister the tissue in its passive position. There must be intimate contact of the
impression material with the tissue.
The hyperplasia is produced in respons€ to ifiitation from movement ofthe denture and from accumu-
lating food debris. The masses prescnt as painless,Iirm, pink, or red nodular pmliferations ofthl] mu-
cosa. Candida albicans may contribute to the inflammation.
. Alcoholism
. Diabetes
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Coplright C 201 l-2012 - Dental Decks
. Vemrcous lulgaris
. Stomatitis nicotina
. Epulis fissuratum
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Cop).right O 201l-2012 - Dental Decks
Xerostomia is a possible side effect associated with more than 400 drugs including anti-
hlpertensives, antidepressants, antihistamines, bronchodilators, anticholinergics, and
sedatives. Mouthwashes, alcohol, tobacco, and caffeine may alter salivary flow or cause
dryness ofthe oral mucosa.
Even though xerostomia is not a disease, it can be a symptom ofcertain diseases. It can
cause health problems by affecting nutrition as well as psychological health. It can con-
tribute to and increase the chances ofhaving tooth decay and mouth infections.
The cleft-like lesions ofepulis fissuratum result primarily from overextension ofden-
ture flanges. The overextension may result from long-term neglect or settling subsequent
to residual ridge resorption. Trar.rmatic occlusion of natural teeth opposing an artificial
denture may also cause this condition.
. Paget's disease
. Hashimoto's disease
. Multiple sclerosis
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Coplrighr O 20ll-2012 - Dental Deck
. Delayed healing
. Mucosal bleeding
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Coplright O 201 I 2012 - Denral Dects
Paget's disease (also called osteitis deformans) ofthebone is a chronic bone disorder in
which bones becorne enlarged and deformed. The exact cause is not known. It is
characterized by excessive breakdown of bone tissue, followed by abnormal bone
formation. The new bone is shucturally enlarged, but weakened with healy calcifications.
Important: Involvement of the skull may enlarge head size and cause hearing loss and
blindness if the cranial nerves are damaged by the bone growth.
Dental Considerations the tissue surface of the dentures and relining with
-relieving
resilient materials can extend the life of the dentures. However, remaking the dentures
freouentlv is unavoidable.
1. Children who wear dentures and patient's with acromegaly who wear den-
, Not"* l tures also often need to have their dentures relined or remade to allow for bone
growth.
2. Diseases ofbone growth or expansion are much rarer than those ofbone
loss.
3. Osteoporosis is the most common change associated with systemic disease.
This condition is a generalized defect in which the quantity and quality ofbone
in the skeleton is reduced.
Diabetes is a disease that can affect the whole body your eyes, nerves, kidneys, heart,
-
and other important systems in the body. It can also affect your mouth. People with dia-
betes face a higher than normal risk of oral health problems. The link between diabetes
and the development of oral health problems is high blood sugar If the blood sugar is
poorly controlled, it is more likely that oral health problems will arise. This is because un-
controlled diabetes impairs white blood cells, which are the body's main defense against
bacterial infections that can occur in the mouth.
Just as studies have shown that controlling blood sugar levels lowers the risk of major
organ complications of diabetes such as eye, heart, and nerve damage so too can
-
good diabetes control protect against the development oforal health problems.
-
Even controlled diabetics present problems for the prosthodontist. The oral mucosa is
prone to the development of sore spots which heal poorly and often become secondarily
infected.
Principles to keep in mind when constructing dentur€s for patients with any debilitating
drsease:
. Maximum extension
. Narrow occlusal table
. Non-pressure impression technique
. Do not use porcelain teeth
. Establish a good occlusion
. Reinforce oral hygiene
. Place on 6-month recall (sooner ifnecessary to reinfor ce oral hygiene)
. Masseter muscles
. Temporalis muscles
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CopriSh O 201 l-2012' Denlal Decls
. An increased vertical dimension that leaves the teeth in a clenched. closed relation in
normal positions
99
Cop)right O 201l'201? - Denral Decls
Muscles acting on the TMJ:
. Opening (depress): lateral pterygoid, digastric (anterior belly) and the omohyoid
muscles.
. Closing (elevate): masseter, medial pterygoid, and the temporalis (anterior fibers)
muscles.
. Protrude: laterals pterygoid muscles acting together
. Retract: posterior fibers ofthe temporalis muscle
. Lateral displacem€nt: lateral pterygoid muscles acting individually.
Important:
. The lateral pterygoid muscles are mostly responsible for positioning and translating
the condyles.
. Ifthe mandible fractures, upward displacem€nt ofthe fractured segment would be
caused by the closing muscles (masseter medial pterygoid, a d temporqlis).
Interocclusal distance: also called "freeway space" is the vertical distance or space between the incisal
and occlusal surfaces ofthe maxillary and mandibular teeth with the mandible in the physiological rest
position. The average interocclusal distalce is about 3 mm. Too much interocclusal distance may re-
sult in muscuiar imbalance.
vertical dimension of occlusion is the vertical length ofthc face as measured between two arbitrarily
selected points, one above and one below the mouth, when the teeth or any substitute ma1e'rial (occlu-
Jiorl ,'rrril are in contact in centric relation. Excessive vertical dimension may result in trauma to thc
underlling supporting tissues (in a derlrtre patient) and strrir'jng ofthe closing muscles as well as
ad\erseft affecting the interocclusal distance (decreasedfreewal, space).
\ertical dimension of rest is the vertical length of the face as measured between two arbitrarily se-
lecred points. one above and one below the mouth, when the mandible is in the rest position; in the
phlsiologicalJy healthy individual, there will always be a vertical space between the teeth (freewal' space)
\hen the mandible is in the rest position. This position is important in complete dentute fabrication be-
cause it p.ovides a guide to the vertical dimension ofthe occlusion.
. Curve of Spee
. Compensating Curve
. Curve of Wilson
. Curve of Pleasure
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Cop)'righr C 20ll-2012 - Dental Dsks
. Tooth-to-tooth relation
. Occlusal relation
. Bone-to-bone relation
. Balanced relation
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Coplright O 201 l-2012 - Dental Deck
The lorm ofthe compensating curve is entirely under the control ofthe dentist, For ex-
ample, ifduring a try-in evaluation, a dentist notes that a protrusive excursion movement
results in the separation of posterior teeth, the problem can be corrected by simply in-
creasing the compensating curve. The value of the compensating curve is that it allows
the dentist to alter the effective cusp angulation without changing the form of the manu-
factued denture teeth. The function ofthis curve is to help provide a balanced occlusion.
Not€: As the condylar inclination increases, the compensating curve must increase to
keep a balanced occlusion. A prominent compensating curve is required when there is a
steep condylar path associated wilh a low degree of incisal guidance.
Orientation of the occlusal plane: The occlusal plane is an imaginary surface which is
related anatomically to the cranium and which theoretically touches the incisal edges of
the incisors and the tips ofthe occluding surfaces of the posterior teeth. lt is not a plane
in the true sense ofthe word, but represents the mean curvature ofthe surface. The ante-
rior point of the occlusal plane is determined by the position of the anterior teeth. The
posterior determinants are anatomical lanalmarks the height of the retro-
-two-thirds
molar pads. Therefore, it is debatable as to the extent ofcontrol the dentist may exercise
over the orientation ofthe occlusal plane.
Cusp inclination is the angle made by the slopes ofa cusp with a perpendicular line bi-
sectin-q the cusp, measured mesiodistally or buccolingually. This is under control of the
dentist (choosittg j0" degree teeth or cuspless teeth, etc.).
Centric refation (CR) (also called the retrudecl contact position) is considered a t€rminal
hinge position and is defined as "the maxillomandibular relation in which the condyles ar-
ticulate with the thinnest avascular portion oftheir respective discs with the complex in the
anterior-superior position against the shapes ofthe anicular eminences". This position is in-
dependent of tooth contact. This position is clinically discemable when the mandible is di-
rected superiorly and anteriorly. It is restdcted to a purely rotary moyement about the
trans\ierse horizontal axis. Important: This is a relationship of the bones of the upper and
loserjarvs without tooth contact.
lmportant points about centric relation:
. The mandible cannot be forced into centric relation fiom the rest Dosition because the Da-
tient s reflex neuromuscular defense would resist the applied force
. The mandible should be relaxed and gently guided into centric relarion
. In fixed and removable prosthodontics, centric relation should be established prior to de-
si_uning the frameworks
. \\'hen a centric relation record is taken in the natual dentition, imprints ofthe teeth
should
be confined to cusp tips and the registration material should not be perfomted
Important point: The current concept about centric relation: it occurs when the condyles are
in their most superoanterior position, resting on the posterior slopes of the articular emi-
nences rvith the discs properly interposed.
Whl do we n€ed to know this? This position is considered to be an optimum relative posi-
tion between all ofthe anatomic components. And more importantly, it is a repeatable refer-
ence position to mount the casts on the articulator.
Helpful hint: Having the patient swallow, tuming the tongue upward towards the palate, re-
laxrng the jaw muscles, or protruding and retruding the mandible can be effective ways to
help in recording centric relation.
Which of the following stNtements concerning selective grinding in
complete d€nture fabrication for centric relation is not true?
. Selective grinding of the imer inclines of secondary holding cusps can be done if
there is a working side interference
. Grind only the cusp tips of the upper buccal and the lower lingual (8. U.Z.Z.) cusps if
they are premature in centric, lateral or protrusive movements
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Selective grinding in centric r€lation:
. Ideally selective grinding should result in harmonious cusp-fossa contacts olall upper and
lower fossa (and maryinal ridges of bicttspi"ds). Do not grind the upper lingual or lower
buccal cusps. A forward slide from centric can be corrected by grinding the mesial inclines
of maxillary teeth and distal inclines ofmandibular teeth
. Primary centdc holding cusps are the maxillary lingual cusps. Never grind these cusps.
See note below.
. Secondary c€ntric holding cusps are the mandibular buccal cusps. Grind these cusps
only ifthere is a balancing side interference
. Only grind cusp tips ifthey are premature in centric, lateral, and protrusrve movements.
Check before grinding.
Selective grinding in working-side relation: The rule ofselective grinding for interferences
in $orking -side movements is the &lgqlEIJ:LL!
. luccal cusp inner inclines ofupper teeth
. lingual cusp inner inclines oflower teeth
\ote: For the National Board Exam questions, you can reduce the maxillary lingual cusp
ifit is high in centric as w€ll as oth€r occlusal positions reality, you should not.
-in
Working side interferences generally occur on the inn€r aspects ofthe lingual cusps of
maxillary molars.
Protrusive interferences generally occur between the distal inclines of the facial cusps
of maxillary posterior teeth and mesiat inclines ofthe facial cusps ofmandibular poste-
rior teeth. The proximity ofthe teeth to the muscles and the oblique vector ofthe forces
make contacts between opposing posterior teeth during protrusion potentially destructive.
The purpose of making a record ofprotrusive relation is to register the condylar path
and to adjust the condylar guides ofthe articulator so that they are equivalent to the condy-
lar paths of the patient.
-{ centric interference (fot'wqrd slide) can be corrected by grinding the mesial inclines
of maxillarv teeth and distal inclines ofmandibular teeth.
qDn
(wwR
\C] IJ V
wk
I
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. It is a line (plane) whichextends from the outer canthus of the eye to the superior
border ofthe tragus ofthe ear
. It is the hne (plane) running from the inferior border of the ala of the nose to the
superior border ofthe tragus of the ear
,!05
In any restorative case involving all teeth in the mouth, the protrusive condylar path
inclination will have its primary influence on the same inclines (distal ofmaxillary and
mesial ofmandibular).
The pathway followed by the anterior teeth during protrusion may not be smooth or
straight because ofcontact between the anterior teeth and sometimes the posterior teeth.
Signilicance of the Camper's line: the plane of orientation for complete denture con-
struction is established in the anteroposterior direction with the rnaxillary occlusal wax rim
parallel to Campers line, which is an imaginary line traced from the ala ofthe nose to the
tragus of the ear, and with the interpupitlary line in the transverse plane, which is an
imaginary line drawn between the eye pupils.
l{ote: The posterior determinants ofocclusion (two-thirds the height ofthe retromolar
pa&./ have the greatest effect on the setting ofthe mandibular second molars.
Rememb€r: The Frankfort horizontal plane extends from the outer canthus ofthe eye
to the tragus ofthe ear. It is commonly used in orthodontics for cephalometric analysis.
In the intercuspal position, the mesiolinguat cusp ofa permanent
maxillary lirst molar occludes where?
. The interproximal marginal ridge areas between mandibular first and second molars
. The interproximal marginal ridge areas between mandibular second and third molars
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. The space between the mesiobuccal and distobuccal cusps of the mandibular first
molar
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Examples:
l The mesiolingual cusp of the mandibular first molar opposes the lingual
embrasure between the maxillary first molar and second premolar
2. The mesiolingual cusp of the mandibular second molar opposes the lingual
embrasure between the maxillary second molar and first rnolar
\ote: The distolingual cusp of the mandibular first molar fits into fopposes) the
lingual groove ofthe maxillary first molar.
Remember: The lingual cusp ofpermanent mandibular first premolars does not occlude
* ith anlthing.
Important: During mandibular movements (working, non-working, e/c.) the outer as-
pects of the lingual cusps of the mandibular molars will not contact their maxillary an-
usonists. All other areas of buccal and lingual cusps may contact during mandibular
mo\ ements (this is assuming that all occlusal reletionships are normal).
\ote: In unilateral balanced occlusion, contact between mandibular buccal cusps and
maxillary buccal cusps, along with simultaneous contact between mandibular lingual
cusps and maxillary cusps will most likely occur in laterotrusive movements.
. Premolars
. First molars
. Incisors
. Canines
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Coplrighr O 20ll-2012 - Dental Dects
This is called canine or cuspid protected occlusion. It is an occlusal relationship in which the
vertical overlap ofthe maxillary and mandibular canines produces a disclusion (separation)
of all ofthe posterior t€eth when the mandible moves to either side. All other teeth, once they
move from centric relation, do not contact. If there is contact of other teeth. it is termed a
"working side" or "non-working side" interference depending on which side the mandible
moves towards. Note: When placing a crown on a maxillary canine, if you change a canine
protected occlusion to group function you increase the pot€ntial for a "non-working side" in-
terference.
l. Some relationships are not conducive to cuspid protected occlusion such as Class
-\otes II or end-to-end relationships.
_. 2. Some relationships are not am€nable to group function such as Class II, deep
^:.
venical overlap.
3. Regardless ofwhat lateral concept is used. no non-working side contacts ar€ a
must because; (l) They are damaging (2) They are difficult to control due to
mandibular flexure and (3) They deliver more force to the teeth than other contacts.
.1. Horizontal forces on teeth are the most destructive to the periodontium.
Remember:
. The facial embrasure between their class counterpart and the tooth distal to it
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. The interproximal marginal ridge area between the maxillary second bicuspid and first
molar
. The interproximal marginal ridge area between the maxillary first molar and second
rnolar
't'fi
Coplright O 201l-20t2 - Denral Dects
*** See picture below
Examples:
1. The facial cusp tip of a maxillary first premolar opposes the facial embrasure
between the mandibular first and second premolars (see note below).
2. The facial cusp tip of a maxillary second premolar opposes the facial embrasure
between the mandibular second oremolar and mandibular first molar.
\ote: During lateral excursive movements, the facial cusp ridge of the maxillary first
premolar on the working side opposes the distal cusp ridge ofthe first premolar and the
mesial cusp ridge of the second premolar.
. Backward and upward direction
112
Coplright O 201 I -20 l2 ' Dental Decl!
.Pr
.E
.T
. RCP
.ICP
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Important:
. A protrusive movement requires the condyles to move downward and forward
direction.
. In lat€ral movements, the working condyle moves down, forward, and laterally.
. In lateral movements, the non-working condyle moves down, forward, and medi-
ally.
Remember: In complete dentures, the path ofthe condyle during free mandibular move-
ments is governed primarily by the shape of the fossa and meniscus (articular disc) as
well as the muscular influence.
The inclination of th€ condylar path during protrusive movement can vary from steep
to shallow in different patients. It forms an average angle of about 3ff with the horizon-
tal reference plane. Ifthe protrusive inclination is steep, the cusp height may be obviously
longer. Similarly, if the inclination is shallow, the cusp will be shorter. This factor is the
most important aspect of condylar guidance that affects the selection of posterior teeth
with appropriate cusp height.
Anterior guidance (vertical and horizontal overlap of anterior teeth) also affects the
surface morphology ofposterior teeth. The greater the overlap, the longer the cusp height.
Important: Anterior guidance must be preserved, especially when restorative proce-
dures change the surfaces of aaterior or posterior teeth that guide the mandible in excur-
sive (lateral, protrusiv€) movements.
PR = Maximum protrusion
RCP-R = the rotational movement of the condyles retuming to centri c relation (tetmi'
nal hinge ais opening)
R-T = the translational moyement ofthe mandible retuming to where the condyles are
in centric relation
Tog€ther these line segments (RCP-R and R-T) make up the posterior border move-
ments of the mandible.
. Intercuspal position f1P)
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. Maximum
. Not present
. Premature
. qli ohr
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Coptright O 201l-2012, Dental Decks
*** IP is also called centric occlusion.
Remember: When the teeth are in centric occlusion, the position of the mandible in
relation to the maxilla is determined by the intercuspation ofthe teeth.
Empty mouth swallowing occurs frequently throughout the day and is an impofiant
function that rids the mouth ofsaliva and helps to moisten the oral structures. The hourly
rate of non-masticatory swallowing is apparently related to the amount olsalivary flow
and, in most instances, may be an involuntary reflex activity.
, ., . , l. The masseter muscles contract and the tip ofthe tongue touches the roofof
.rNote*: the mouth during normal swallowing.
\&|| 2. Tooth contacts are of longer duration in swallowing than in chewing, but
there is wide variation in frequency and duration from one person to another.
This position results when the mandible and all of its supporting muscles (eight muscles
o-/'ntastication plus the supra - and inf'ahyoids) are intheir restingpostve (there is a rel-
atie nruscular equilibrium). The term used to describe this absence ofcontact is
"free_
space" or "interocclusal distance". It usually averages between 2_6 mm. This
rr a'r'
position is a 'rmuscle-guidedfi position. It is the beginning and end point of most
mandibular movements-
The protruded contact position is s),rnnetrical, and the underside of the meniscus /ar_
ticular disc) moves distally relative to the superior surface of the mandibular condvle.
The condyle moves forward and canies the disc with it.
record should haye what important characteristic?
. Offer a maximum resistance to the patient's jaw closure and have high flow at
mixing
. Offer a marimum resistance to the patient's jaw closure and have low flow at mixing
. Offer a minimum resistance to the patient's jaw closure and have low flow at mixing
. Offer a minimum resistance to the patient'sjaw closure and have high flow at mixing
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. Modeling plastic
. Wax
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In recent years, polyvinyl siloxane (addition silicones) impression materials have domi-
nated the IOR (interocclusal record) market. These materials have very low flow when
mixed and become rigid after setting.
In the past, an interocclusal record was made by placing the IOR material into the mouth
and closing the patient's jaws into the material at the desired relationship. Although this
concept is acceptable may produce a relatively accurate IOR act of closing
-and of its lack of viscosity, often causes-the
into any material, regardless a deviation of the
mandible away from the desired contact position.
Materials used to record jaw relationships have varied widely over the years An ideal
recording medium would be characterized as easy to handle, uniformly soft while the
record is being made, rapid setting, and totally rigid but not brittle when set. Rapid set-
ting plastet zinc oxide and eugenol pastes, and modeling plastic all approach the ideal.
Avoid soft waxes as a recording material. They never become rigid and are likely to be
distorted during the cast mounting procedure.
If sufficient natural posterior occlusion exists, the mandibular cast may be mounted in
centric occlusion using a zinc oxide-eugenol reinforced wax bite. In the case ofthe dis-
tal extension partial denture' base plates and occlusion rims should be placed on the
framework ard the patient closed into softened recording wax or zinc oxide-eugenol
pxste (preferred). Whether this record will be in centric occlusion or centric relation will
depend upon the individual case and is dictated by the presence or absence of any natu-
ral posterior occlusion in the patient.
A retiable method is to use a record ofall remaining occluding surfaces in a wax wafer
with the mandible in the terminal hinge position ard the teeth just out ofocclusion.
Primary requirements for making a centric relation record when fabricating a removable
dentue:
. To record the correct horizontal relation ofthe mandible to the maxilla
. To stabilize the lower record base with equalized vertical pressure
. To retain the record in an undistorted condition until the casts have been accurately
mounted on the articulator or until a previous record can be verified
. Non-supporting and working
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. Horizontal overlap
. Vertical overlap
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Five Common Characteristics of Supporting Cusps
l. They contact the opposing tooth in the intercuspal position.
2. They support the vertical dimension ofthe face.
3. They are nearer the faciolingual center ofthe tooth than the non-supporting cusps.
4. Their outer incline has a potential for contact.
5. They have broader, more rounded cusp ridges than non-supponing cusps.
Remember: The supporting cusps are the maxillary lingual and the mandibular buc-
cal. These cusps do grinding work because they occlude in a fossa or marginal ridge and
are also called working cusps. They are sometimes called centric cusps because they
hold the occlusion in a middle position (centric position).
The non-supporting cusps are the maxillary buccal and the mandibular lingual. These
cusps do not occlude or fit into fossa or marginal ridge areas and are called balancing or
non-c€ntric cusps. These cusps allow the dentition to move apart, out ofocclusion. They
allow teeth to "unlock" and move back and forth and side to side. These cusps have
sharper cusp ridges that serve to shear food as they pass close to the supporting cusp
ridges during chewing strokes
Non-supporting Cusps Supporting Cusps
W
Maxillary Mandibular
W
Supporting Cusps
Right
First Molar
Non-supporting Cusps
Right
First Molar
-{nterior teeth have a mechanical advantage over posterior teeth, due to the fact that they
are fanher away from the fulcrum (condyles), giving them better leverage to offset the
closing musculature. This apparent is apparent when one tries to occlude maximally with
anterior teeth as opposed to occluding maximally in the molar region. The further away
lrom the site of muscle action, the less force is exerted.
Important point ofall this: ifanterior guidance can be accomplished, the least amount
of tbrce u'ill be placed on the teeth during muscular contraction.
Incisal guidance is a measure of the amount of movement and the angle at which the
lo* er incisors and mandible must move from the overlapping position of centric occlu-
sion to an edge-to-edge relationship with the maxillary incisors.
It is the second end-controlling factor in articulator movement. It is, to some degree, under
the control ofthe dentist. Influencing factors include: l) esthetics, 2) phonetics, 3) ridge
relations, 4) arch space, and 5) inter-ridge space. Esthetics and phonetics are the primary
factors limiting the dentists control of incisal guidance. The incisal guidance on the ar-
ticulator is the mechanical equivalent ofhorizontal and verlical overlap.
Note: The right and left condylar mechanisms are the other end-controlling factors in ar-
ticulator movement.
. Optimum occlusion requires minimum adaptation by the patient
. Bilateral balanced occlusion dictates that a minimum number of teeth should contact
during mandibular excursive movements
.Unilateral balanced occlusion or "group function" calls for all teeth on the working side
to be in contact during a lateral excursron
. Mutually protected occlusion, also called "canine guided" or "organic" occlusion is the
one in which anterior teeth protect posterior teeth in all mandibular excursions
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. The amount and direction oflateral shift in the working side condyle
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Coptrighr O 201 1,201 2 , D€ntal Decks
Important: In bilateral balanced occlusion the maximum number ofteeth should con-
tact during mandibular excursions. This concept ofocclusal arrangement, though ideal, is
very difficult to achieve.
The determinants of occlusion include the right and left TMJ, the occlusal surfaces of
the teeth and the neuromuscular system. The concepts of occlusal arrangement aim to
place the artificial teeth in harmony with the TMJ and the neuromuscular system. If this
is done properly, it will result in minimum stress on the teeth and only a minimum effort
will need to be expended by the neuromuscular system when performing mandibular
movements.
There are four features ofthe human dentition which directly affect the health ofthe PDL
and its hard tissue anchorage in terms ofresisting occlusal force:
l Ant€rior teeth have slight or no contact in the intercuspal positton.
2, The occlusal table is less than sixty percent ofthe overall faciolingual width ofthe
tooth.
3. The occlusal table of the tooth is generally at right angles to the long axis of the
tooth.
,1. Crowns of mandibular molars are inclined about l5-20 degrees toward the lingual.
The four theoretical determinants needed for restoring a complete and functional oc-
clusal surfaceofa tooth are:
1. The amount ofvertical overlap ofthe anterior teeth
2. The contour of the articular eminence
3. The amount and direction of lateral shift in the working side condyle
4. The position of the tooth in the arch
However, the jaw relationship most frequently used in the actual design of restorations
is the acquired centric occlusion.
Note: The anterior determinant of occlusion is the horizontal and vertical overlap
relationshio of anterior teeth.
. The maximum distribution ofocclusal stresses in centric relation
. The forces of occlusion should be bome as much as possible by the long axis of the
teeth
. Once centric occlusion is established. never take the teeth out ofcentric occlusion
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. The developmental groove between the distobuccal and the distal cusps of the
mandibular first molar
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Cop).right O 20ll-2012 ' Dertal Decks
*** This is false; when there is surface-to-surface contact of flat cusps, it should be
changed to a point-to-surface contact.
,w'-w
Surface-to-surlace point-to-suface
Important:
. The mesiobuccal cusp ofthe maxillary ftrst molar opposes the mesiobuccal groove
ofthe mandibular first molar. This relationship is a key factor in the definition of Class
I occlusion.
. The distobuccal cusp ofthe maxillary first molar opposes the distobuccal groov€ of
the mandibular first molar. Note: This distobuccal groove also serves as an escapeway
fol the )IL cusp ofthe maxillary first molar during non-rvorking excursive movements.
. The oblique ridge ofthe maxillary first molar opposes the developmental groovebe-
t\\'een the distobuccal and distal cusps ofthe mandibular first molar
Remember: The maxillary buccal (facial) and the mandibular lingual cusps are guid-
ing cusps. The inner occlusal inclines leading to these cusps are called guiding inclines
because in contact movements they guide the supporting cusps away from the midline.
Thus. there are the bucco-occlusal inclines (lingual inclines oJ the buccal ctrsps) of the
maxillary posterior teeth and the linguo-occlusal inclines (huccal inclines of the lingttol
c u.rp.s) ofthe mandibular posterior teeth.
. Non-working side condyle only
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Coplrigh e 201 I 2012, Denral Decls
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Coplrigh O 201l-201? ' Dental Dec16
In a lateral movement, the non-working side condyle moves downward, forward, and
medially. The working side condyle moves laterally. Since the mandible is a solid bone,
the amount that the non-working condyle moves medially determines how far the work-
ing side condyle moves laterally. The Bennett movement is sometimes called the lateral
shift of the mandible or immediate side shift.
Important: This movement influences the lingual concavity of the maxillary anterior
teeth and directional placement of the ridges and grooves on the mandibular posterior
teeth as well as the mesiodistal position ofthe cusps of posterior teeth. Note: The Ben-
nett angle is the angle formed by the sagittal plane and the path of the non-working
condyle during lateral movement ofthe mandible, as viewed in the horizontal plane.
These cusps are also called balancing, non-supporting, non-centric or shearing cusps.
These cusps do not occlude or fit into fossae or marginal ridge areas on the opposite arch
They allow the dentition to move apart, out ofocclusion. They allow the teeth to'.lln-
lock" and move back and forth and side to side.
Supporting cusps are the maxillary lingual cusps and the mandibular buccal cusps. These
cusps are also called working, stamp or centric cusps. Centric stops are areas ofcon-
tact that a supporting cusp makes with opposing teeth. For example, the mesial lingual
cusp ofthe maxillary frst molar (a supporting cusp) makes contact with the central fossa
lcentric stop) of the mandibular first molar.
Supporting cusps contac! the opposing teeth in their corresponding faciolingual center
on a marginal ridge or a fossa. Non-supporting cusps overlap the opposing tooth with-
out contacting the tooth.
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Five significant factors that govem the establishment ofbalanced articulation are:
. Inclination ofthe condylar guidance: totally diatated by the patient
.Inclination ofthe incisal guidance: horizontal and vertical overlap Some ofthese,
. Inclination ofthe ifnot all, are
occlusal plane: plane oforientation
. Convexities ofthe compensating curve contolled by
. Angle and height ofthc cusps the dentist.
Balanced centric occlusion in partial dentures is necessary for the stability ofthe appliance. De-
sign ofthe framework and the relationship ofthe teeth to the ridges also influences the stability of
the partial. Bilateral ecceltric balance is not an objective in partial denture construction unless
the partial prosthesis is opposed by a complete dentur€. The vertical relation for RPD'S is usually
determined by the remaining natural teeth (unlike complete dentures).
- , I . Eccentric occlusion is defined as protrusive and right and left lateral contacts of the
fiotei. inclined planes of the teeth when the jaw is not moving.
2. Articulation can be defined as the relationship ofteeth during movements into and
=;jji awav from eccentric Dosition while the teeth are in contact.
*** This is done to prevent duplicating the deflective occlusal contacts in the final restora-
tron.
Note: One cornmon case in which it would be pr€ferable for selectiv€ grinding to be
completed after the fixed bridge or partial dentue is in place is when a fixed or remov-
able partial denture is to be constructed for a space over which the opposing tooth has ex-
truded slightly. The bridge or partial is frequently constructed to the ideal plane of
occlusion and the opposing tooth is adjusted after insertion.
The most common complaint after cementation of a fixed bridge is sensitivity to hot /
cold and is an indication ofa deflective occlusal contact. The teeth involved may also be
sensitive to touch and this may be noticed by the patient while brushing. In these cases,
an immediate correction ofthe occlusion must be made.
. A periodontal problem
. Occlusal trauma
. An open margin
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Coplright O 201 I -20 l2 - Dental Deck
If centric relation occlusion is high, patients will complain of cold sensitivity and pain
upon biting down hard. All patients should have an appointment specifically to check the
occlusion on all crowns and bridges. Excursive movements should also be evaluated.
Many times patients will complain of pain on chewing soft foods, which indicates im-
proper balancing or working contacts. The occlusion ofgold restorations is best checked
with silver plastic shim stock.
Note: If a marginal ridge is left higher than an adjacent marginal ridge, an interference
in retrusive movement may occur.
Remember: The success or failure of a bridge depends mostly on the design of the
pontic. The design is dictated by function, esthetics, ease of cleaning, patient comfort,
and the maintenance by the patient ofhealthy tissue on the edentulous ridge.
Proper d€sign is more important to cleanability and acceptable tissue well-being than is
the choice of materials (porcelain, gold, etc.).
Note: Multiple adjacent pontics on an anterior fixed bridge have reduced facial embra-
sures to enhance esthetics.
. Is totally controlled by the dentist
. Is padially dictated by the patient but can be adjusted by the dentist ifnecessary
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Coprighr O 201 l-2012 - Denlal Decks
. A loss of interocclusal distance when the mandible is in the rest positton (decreased
free*^ay space)
. Neither ofthe above, vertical dimension ofocclusion does not affect interocclusal dis-
tance
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CopriShr O 201 l-2012' Dmtal Decls
Condylar guidance is the mechanical device on an articulator which is intended to pro-
duce similar guidances in articulator movement that are produced by the paths of the
condyles in mandibular movements.
Rememb€r:
. The incline or angulation ofthe condylar element on the articulator is anatomically
related to the slope of the condylar articular eminences (condylar inclination).
. When adjusting the condylar guidance for protrusive relationship, the incisal guide
pin on the articular should be raised out of contact with the incisal guide table. The
protrusive record is probably the least reproducible maxillomandibular record.
Note: When restoring the entire mouth with crowns, the protrusive condylar path
inclination influences the mesial inclines ofthe mandibular cusps and the distal inclines
of the marillarv cusos.
A classic example of a decreased vertical dimension: People with no teeth or people who have wom
dentures fora long time present with the lower portion ofthe face scrunched up or do not show their lips
anymore (poor facial proftle).
Solution: Make new dentues and increase the vertical dimension ofocclusion. By doing this, you will
decrease the int€rocclusal distance and decrease freeway space.
Some effects ofexcessive vertical dimension ofocclusion:
. Exccssive display ofmandibular teeth
. Comf'laint of faligue oImuscles ofmasticalion
. Clicking ofpostcrior teeth when speaking
. Strained appearance ofthe lips
. Patient not able to wear dentures
. Discomfofi
. Excessive trauma to the supporting tissues
. Gagging
Some effects of insulficient vertical dimension of occlusion:
. Aging appearance ofthe lower third ofthe face due to thin lips, wrinkles, chin too near the nose,
overlapping comers of the mouth
. Diminished occlusal force
. Angular cheilitis
. "Muscle-guided" position
. "Ligament-guided" position
. "Tooth-guided" position
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. A prerequisite for the use of this technique for the restoration of a single tooth is the
presence ofa Class III occlusion
. This technique allows the cuspal movements of the dentition to be recorded in wax
intra-orally and transferred to the articulator in the form ofa static plaster cast
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Coplri8ht Ci 2011,2012 - DentalDecks
Three Basic Jaw Positions
1) Centric occlusion {'CO) or the intercuspal /C) position is the relationship between maxillary and
mandibular occlusal surfaces that provides the maximum contact and or intercuspation independent
ofcondylar position. It is a "tooth-guided" position.
2) Centric rel.tion fCR) (also called the retruded contact position) 1s the most unstrained, retruded
anatomic and functional position ofthe heads ofthe condyles ofthe mandible in the mandibular fgle-
noid) fossae ofthe temporomandibular joints. This is a relationship of the bones ofthe upper and
lowerjaws without tooth contact. The presence or absence ofteeth, or the type ofocclusion or mal-
occlusion, are not factors. It is a "ligament-guided" position. Note: The mandible cannot be forced
into cent c relation from the rest position because the patient's reflex neuromuscular defcnse would
resist the applied force. The mandible should be relaxed and gently guided into cenhic relation.
3) The rest position of the mandible or the postural position is determined mostly by the muscu-
lature, The usual reflex cited as the basis for the postural position of the mandible is the tonic stretch
reflex ofthc mandibular levators fi.€., the myotatic rellex).lt is a "muscle guided" position.
*** This is false; a prerequisite for the use ofthis technique for the restoration ofa sin-
gle tooth is the presence ofan optimal occlusion.
A major difficulty for any dental laboratory technician is to determine the cuspal move-
ments ofthe dentition using hand-held casts or casts mounted on a simple hinge articula-
tor. The functionally generated pathway technique allows these movements to be recorded
in wax intra-orally and transferred to the articulator in the form ofa static plaster cast (the
functional index).
The involved tooth should be immobile and the recording material (low-fusing hi-Ji wax)
retained on the prepared tooth, not moving separately, during the generation ofthe FGP
wax record. The involved tooth should have unprepared teeth anterior and posterior to it
to act as refer€nce surlaces for checking the complete seating ofthe functional core ofthe
$,orking cast. There should be no occlusal interferences pre-operatively and the op-
posing surfaces should be properly restored.
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. Poor esthetics
. Expansion
. Brittleness
. Radioactivity
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Copyrigh O 201 I ,2012 - Dental Decks
The following must be considered while verifying the vertical dimensions of the
occlusion:
. Pre-extraction records
. The amount ofinterocclusal distance (freeway space) to which the patient was previ-
ously accustomed to
. Esthetics harmony should be noted along with facial expresston
. Phonetics -facial sounds
-speech
. Length ofthe lip in relation to the teeth
. The condition and amount of shrinlage ofthe ridges
The compressive strength ofceramic bodies is greater than either their tensile or their shear strength The
tensile strength is low because ofthe unavoidable surface defects. The shear strength is low because of
the lack ofductility or ability to shear, caused by the complex stluctule ofthe glass ceramic materials.
The shear and tensile strengths of the fired porcelain are so low that the slightest imperfection in the
preparation ofthe cavity in the tooth may cause thejacket crown to ilactue in service.
Remember;
. Tle tooth preparation reduction for the mettl-ceramic restorations (1.5-2.0 nn) must provide
space for the metal f0. 5 ht ) and porcel^in (1 .0- 1.5 nm)
. The metal substructure provides support and increases the strength ofthe porcelain
. All intemal line angles where porcelain is veneered should be rounded to prevent shess concen-
tration
. The metal-porcelain junction should be at a right atrgle to avoid porcelain fracture
. Occlusal contacts must be at least 1.5 mm away from porcelain/metal junctton
. The coefficient ofthermal expansion ofthe porcelain must be slightly lower thafl that ofthe metal
to place the porcelain in slight compression when cooled
. Porcelain is stronger under compressive forces than it is in tensile forces
. Metal oxide formation is necessary for the metal-cemmic bond
1. Many porcelains rust at a temperature over 2000pF.
,. *-o6g] 2. The glaze firing is the last firing and it produces a smooth, translucent surface.
e_ 3. Denlal porcelain has good biocompatibility. but is very brinle.
ry _ i 4. All-porcelain crowns are superior to ceramo-metal crowns in esthetics oriy (as compared
wilh stre gth, hanlness and toughness).
5. In a ceramo-metal unit, the porcelain surfacc should be under slight compressive stress
(it should not be under tensile or shear stress).
6. The core material in an all ceramic crown is usually a high strength sintered ceramic.
7. Porcelain substrate alloys, when comparcd to faditional alloys, melt at a higher tem-
perature.
. Interposition ofan intermediate metal layer
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Coplrighr O 20ll-2012 'Denial Decks
. Hue
. Chroma
. Value
.Intensity
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Porcelain attaches to metal substrates by mechanical and chemical bonding. Roughness from sand-
blasting the cast metal restoration allows porcelain to mechanicaliy bond to metal. The mixing ofoxi-
dized metal layers with porc€lain oxides allows the porcelain to chemically bond to metal. Note: Tle
elements Sn,In, Fe, and Cr all conhibute to metal oridation for chemical bonding to porcelain. Im-
portant: (l) Fe is key in PFM bonding to gold b.sed alloys (2) Cr is key in PFM bonding to gold-sub-
stitute alloys.
Three layers of porcelain
. The opaque porcelain must mask the dark oxide color as well as provide the porcelain-metal bond
. The body porcelain makes up the bulk ofthe restolation, providing most ofthe color or shade
. The incisal porcelain is a translucent layer ofporcelain in the incisal or cuspal portion ofthe tooth
The opaque is applied lirst to mask the metal and to give the restoration its basic shade. Body porce-
lain is then added overthe opaque. Incisal porcelain is added to the incisalone{hird to give translucency.
The restoration is bufked out (overcontoured) to compensate for the 20yo shrinkage, which occurs dur-
ing firing.
Opaque porcelain showing through on the facial surface ofa metal-cemmic crown may be caused by
the following:
. Inadequate tooth reduction fault ofthe dentist
- ofthe lab
. The metal is too rhick fault
. The opaque porcelain is too thick of the lab
-fault
. Inadeouate thickness ofthe bodv Dorcelain ofthe lab
-fault
L All ofthe following can lead to "pop-off' ofporcelain from PFM crowns:
. Contamination of the porcelain-to-metal interface
. Thick layers ofsurface conditioners on the metal
. Under-firing ofthe opaque layer
2. Surface mic.o-cracks in porcelain are caused by cooling stresses related to thc poor thcr-
mal conductivjty of porcelain.
3.Built-in strcsscs in the Dorcelain contributcs most to PFM failure.
The surface characteristics ofporcclain can affect the perceived form ofthe final restomtion in the follow-
ing ways:
. A smooth surface will give the impression ofa larger size
. Changes in contour can be used to alter the apparent long axis inclination of a tooth
. Fluorescence
. Metamerism
. Opaqueness
. Opalescence
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Cop),righr O 201 I -20 l2 - Dental D€cks
. Obtained by heating the previously fired body very slowly for 60 minutes at its fusing
temperature
. Nonporous, resists abrasion, possesses esthetic ability and is well tolerated by the
gingiva
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This property is important in matching the shade of a metal-ceramic crown to a natual
tooth. Thus, ifpossible, color matching should be done under two or more different light
sources, one of which should be sunlight. Note: Staining ofthe porcelain will increase
metamenc responses,
Fluorescence is the optical property by which a material (for example, teeth) reflects r0.l-
traviolet radiation. The energy that the tooth absorbs is converted into light with longer
wavelengths, in which the tooth actually becomes a light source. Human teeth fluoresce
mainly blue-white furcs (400450 nm range). Fhtorescence makes a definite contribu-
tion to the brightness and vital appearance ofnatural teeth.
Opalesence is the light effect of a translucent material (incisal edge of some teeth) ap-
pearing blue in reflected light and red-orarge in transmitted light.
Note: The production of color sensation with a pigment is a physically different phe-
nomenon from that oblained by optical reflection, refraction and dispersion. The color of
a pigment is determined by selective absorption and selective radiation (scattering).
Remember: The light source affects the perception of color, because the light source
must contain the wavelensth ofthe color to be matched in order to see that color.
At least three stages are generally recognized in the firing of dental porcelain: 1) low
bisque firing 2) medium bisque firing and 3) high bisque firing. The temperature at which
each occurs depends upon the type ofporcelain used.
A natural glaze occurs when the porcelain restoration itselfis glazed by a separate firing
(this process is referred to as "the glaze firing'). Ifthe body, previously fired as a high
bisque, is heated rapidly (10- I 5 ninutes) to its fusion temperature and maintained at that
temperature for approximately 5 minutes before it is cooled, the glass grains flow over the
surlace to form a vitreous layer, which is called a glaze. Note: This type ofglaze is much
more permanent than the overglazes.
Overglazes (or applied glazes) are ceramic powders that may be added to a porcelain
restoration after it has been fired. A transpa:ent, glossy layer forms over the surface of the
porcelain restoration at a maturing temperature lower than that ofthe body porcelain. The
result is a glossy or semiglossy surface that is non-porous. Erosion of this overglaze
may occur in the mouth and this leaves a rough and sometimes porous surface.
Note: Glazed porcelain (either type) is the least irritating to the gingival tissues com-
pared with polished cast gold, polished direct filling gold and polished acrylic resin.
. Denture teeth
. Metal-ceramic crowns
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Cop"ighr O 201 l'2012' D€ntal Deks
. Quenching
. Pickling
. Degassing
. Investing
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coptright @ 20ll-2012 - Denbl Decks
The difference beween low- medium- and high-fusing porcelains is the firing temperature used to fuse
the glass. Today's low-fusing porcelain was developed to be less abrasive to opposing dentition by in-
corporating finer leucite crystals in lower concentrations.
Classifi cation based or\ fusion (vitrif ic a t io n ) temperature:
. High-fusing: 1288 to 137l"C (2350 to 2500"F): wed for denture teeth
. Medium fusing: 1093 to 1260'C (2000 to 2300"F): $ed fot all-ceramic and porcelain Jacket crowns
. Low fusing: 8'71to 1066"C (1600 lo /950'F): uesd for metal-ceramic crowns
Remember:
I. The compressive strength (350-550 MPa) of a porcelain testoration is greater than its tensile
(20-60 MPa) or shear strengths, which is typical ofa brittle solid.
2. Aluminous porcelain uses alumina instead ofquartz as a strengthener. This type ofporcelain is
considerably stronger than conventional porcelains.
3- Dental porcelain restorations are brittle and are not capable ofmuch plastic deformation.
Ceramic Properties:
L Physical Properties:
. Inrermediate density (1.0-3.8 gns/cc)
. High melting point (: reJi'actory,t
. Low coefficient ofthermal expansion (l-l5 ppmfC)
2- Chemical Properties:
. Low chemical reactivity
. Low absorption and solubility
J. \Iechanical Properties;
. High modulus ofelasticity
. Much stronger in compression than tension (approximately 10X)
. Biftle (\o'|, plostic deformation (<0.1%o);low fracture toughness
-+. BiologicalProperties:
. Relatively inert
It is necessary for all gold-porcelain systems. Degassing ofthe metal at too low a tempera-
ture will effect the formation of the oxide layer, which is important in bonding ofthe porce-
lain. The number ofbubbles formed at the interface decreases as the time and temperature of
degassing are increased.
the casting is ready for porcelain addition. The metal liamework must not b€
After degassing
contaminated by handling prjor to porcelain addition. Ifit is, the bond ofthe opaque will be
veakened.
\ote: Both the metal (alloy) and ceramic (porcelain) must have coefficients of thermal ex-
pansion that are clos ely malched (alloy is usually slightl, harder) ifundesirable tensile stresses
at the interface are tobe avoided (racnre of the porcelain). Alloys should have a high pro-
portional limit, and particularly, a high modulus of elasticity. Alloys with a high modr.rlus
\\'ill reduce shess on the porcelain.
Pickling is the process ofremoving surface oxides from a casting prior to polishing. The cast-
ing is placed in an acidic solution which reduces the surface oxides. To prevent injury safety
goggles should always be wom when pickling.
. The first statement is true; the second statement is false
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Classilicstion according to method of frbrication:
. Powder condensation:This is considcrcd thc tmditional way for f'abrication ofan all-ccramic rcstoration. This
tcchniquc involvcs applying moist porcelain using a spccial brush, thcn compacting the porcelain by rcmoving thc
cxccss moisturc- Thc porcclain is (hcn fircd undcr vacuum allowing fu(hcr compaction. Ccramics fabricatcd by
this technique havc a great amount oftranslucency and are highiy csthciic, and arc uscd maidly as vcnccrirg ]ay-
crs. Notei Powder condcnsation utilizcs fcldspathic porcclain.
Feldspathic porcelain: Potassium and sodium fcldspars arc naturally occurring clcmcnts composed mainly ofpotash
(K20) and sod^ (Na
20) , thcy also contain alumina (Al2O) and soda (Na2O) . Leucitc and a glass phasc arc fonncd
whcn potassium feldsparis fircd to high tcmpcraturcs. Thisglass phase softens during firing allowing coalescencc of
thc porcclain powdcr particlcs. This proccss is callcd liquid phasc sintcring. This proccss occurs at a relativcly high
temperaturc allowing thc formation ofa dense solid. Sincc lcucitc has a largc cocfl'icient ofthermal cxpansior, it is
added to somc glasscs to control thcir thcrmal expansion. Feldspathic porcclain is composed mainly ofoxidc com-
poncnfs including:
. SiO2 62-62 %)
"'t
'Al2O/ll-16fl!/o)
. Na2O (5-7 wt %)
. Li"O and B2O as additivcs
Since the porosity ofa ceramic is highly correlated with ils mechanical properties, reducing thc number ofdcfbcts in
a ccramic is a common way ofincrcasing its sfcngth, Thc most common way oflowcring a ccmmic's porosity is sin-
iering. During sjntcring a ceramic material isheated in a fumace or ovcn likc dcvice;where it is crposcd 10 high lem-
pcratu.cs. Thcse tcmpcratures depend on the material,butyou should know that they\yill alwaysbe below thc mclting
point of$e ceramic. During thc sintcring proccss thc porcs in thc ccramic will closc up thcrcby reducing the num-
ber oidelccts. Sintered all-cerNmic mat€rials include: alumina based ceramic, leucitc-rcintbrccd feldspathic porcc-
lain, magncsia-bascd corc porcelain, heat-pressed all-cemmic matcrial and lcucite-based Iithium disilicate basc.
. Slip Casting: This techniquc involves forming a mold ofthc desired framework gcomctry and pouringa slip inlo
rhe formcd mold. Gypsum is usually utilized to form thc mold due to its ability ofcxtracting somc ofthe watcr
from ihe slip. Thc slip thc bccomcs compactcd against thc mold forminga fiamcwork. Thc frameq,ork is thcn re-
molcd from the mold by partial sintcring. Thc rcsulting ccramic is vcry wcak and porous and must be infiltcred
$ith glass or fully sinlcrcd bcforc application ofthcvcnccring porcclain. Matcrials processed by this tcchniquc tcnd
ro halc tcwcr defects from proccssing, and cxhibit highcr toughncss lhan thc convcntional fcldspathic porcclain.
Thc usc of this tcchnique in dcntistry has been limited to one ofthrce products. This limitation might bc duc thc
complicatcd stcps, which makcs achicving an accuratc fit diflicult. Slip cast all-ceramic materials include: alu-
mina brscd. sDincl zirconia-based. and machined all-ceramic material.
Firing porcelain causes the powders to become "sintered." Sintering changes the porce-
lain from a powder to a solid. The powder is not melted, so the general shape is main-
tained. Sintering porcelain is the same process that is used to fire clay pots, china, and
ceramic tiles. Reducing the porosity of the resulting product is very important. The less
porous (more dense) the product is, the greater the strength of the final product will be.
After sintering, the final shape ofthe restoration is refined by grinding.
l. When porcelain is fired too many tirnes, it may devitrify. This appears as a
state" and makes glazing very difficult.
:.;Xot"J;.':. "milky
2. Aluminum oxide is added to low-fusing dental porcelains (during its man-
tufacture) in order to increase its resistance to "slumping down" during firing.
3. Glass, which is a prevalent phase in dental porcelain is arnorphous and frag-
ile.
4. The strength ofa ceramic decreases with flaw size.
5. Ceramic restorations are severely damaged by acidulated fluoride.
6. All-ceramic restorations are more prone to fracture ifthe preparation line an-
gles are not rounded.
7. Machine grinding of ceramics induces surface cracks.
. A tooth-bome removable partial denture
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Cop}Tighl O 20ll-2012 - Denral Decls
. The connecting tang between the denture and other units ofthe prosthesis
. The part of the denture base which extends from the necks of the teeth to the border
of the denture
. The unit of a partial denture that connects the parts of the prosthesis located on one
side ofthe arch with those on the opposite side
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Cop).righr O 20ll-2012, Dental Decks
A distaf extension removable partial dentve (either bilateral or unilateral) receives its
suppoft ftom the residual ridge, tissue-bearing areas, selected abutment teeth and the fi-
brous connective tissues overlying the alveolar process.
The most important factor in detemining the success of distal extension removable par-
tial dentures (bilateral and unilalera, is proper coverage over the residual ridge. Cov-
erage of the free-end should extend over the retromolar pad to create stability of the
RPD and to minimize the torquing forces on the abutment teeth.
The major connector must be rigid so that stresses applied to any one portion ofthe den-
ture may be effectively distributed over the entire supporting area. lt connects other com-
ponents ofthe prosthesis and provides cross-arch stabilization.
Note: A minor connector is the connecting link (or tang)between the major connector
or base ofthe partial dentue and other units ofthe prosthesis, such as clasps, indirect re-
tainers and occlusal rests.
. 2-4 mm wide
. 8-10 mm wide
. At least 12 mm wide
146
CoplriSh O 201 l-2012 - Dental Decl!
. 3 mm ofvertical height between the gingival margin and the floor ofthe mouth
. 5 mm ofvertical height between the gingival margin and the floor ofthe mouth
. 7 mm ofvertical height between the gingival margin and the floor of the mouth
.9 mm ofvertical height between the gingival margin and the floor ofthe mouth
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Structurally, this combination of major connectors exhibits many ofthe same disadvan-
tages as the single palatal bar To be sufficiently rigid and to provide the needed support
and stability, these comectors could be too bulky and could intefere with tongue func-
tron.
Pllrt l plrt€: is a thin, broad conueclor ihat is indicated when all posterior te€th are missing bilat-
eratly. when used the portion contactiDg the teeth rnust have positive lupport hom adequate rest
sea6.
Slngle prlstaf strrp: is indicated in tooah-bot[ e &PDs (Keknedy Class 1,4, s'ith bilat€ral, short
span edentulous areas,
Anterlor-posterior p.lrtd strapsi structumlly, this is a rigid palatal major connector; it lnay be
used in almost any maxillary partial denture design.
Sirgle palrtal brr: are obj€ctiomble because they lack rigidity. Their use is limited to tooth-bome
restorations for bilateml short spar edenlulous areas. The wide, thirr bar 6tdp) is more riSid with
less bulk compared 10 a narow bar.
Hors€shoe designi is the le.st rigid maxillary connertor; should only be l]sed when a large,
inopemble palalal torus pr€venls the use ofo$er desigts.
Ant€rior-posterlor pslatal baft: to b€ sufficieDtly rigid to pfovide required suppon and stability,
these majoi connector must be excessively bulky, which ofien irterteles with the tonglle.
Remember: The major and minor connectors must be rigid in order for the functional
stresses that are applied to the partial dentures to be distributed evenly throughout the
mouth
Linguoplrte: used when the depth ofthe lingual vestibule is less than 7 mm; when lingual tori
are present and when al1 posteiior teeth are to be replaced bilaterally. Contraindication is
severe anterior crowding.
Lingual bar: requires a minimum of 7 Inm of vertical heiglt between the gingival margin and
the floor of the mouth. Lingual bars should be placed so that the upper border is a minimum of
3 mm below the gingival margins 8nd at least 4 mm is required for ihe vertical height ofthe
lingual bar; simplest and most commonly used major cormector.
Labial bar: is .sr€ly indicared. It can be used satisfactorily when large mandibular tod inter-
fere with conventionat lingual bar placement or when lower teeth are severely lingually tipped
and placement ofthe lingual ba! is aot possible.
. High flexibility
ta8
CoplriSht O2011,2012 - Dental Decks
't4t'
Cop)'right O 201 I -2012 - Dental Drck
A high yi€ld strength and low modulus ofelasticity produce higher flexibility' The gold al-
loys are approximat€ly twice as {lexible as the chromium-cobalt alloys, which is a distinct
advantage in the optimum location or retentive elements ofthe framework in many instances.
Note: The std?ess ofthe chromium-cobalt alloys can be overcome by including wrought-
wire retentive €l€ments in the framework.
The popularity of chrcmium-cobalt alloys for fabrication ofcast frameworks for removable
partial dentures has been attributed to their low density (weight), hrgh modulus ofelasticity
(stffiess),low material cost and resistance to tamish. Note: Chromium-cobalt alloys are more
rigid in comparison to gold or palladium alloys.
Composition of chromium alloys for partial dentures:
. Chromium: ensures that the alloy will resist tamish a\d corrosion (due to formation
of a complex chromium oxide Jilm)
. Cobalt: contributes strength, rigidness and hardness
. Nickel: increases ductility
. Minor constituents: carbon has a pronounced effect on the strength, hardness and duc-
tility. Tin, indium and other readily oxidized minor components ofthe alloy firnction to im-
prove bonding.
Remember: The form ofchrome-cobalt alloy connectors is flat, broad and reinforced along
the borders by the bead on the tissue surface. The process ofbeading not only helps maintain
tissue contact, but also provides additional strer,gth (for maxillary major connectors).
Possible causes of fracture of chromium-cobalt partials include cold-working (which re'
duces the percentage of elongation that causes a decrease in hardness), shrinkage porosity
Ithese alloys shrink approximately 2.3o.4 and the result is porosi4,), low percent €longation
/is directl!- related to greater brittleness) and excessive carbon in the alloy (wrlrlch rcucts with
the other constituents to form carbides).
Surveying is generally perfomed at right-angles to the occlusal plane in the first instance, as this is the
likely path ofdisplacement. Sun'eying will identiry three principal factors: (1) The pfesence ofunder-
cuts (2) The contour ofthe undercuts rclativc to the gingival margin and (3) The depth ofthe undercuts
Extracoronal retainers are the most common type ofdirect retainer that is used for removable par-
tial dentures. They arc called clasps. The purpose ofthe clasp is fetain the RPD by means ofthe abut-
ments. To prevent horizontal movement of the clasp, this should encircle the tooth more than 180
degrees or one-halfthe circumference ofthe tooth. Their ability to provide retention is based on the re-
sistance of metal to defotmation. Note: Retentive clasps should beoome active only when dislodging
forces are applied to thcm. There are two basic categories ofextracoronal retainers: suprabulge and in-
fr.bulge retainers.
Requirements ofa properly designed clasp:
l. Support - against vertical forces
2. Bracing - against horizontal forces
3. Retention - resist forccs in a occlusal direction
4. Encirclement - of more than halfit's circumference
5. Rcciprocity - equal and opposite forces by clasp arms
6- Passivity - at rest when seated
Intracoronal retainers (precisio attuchmettlt are the other tlpe ofdirect retainer that is somctimes
used for removable partial dentures. These are attachments which are built into the contour of a crown
/c.rs,ingl to produce mechanical and frictional retention. By eliminating the need for a visible retentive
clasp, these retainers give optimtl esthetics. They provide vertical support through the rest seat located
more favorably in relation to the horizontal axis ofthe abutment teeth.
lmportanti Intracoronal retaineas are not used when a partial denture depends upon an edenfulous area
for support /distdl eiter.slorl. These retainers may provide a rigid con[ection between the denture and
the abrltment (line for looth-bone pdrlials). However, in distal extensions, functional motion must be
permitted without torquing the abutment teeth.
. Below the height ofcontour
150
Copyrighr O2011,2012 - Dental Decks
. Cleaner
.I Bar - 2.5 mm liom gingival margin, crosses at right angles in a .01" undercut at the greatest M-D promi-
nence to permit it to disengage during function
*** This is false; infrabulge retainers are more bothersome to vestibular tissues.
Infrabulge retainers are clasps that originate from below the survey line. They are metal
projections emanating from the denture base struts in the framework. They course tluough
the denture base and project parallel to the mean plane ofthe gingiva until they make a
gentle right angle tum. Then they cross the gingiva and come to rest upon the abutment
tooth in a specified undercut area.
Infrabulge retainers must not be placed into tissue undercuts, nor should they contact the
abutment at any place except at the specified undercut.
The bar clasp arm has been classified by the shape of the retentive terminal. These in-
clude the T, modified I I, or Y. These bar clasp arms and circumferential clasp arms (a
suprabulge retainet), both provide retention by the resistance of metal to deformation,
rather than frictional resistance created bv the contact ofthe clasD arm to the tooth.
The one located the closest to the clasp tips which is located furthest from the
edentulous area
The one located the furthest from the clasp tips which is located nearest to the
edenfulous area
The one located the furthest from the clasp tips which is located furthest from the
edentulous area
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r
Which of the folowing Kennedy classes of removlble partial
dentnres are not tooth-borne?
I
. Class I
. Class II
. Class III
. Class IV
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Coplriehr O 201 l-2012 - Dertal Decks
Explanation ofansw€r: As unseating occurs in the edentulous segments, a line through
III lever
the rests located furthest from the retentive clasp tips acts as the fulcrum in a Class
system. Moving the fulcrum line still further from the clasp tips improves the mechani-
cal advantages ofthe lever arm system. By maintaining this position, the most distant
rests augment the retentive action ofthe clasp and indirectly contribute to retention. Thus,
the term indirect retainers Dertains to rests. which ausment mechadcal ret€ntion.
As the denhrre base moves upward, the most anterior rcst (lrhich is the indirect
retainer) rcsists downward movement and this increases the effectiveness of the direct
retainer.
Tooth-borne removable partial dentures fclass 1/1and Class IV) depend entirely on abutment
teeth for support.
Kennedy classifications are based on the most posterior edentulous area to be restored. Although
Class Ilt and IV partial dentures are supported entirely by the abutment teeth, Class I and ll partial
dentures are supported also by the residual ridge, the subjacent tissues and the fibrous connective
tissue overlying the alveolar process.
Applegates rules governing the application ofthe Kennedy classification system:
. Rule l: the classification should follow, not precede extractions.
. Rule 2; ifa 3rd molar is missing and not to be replaced, it's not considered in the classifica-
hon-
. Rule 3: if a 3rd molar is present and not to be used as an abutment, it's not considered in the
classification.
. Rule 4: if a 2nd rnolar is missing and not to be replaced, it's not considered in the classifica-
tron.
. Rule 5: the most posterior area always determines the classification.
. Rule 6: edentulous areas other then those determining the classification are referred to as rnod-
ifications and are designated by their numbers.
. Rule 7: the extent ofthe modification is not considered, only the number ofadditional eden-
tulous areas.
. Rule 8: there are no modification areas in Kennedy Class IV arches.
Note: The alveolar ridge resorption under the distal extension partial denture is ofparticular con-
cem and can be reduced by maximizing the coverage ofthese supporting areas.
Very Important! Likewise, the periodontal damagc to abutment teeth is avoided with firm tissue
support a stable base-tissue relationship.
-maintaining
Rememb€r: Rests should be placed on abutment teeth next to the edentulous areas for maximum
support when designing a tooth-bome partial. These rests limit movement ofthe denture in a gin-
eival direction.
The followlng partially edentulous rrch would be classilied as:
. Kennedy Class I
. Kennedy Class II 'i:-_(-- \
-_:- I -- s<
. Kennedy Class III
. Kennedy Class IV
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Coplaight O 201l-2012, Denral Decks
\
What is the recommended treatuent for a patient who has lost
her four maxillary incisors some time ago and has suflered
excessive ridge resorption?
. No treatment
. A Maryland bridge
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Coplaight O 20ll-2012 - Dertal D€cks
Kennedy Class I Kennedy Class II Kennedy Class IV
Bilateral distal extension Unilateral distal extension Anterior extensions
crossing the midline
Any other additional edentulous area is referred to as modification (except in Class IV)
e.g.. If Kennedy Class I (bilateral clistol extension) above, also has another edentulous
area anteriorly, then it would be referred to as Class I modification I.
*** Ifexcessive ridge resorption has occurred after tooth loss in the anterior region, the
pontics required to replace these teeth may be quite unesthetic. A removable partial den-
ture rvith its tissue colored acrylic base can provide this esthetic consideration.
. Long span edentulous area: sufftcient abutment teeth are not present to support the
occlusal forces, which would be placed on the fixed bridge.
. Economics: may force the use ofa partial denture as an interim solution to a prob-
lem that must evcntually be solved with fixed prosthodontics.
. When the lingual frenum is high or the space available for the lingual bar is limited
.In Class I situations in which the residual ridges have undergone excessive vertical re-
sorption
. When the futue replacement of one or more incisor teeth will be facilitated by the ad-
dition ofretention loops to an existing linguoplate
'| 56
. More than 25%o, allowing the clasp to bend without microstructure changes that could
compromise its physical properties
. More than 6%, allowing the clasp to bend without microstructure changes that could
compromise its physical properties
. Less than 6%, allowing the clasp to bend without microstructure changes that could
compromise its physical properties
. Less than 250lo, allowing the clasp to bend without microstructure changes that could
compromise its physical properties
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Cop)righr O 20i I 2012 - Denlal Decks
*** This is a contraindication to the use oflinguoplate
The linguoplate is a lingual bar that has been extended upward to cover the cingula and in-
terproximal spaces between mandibular anterior teeth. It should be thin and follow the con-
tours ofthe teeth and embrasures. The upper border should be located at the middle thAd of
the lingual surface ofthe teeth and extend upward to cover interproximal spaces to the con-
tact Doint.
A lirought wire clasp is fabricated by d&wing the metal from which it is made into a wire.
The success ofwrought wire clasps depends on their physical properties and the changes that
ma-,- occu during fabrication. Laboratory ptocedures can compromise desiable physical prop-
enies due to improper heating and cooling. Manufacturer directions should be followed for
each panicular alloy. It is important that a wrought wire clasp have an €longation percentag€
ofmore than 670, allowing the clasp to bend without microstructure changes that could com-
promise its physical properties. Tapering a wrought wire clasp to 0.8 mm at the tip before con-
rouring allows for more uniform stress distribution throughotlt the clasp, making it more
sen iceable and efficient. Remember: The most important mechanical property involved
when a clasp is adjusted is elongation.
Desig:ning a chrom€ cobalt clasp to engage less undercut is the most reliable way to de-
crease its retentiveness; switching to a gold clasp while maintaining the same amount ofun-
dercut will have a similar result. Gold clasps offer half the retention ofchrome cobalt clasps
$hile engaging identical undercuts. Because the grain size ofchrome cobalt is large by com-
parison, it possesses a lower proportional limit; as a result, the risk offracture increases as its
bulk decreases. Since cobalt work hardens more rapidly than gold, bending chrome cobalt
clasps is associated with an increased likelihood of fiacture.
Note: A cast m€tal is any metal that is m€lted and cast into a mold (e.g., an inlay, crown or
c/nspl. When the casting is cold-worked in some manner to provide the required article or ap-
pliance (e.g.,lrire), it is calted a wrought metal in contrast to a cast metal. As stated above,
many mechanical properties ofthe wrought structure are sup€rior to those ofthe cast struc-
i)re (e.g., tensile strength, hardness and strength). Tttis means that a wrought structue hav-
ing a smaller cross-section than a cast stmctue may be used as a retainer arm (retentive) to
Derform the same function.
. It is a rest seat
. The function is to prevent vertical dislodgement ofthe distal extension base ofa remov-
able partial denture
. 50lo greater than the cast alloy from which it was fabricated
. 25olo greater than the cast alloy from which it was fabricated
. 50% less than the casl alloy from which it was fabricated
. 7570 greater than the cast alloy from which it was fabricated
159
Cop)'righ! O 20ll-2012 - Denral Decks
***This is false; it is usually found on a canine or premolar.
Indirect r€tention is the component ofan RPD that assists the direct retainers (clasps)
in preventing displacement of a distal extension base by functioning through lever ac-
tion on the opposite sid€ of the fulcrum line when the denture base rotates away from
the tissues around the fulcrum line.
Remember:
. An indirect retainer should be placed as far from the distal extension base as pos-
sible in a prepared rest seat on a tooth capable of supporting its function
. The term indirect retainer pertains to rests, which augment mechanical retention
Har,e a greater tensile strength than cast clasps and therefore can be used in smaller
diameters to provide greater flexibility without fatigue and ultimate fracture
Important: Having been formed by being drawn into a wire, the wrought-wire clasp has
toughness and ductility exceeding that of a cast clasp arm. The clinical effect of this is
that there is an increased capacity for deformation ofthe wrought-wire without breaking.
Horvever, the yield strength ofboth gold and chromium-cobalt alloy wrought wires can
be drastically reduced simply by subjecting the wire to too much heat. lfthe heat is high
enough. the fibrous microstructure of the wrought wire disappears and is replaced by a
grain or crystalline microstructure. This process is known as recrystallization or gain
gro$th and is a most undesirable occurrence in wrought-wire retainer arms.
\ote: The terminal end ofthe retentive arm is optimally placed in the middle ofthe gin-
gival third ofthe clinical crown. However, it is acceptable to place it at thejunction ofthe
gingival and middle one-third ofthe clinical crown. When the partial is completely seated,
the retentive arm should be passive and applying no pressure on the teeth.
. Rigid plating
. Minor connectors
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Coplri8h O 201l-2012 - Deotal Decks
. Maxillary canines
. Mandibular canines
tG1
Coplriehr @ 201 l'2012 - Dental Decks
Reciprocation as applied to partial dentures refers to the function of the lingual clasp arm
(which is the reciprocal clasp arm or stabilizing clasp orm) to counteract forces exerted by
the buccal clasp arm (which is the retentive clasp arm).
Reciprocation is the means by which one part ofthe fiamework opposes the action of the re-
tainer in function. Reciprocation may be achieved by opposing flexible retainers with guide
planes, minor connectors, rigid clasp arms or plating. lf true reciprocation is to occur, the re-
ciprocating element must be placed opposite the direct retainer and must contact the abutment
as the retentive tip passes over the height ofthe contour ofthe tooth,
Remember: Th€ curr€nt conc€pt of bar clasp design is the R.P,I. system:
. Mesial rest - point olrotation which exerts a mesial force on the tooth
. Proximal plate - superior edge at bottom of guide plane to disengage during loading.
Slightly lingual for reciprocation
. I Bar - 2.5 mm from gingival margin, crosses at right angles in a.01" undercut at the
greatest M-D prominence to permit it to disengage during function
Important: The term guiding plane is defined as two or more parallel, vertical surfaces of
abutment teeth, so shaped to direct a prothesis during placement and removal. The functions
ofguiding plane surfaces are as follows:
. To provide for one path ofplacement and removal ofthe denture
. To ensure the intended actions ofreciprocal, stabilizing, a nd retentive components
. To eliminate gross food haps between abutment teeth and components ofthe dentue
As a rule, proximal guiding plane surfaces should be about two thirds as $ide as the distance
benveen the tips ofadjacent buccal and lingual cusps or about one third ofthe buccal lin-
gual width of the tooth and should extend vertically about two thirds of the length of the
enamel crown portion ofthe tooth from the marginal ridge cervically. Note: Proximal plates
are metal plates that contact the proximal surface or guide plan€ ofan abuhrent tooth.
*** These teeth have a gradual lingual incline and a prominent cingulum. In some in-
stances, cingulum rests may be placed on mfiillary central incisors. The lingual slope of
the mandibular canine is usually too steep for an adequate cingulum rest to be placed in
the enamel.
The cingulum rest is a veftical stop on an anterior tooth whose lingual anatomy lends ir
selfto ready preparation for a positive seat.
. Inverted V or U shape
. Mesiodistal length = 2.5 to 3 mm
. Labiolingual width : 2.0 mm
. incisoapical depth = 1.5 nm
*** Not all teeth have sufiicient cingulum contour to receive a seat (i.e., mandibular
central snd lateral incisors).
The incisal rest is employed when other preferred support is not available. The high place-
ment ofthis style ofrest may be esthetically objectionable. The distal incisal rest is usu-
ally less esthetically visible than the mesial incisal rest. Never place an incisal rest so deep
that it interferes with the proximal contact.
. Rounded notch at an incisal anele
. Width = 2.5 rnm
. Depth = 1.5 mm
Note: Two advantages of a cingulum rest over an incisal rest are: l) It is more esthetic;
2) The resulting stress relayed to the abutment has a less torquing influence.
Important: The prirnary purpose of the rest (any type -+ occlusal, cingulum or incisal)
is to provide vertical support for the removable partial denture.
. Occlusal third
. Middle third
. Gingival third
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Cop}1ighl O 20ll-2012 Denial Decks
w|lrc|l ol
Which of the
r|lc lurrowr[g
following rs
is ocrxrcu ru ''"The
delined as rI|c qu![ty
qurlity ot
of a rcslorauofl
restoration to
be lirm, steady constant and not subject to change of position
when forces are applied?"
. Retention
. Stability
. Adhesion
. Reciprocation
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Coplright O 201 l-2012, Dental Decks
Retentive components should be located as close as possible to th€ tooth's horizontal axis of
rotation. It is easier to overstress the tooth support by clasping it near the occlusal surface.
The distal extension moves up and down during function, indicating that a clasp design in the
gingival third ofthe tooth that disengages the undercut during function would be less stress-
ful to the periodontal support ofthe tooth.
The clasp assembly consists ofa retentive clasp arm and a reciprocal or stabilizing clasp
arm, plus any minor connectors and r€sts fiom which they originate or with which they are
associated.
The functions ofthe r€ciprocal clasp arm of a removable partial denture include reciproca-
tion, stabilization and auxiliary indirect reterfii.on (bracing). Points to remember concerning
reciprocal clasp arms:
. ln positioning cast clasps on abutment teeth, the horizontal undercut is considered a sig-
nificant measurement and height of contour is considered a controlling factor in clasp po-
sittLoning. (Reciprocal clasp should contacl tooth on or qbove contour). See note below.
. In general, you should not use retentive areas on the buccal and lingual ofthe same tooth.
Reciprocal bracing on the lingual and retenlive portion of the clasp on the buccal is
more desirable.
. As with all clasps, they should be designed to permit insertion and removal without ap-
plying excessive force.
. _ l. Altering the natural tooth form to allow effective clasping may involve produc-
Noredi ing guiding planes or changing the location of th€ h€ight of contour. Facial and
,*-- proximal contours of premolars and molars most often need to be altered. Crown
fabrication may be necessary to provide the appropriate contour.
2. Guiding planes serve to ensure predictable clasp retention. Failure ofpartials due
to poor clasp design can be avoided by altering tooth contours.
In dentures, stability is the relationship of the denture base to bone that resists dis-
lodgement of the denture in a horizontal direction. In removable partial dentures sta-
bilit_v is best insured by incorporating a harmonious occlusion.
Retention is that quality in a restoration, which resists the force ofgravity, sticky foods
and tbrces associated with mandibular movement. Note: For RPD's the distal parts of the
rerenti\ e clasps produce the aclive retention.
Reciprocation is the means by which one part ofa restoration is made to counter the ef-
fects created by another part. Note: For RPD's true reciprocation can only be achieved if
the reciprocating element touches the tooth before the retentive clasp
For panial dentures, support is given by occlusal rests and the edentulous ridge areas. This
design characteristic (support) is most important to oral health. Other design character-
istics of a partial denture include:
. Retention: by clasps placed in undercut areas of abutment teeth
. Bracing: or horizontal force transmission through placement of rigid portions of
clasps or other parts ofthe partial denture in non-undercut areas of abutment teeth
. Guidance: during insertion and removal obtained by contact of rigid parts of the
framework with areas on axial tooth surfaces parallel to the path of insertion
. Labial notch and labial flange
. Posterior border
. Distobuccal flange
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Coplrighr O 201l-2012 - Denral Decks
165
Cop]rishr O 201 l-:012 - Dental Decks
Excessive thickness of this area can lead to this problem. As the buccal frenum moves
posteriorly during smrling (or otherfacial expressions) it encroaches on the denture bor-
der that is too thick and the denture becomes loosened.
You can test the borders for overextension by slowly seating the denture. Ifyou observe
premature contact with frenae or vestibular tissues as the denture conlinues toward its
final position, then the border is probably overextended. Adapt a thin roll ofdisclosing wax
to the denture border Seat the denture and instruct the patient to exeft vigorous muscle
function. In about one minute, the wax will soften and be displaced by muscular action
across the overextended denture border
l. The complaint that the denture becomes loose when the mouth is wide opened
. f otedr' as in yawning, could be due to the distobuccal flange ofthe denture being too
thick. This may interfere with the movement ofthe coronoid process.
2. Ifpatient complains ofsore gums and aching muscles at the bottom ofthe face
after wearing dentures for several hours, opposing teeth ofthe denture have in-
sufficient space. Reduce the vertical dirnension of the occlusion.
3. Tingling or a numbing sensation at the comer ofthe mouth or in the lower lip
after a few days of denture wearing is caused by excessive pressure from th€
lower truccal flange in the region of the mental foramen.
Impression materials cannot record anatomic form ofthe teeth and physiologic form ofthe soft tis-
sue in a functional relationship all at the same time. To achieve these objectivcs, the altered cast
technique can be used. This technique is a secondary irnpression system which utilizes the metal
frame\\'ork to hold customized impr€ssion trays for the edentulous area. The advantage of the al-
tercd cast procedure is that an accurate relationship between the denture base and the metal frame-
$ork is established prior to tooth arrangement which should result in less occlusal adjustment at th€
time of insertion. The objectives ofthe altered cast technique are to obtain thc maximum possible
support from the distal extension base ofthe RPD and to accurately relate the soft tissue sur-
face ofthe denture basc to the metal ftamework
Distal extension removable partial dentures fRPDb/ derive their support from the abutment teeth
and the mucosal tissues overlaying the residual alveolar process. There are di{Iering philosophies
in the scientific literature regarding how much support should be provided by the abutment teeth and
how much support should bc provided by the soft tissues. Howevet th€re is consensus that: (1) oc-
clusal stress should be shared by both in such a manner that neith€r the abuhnent teeth nor the resid-
ual ridge is abused; (2) accurate fit ofthe denture base is an important factor in minimizing stress
on the abutment teeth; (3) stability ofthe prosthesis is the most important requirement fbr prop€r
function and patient comfort.
't66
Coprright O 2011,2012 - Dental Decls
. The functional load is dispersed down the long axis ofthe abutments by virtue ofthe
low central loading at the base ofthe attachments
. The restorations permit the patient access to all areas of the tissues when the denture
is not in place
. If both sides of the dental arch have this t)?e of restoration and are joined by a rigid
major connector, excellent bilateral stabilization is provided to the abutments
167
Cop),righr O 201l-2012 - Dental Decks
When these devices are incorporated next to a free-end distal extension RPD, the thrust
of the functional stress is directed onto the residual ridge, Only minimal transfer of
functional stress to the abutment teeth occurs. Since vertical and horizontal forces are
concentrated on the residual ridge, increased ridge resorption frequently occurs. Relin-
ing ofthe free-end saddle area must be done when needed to prevent excessive ridge re-
sorptlon.
Types of Stressbreakers:
1. Have a flexible connection between the direct retainer and the denture base:
. Simplest form ofstress reliefis the wrought-wire retentive clasp
. Split bar major connectors; example is the Ticonium "Hidden-Lock" design
2. Have a movable joint between the direct retainer and the denture base:
. The "DE" hinge
. The Dalbo attachment
. The Crismani attachment
. The ASC-52 attachment
\ote: When a stressbreaker is placed on the distal surface of a pontic, occlusal forces
$ ill tend to unseat the key from the key.
A semiprecision attachment is cast into the crown and the RPD. The female portion is
normally made ofpreformed plastic that is positioned into the wax form and then cast. The
male portion is cast with the RPD framework. The female and male parts fit together with
much more tolerance than in the precision attachment, resulting in less retention.
When surveying casts, the clinician/technician must perform an important step
in order to correclly record the path of insertion, the position ofthe
survey line and the location of undercut and noD undercut Nreas.
tttL:^L
Which of the a^tl^-..:--
^f.L^ following :- -^--:,J^--r
is considered to be that step?
. Placing tripod marks on the cast to record the orientation of the cast to the surveyor
168
Cop)righr @ 201l-201? - Denral Decks
. Form acute angles with the minor connectors that connect them to the major connectors
169
Cop)rightO 20ll-2012 - Dental Decks
The tripod marks (which are three spots placed at three different locations around abut-
ment teethfrom a single point ofview) ensure reproducible orientation ofthe cast to the
surveyor.
The prirnary purpose ofthe rest is to provide vedical support for the RPD.
Note: Occlusal rests are prepared primarily to resist the vertical forces of occlusion. In
doing so the rest also does the following:
. It maintains established occlusal relationships by preventing settling ofthe denture
. Prevents impingement of soft tissues
. Directs and distributes occlusal loads (through the long at, to abutment teeth
Rememb€r: The rest must be rounded (spoon shaped) to permit functional movement.
. The useful posterior tooth space
170
Cop)'right C 201l-2012 - Dental Decks
. 20 - gauge
. 19 - gauge
. l8 - gauge
. 16 - gauge
171
Coplright c) 201 1,2012 - Denial tlecks
Factors which are relevant to the selection of posterior teeth for a removable partial
denture:
. Occlusogingival length: the most important factor in determination ofposterior tooth
length is the available interarch space.
. Mesiodistal width: the total mesiodistal space available for the posterior teeth is de-
termined by measuring from the distal of the lower canine to the point where the
mandibular residual ridge begins to slope upward.
. Buccolingual width: the buccolingual width is narrowed in r€lation to the missing
natural tooth. It is thought that reducing the area of the occlusal table decreases
stressed transferred to the denture support area during food bolus penetration. Addi-
tionally, reducing the buccolingual width increases tongue space.
. Shade: the shade for posterior teeth is usually selected to harmonize with that ofthe
anteriors.
. Occlusal surface form: at this time, it appears that no superior tooth form or arrange-
ment is identified. It is therefore logical to use the l€ast complicated approach that ful-
fills the needs ofthe patient.
. \Iaterial: plastic bonds well to the acrylic resin and therelore plastic teeth are re-
tained bener than oorcelain leeth
*** 20 - gauge or finer, as < 7 mm, is a short arm clasp and shorter length clasps must
har.e a finer gauge of wire for optimum flexibility.